Currently, Medicare Advantage is finishing up the Open Enrollment Period (OEP), which ends March 31st. “OEP allows members to make a one-time plan switch, which is a protection for beneficiaries,” says Phillips, noting that “historically switching has occurred when members lose confidence in a newly elected plan if, for example, they received incorrect network information or delays with receipt of member materials.”
While the enrollment process is simple for a beneficiary, administratively, the coordination between insurers and the Centers for Medicare & Medicaid Services (CMS) can be cumbersome. Phillips explains: “Eligibility determination, low-income subsidy verification, and coordination with other programs like Medicaid are just a few processes that need to happen at the point of enrollment to properly serve new members, and this is often where errors occur.”
“Our technology team at Cavulus confronted manual management of enrollment workflows in 2018 with introduction of our EMMA [Enrollment, Member Management & Administration] solution,” said Phillips. “Our breakthrough technology has since dramatically improved and modernized enrollment operations for Cavulus clients.”
Mary Beth Jenkins, Chief Administrative and Operating Officer of UPMC Health Plan, said: “EMMA has been pivotal in helping us to achieve our organizational goals through increased automation and visibility of the member enrollment experience. Real-time enrollment and member communications have enabled us to implement simpler, more efficient processes, reducing our overall compliance risk through less manual intervention. Increased visibility to enrollment key performance metrics has resulted in simpler regulatory oversight.”
Phillips explains, “At its core, EMMA automates administrative functions and provides transparency so insurers can be proactive and provide high touch service when necessary to ensure an excellent member experience.”
ABOUT CAVULUS – Cavulus is a technology driven specialist in Medicare Advantage insurance solutions. The Cavulus Cloud-based Medicare Advantage Platform (Cavulus MAP™) unifies marketing, sales and enrollment operations, and is utilized by many of America’s top insurers, including several BlueCross/ BlueShield companies, UPMC Health Plan, Johns Hopkins, Lumeris and United Healthcare. For details visit: www.cavulus.com. Media Inquiries: 800-760-6915 Email: [email protected]
SOURCE Cavulus
