Medicare Advantage Part D (MAPD) and Prescription Drug Plan (PDP) Program Administration
We're experts at Medicare Part B and D enrollment and
administration and have participated in the Part D program since
its inception. We have an exemplary compliance record with CMS and
other regulatory organizations as well as extensive expertise in
Medicare, Medicaid, commercial insurance and secondary billing.
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.
Our MAPD and PDP solution provides a menu of
operational and technical management tools. It is offered as an
entire package or a la carte, and most components are customizable
to meet your specific business needs.
We provide:
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 development available
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
Part B
Conversion
- Conversion of self-funded employer retirees to part B for
diabetic and respiratory supplies
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
Reorder Your Diabetes Supplies
"We’re not just focused on outreach, we’re driving outcomes."