Medicare Advantage Plans

We're experts at Medicare Part B and D enrollment and administration. In fact, we've participated in the Part D program since its inception. We have an exemplary compliance record with CMS and other regulatory organizations. We also have extensive expertise in Medicare, Medicaid, commercial insurance and secondary billing that minimizes client and member spend. 

Our MAPD, PDP and Employer Group Waiver Program (EGWP) solutions provide a robust menu of operational and technical management tools.

NationsHealth has also invested heavily in the development of a flexible enrollment platform specifically for the administration of Part B and D benefits. It consistently delivers the precision and compliance required in this highly regulated environment. Every client is also assigned a team of experienced member outreach agents whose only focus is shaping your members' healthcare choices.

These solutions can be purchased as an entire package or a la carte, and most components are customizable to meet your specific business needs. They include:

Medicare Part D BPO Services

Licensed Insurance Agents

• Year-round enrollment activities
• Medicare Annual Election Period (AEP) enrollment
• Insurance broker outreach
• Retention

Unlicensed Representatives

• Year-round member service
• Outbound education and verification
• Customer satisfaction surveys
• Plan change services

Flexible Technology

• Innovative healthcare IT platform
• Robust reporting and analytics capabilities
• Eligibility management
• Enrollment / disenrollment management
• Premium billing and collections
• Member mail management
• Fulfillment services
• Document reconciliation and management
• Three-way reconciliation (CMS, fiduciary, PBM)
• PBM integration
• EGWP functionality to administer group enrollment and eligibility

Healthcare BPO Services

Member Engagement Center Services

• Clinical and non-clinical staffing
• Clinical and non-clinical rollover capacity
• Inbound / outbound engagement services
• Physician and insurance broker outreach
• On-shore and off-shore agent options
• Survey capabilities for satisfaction measurement as well as clinical data gathering (Five-Star and HEDIS support)
• Inbound / outbound provider engagement
• Compliance and audit services
• Health education, reminders and reporting
• Flexible thin client IT environment with robust reporting capabilities
• Automated call processing (IVR)
• Print and email campaigns
• Internet landing pages for information capture and educational content delivery

Medical Product Services

Fulfillment Services

• Fulfillment and distribution services (i.e. diabetes, respiratory, ostomy and urological)
• Specialty pharmaceutical mail order delivery program - with deep Part B experience
• Formulary development assistance
• Physician outreach
• Retail to mail conversion

Over-the-counter (OTC)

• Over-the-counter (OTC) product distribution and benefit administration
• Development of CMS compliant catalogs and literature
• Custom and special products

Distribution Engagement Services

• Proactive patient outreach to educate and encourage compliance with physician orders
  • Average telephonic patient outreach frequency of four times per year
  • Hassle Free Healthy Living program educational literature and tools delivered to patients / members as part of our mail order supply program
• We do not compete in the prescription drug space
• Medical billing and compliance infrastructure to mitigate risk

We deliver these strategic advantages:

• Outstanding reliability, scalability, and flexibility of healthcare contact services
• Multiple locations to mitigate service disruptions caused by weather or other unforeseen circumstances
• Capacity scaling expertise to allow for fast response to unexpectedly large call volume
• Multi-lingual services