Medicare Eligibility Enhancement Services

Many Medicaid programs may not have the adequate staffing, specific expertise, or technical toolkit to fully evaluate their populations for potential Medicare benefits—and may not identify additional opportunities for enhanced Medicare savings.

As a result, your state can miss populations of Medicaid members who may qualify as dually eligible, lose out on potential Medicare cost savings, or overpay for Medicare premiums. This can cost members valuable benefits and states millions of dollars.

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   Our services complement and supplement a states’ existing TPL and Medicare matching activities. Our specialized eligibility enhancement approach for identifying TPL savings opportunities includes:
   
   
   • Data Assurance Review: Employs proprietary data integration and advanced analysis techniques to identify and validate missed Medicare coverage information which has not been updated in state Medicaid systems.
   • Enrollment Support: Utilizes enhanced data mining and proactive, comprehensive customer service support to successfully enroll Medicaid members aged 65 and older into Medicare.
   • Medicare and Disability Entitlement Correction: Secures Medicare for Medicaid recipients who are under age 65 and disabled and appear to qualify for Medicare and Social Security Disability Insurance cash benefits, but may have been missed or erroneously denied by the Social Security Administration (SSA).
   • Premium Payment Review: Detects and pursues the correction of state Medicare premium overpayments with the SSA and Centers for Medicare and Medicaid Services (CMS) to recover inappropriate historical payments and realize ongoing cost savings.
   • Customized Medicare Eligibility Enhancement and TPL Consulting: Offers tailored Medicare identification, enrollment, and Medicare Savings Program consulting services to address specific state-level challenges and goals, providing actionable recommendations that will optimize results.

We help our Medicaid clients achieve results beyond the routine Medicare data matching and coordination activities. Our TPL experts combine unmatched federal rule knowledge, proprietary data methods, and personalized member support to maximize Medicare coverage and optimize cost avoidance. States and members both win—expanded benefits for individuals and substantial savings and recoveries for Medicaid programs.