Medicaid Redetermination (MReD for MCOs)

Seamlessly address Medicaid redetermination

Enhance member experience and retention through proactive digital engagement

Drive superior revenue integrity

Typically, the Medicaid redetermination process must occur at least every 12 months, ensuring that a beneficiary is still eligible to receive Medicaid benefits. This process, however, has been delayed due to the ongoing Public Health Emergency (PHE). When normal Medicaid enrollment and eligibility processes are restored at the end of PHE, States and Health Plans will be under significant pressure to tackle the challenges resulting from the pending verifications, redeterminations, and renewals.

For one, they must quickly process significant volume backlogs and ensure readiness within the timelines mandated by Centers for Medicare and Medicaid Services (CMS). For another, they must ease the confusion among members caused by the lack of clarity around the redetermination process, issues with language comprehension, etc. Additionally, studies indicate that nearly 40% of members are unaware of the nuances of the renewal process while nearly 50% of enrollees rely on telephone, mail and in-person applications. Delayed submissions could result in the disenrollment of large chunks of members, impacting healthcare outcomes for members and revenues for Health Plans.

With COVID vaccination navigation being currently addressed as a top priority, ensuring timely Medicaid redeterminations could be the next significant administrative burden on States and Health Plans. MReD, our modularized Medicaid Redetermination solution, blends digital engagement with proactive outreach to alleviate the burden. It helps members seamlessly navigate the redetermination process, improving outcomes within 30 days of implementation.

Transforming Member Confusion to Member Access to Care with Unified Messaging
Move from a reactive member follow-up to Proactive Digital Engagement – from Day 1
Transform a potential member dis-enrollment and the revenue-at-risk situation into superior Member Retention and Revenue Integrity

Choose all or some of the components based
on your requirements

Digital engagement platform

Enables digital deflection through multi-channel outreach based on member preferences – QR code on paper form, Email, Text, Phone with call back options – and directs them to a built-for purpose microsite with a replica of a pre-filled renewal application.

Member outreach

Offers phone outreach, both outbound and in-bound, across products to help members navigate the application process and provide necessary proof documents within 30 days.

Rules-driven eligibility checks

Identifies potential members that meet the criteria set by states and flags them during submissions for faster decisions.

End-to-end omnichannel tracking and reporting

Provides granular insights, including number of members contacted, number of closed files, number of unreachable members, work-in-progress and so on.

Outcomes Delivered

Higher, Accurate and Timely Renewals Conversion

100% ownership of form completion – our Certified Application Counselors (CACs) get members’ authorization to represent, secure and submit on their behalf.

Significantly Reduced Member Effort

Improved member awareness, engagement and experience with personalized digital touch and 24X7 self-service portal with pre-filled forms.

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.

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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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