RP Sanjiv Goenka Group

Medicaid Redetermination

The time to prep for a historic redetermination surge is NOW

Enhance member experience and retention through proactive digital engagement

Ensure continuity of care and maximize revenue

When the federal public health emergency (PHE) ends, states will generally have up to 12 months to return to normal eligibility and enrollment operations. With nearly 80 million Medicaid recipients facing redetermination, outdated technologies and labor-intensive processes will be insufficient to meet the challenge. What’s more, this massive surge comes at a time of acute staffing shortages, with the ‘great resignation’ accounting for intense employee churn.

Studies project that more than 15 million individuals could potentially lose coverage, if states and healthcare organizations are not adequately prepared. Given the scale and complexity, helping eligible individuals maintain Medicaid coverage requires immediate action as well as the support of technology-based solutions and experienced partners with domain expertise.

Transform member confusion into improved member access and care through unified omnichannel messaging
Move from a reactive member follow-up mode to proactive digital engagement – from Day 1
Convert potential member disenrollment and revenue-at-risk scenario into superior continuity of care and revenue maximization

Choose all or some of the components based
on your requirements

Multi-Channel Digital Outreach & Reminders

100% Member Coverage and reminders to take action

Live Agent Outbound Calling

Education and awareness

Reduced calling effort by 50% to 60%

Application Assistance

High touch advocacy program

Incremental Digital push of 40% – 60%

Design a solution
that works best for you

MReD – our modular Medicaid Redetermination solution – blends digital engagement with proactive outreach, helping you get closer to your members and improving outcomes within 30 days of implementation. With our scalable, compliant and flexible solution, you can pursue a course of action that best fits your business needs. Leverage your existing systems or deploy our stand-alone solution. Implement one or more modules or utilize the turnkey solution. The choice is yours.

The ready-to-go platform leverages our Medicaid managed clients and CAC staff expertise to reduce your administrative burden while enhancing the member experience.

Multi-channel digital outreach

Live agent outbound calling

End-to-end Application Assistance

Outcomes Delivered

Significantly Reduced Member Effort

Improved member awareness, engagement and experience with personalized digital touch.

Member Retention and Reduced Churn costs

Proactive member advocacy program to ensure members stay enrolled, preventing revenue loss and saving $400 – $600 per member on churn related admin costs.

Rapid Implemetation

Ready-to-go platform for rapid scalability, with forms submitted through an API based integration.

Stringent Medicaid Compliance

Ability to meet CMS timelines and mandates, supplemented by performance dashboards that offer granular visibility into day-to-day progress.

Design a solution that works best for you

MReD – our modular Medicaid Redetermination solution – blends digital engagement with proactive outreach, helping you get closer to your members and improving outcomes within 30 days of implementation. With our scalable, compliant and flexible solution, you can pursue a course of action that best fits your business needs. Leverage your existing systems or deploy our stand-alone solution. Implement one or more modules or utilize the turnkey solution. The choice is yours.

The ready-to-go platform leverages our Medicaid managed clients and CAC staff expertise to reduce your administrative burden while enhancing the member experience.

Multi-channel digital outreach

Live agent outbound calling

End-to-end Application Assistance

Stay Ahead With Firstsource

30+

Years experience across Providers and Plans

750+ Facilities

Eligibility determination for Medicaid and other LOBs for members visiting the hospitals

700K Lives

Medicaid Enrollment & Eligibility approvals in 2020 alone

750 CAC Associates

Certified Application Counsellors

8.2M Lives

Medicaid members served in top national plans

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Getting Ready for a Historic Medicaid Redetermination Cycle

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