AI-driven dual-eligibility advocacy for enhanced member benefits
Our Eligibility and Enrollment Assistance solution uses advanced AI and behavioral science to identify dual-enrollment eligibility and guide members through the application process for Medicare Savings Program (MSP) and Medicaid, helping them access all entitled benefits. Proprietary analytics and multi-channel outreach optimize enrollment.
We have over 20 years of Medicaid expertise. Our team stays current with CMS regulations and uses an empathetic approach to support members. We excel in successful appeals and detailed reporting to promote compliance and efficiency.
Our approach
AI-enhanced identification of dual-enrollment eligibility
Identify more members who qualify for both Medicare and Medicaid. Improve efficiency with a precise target list and enhance model accuracy through ongoing learning.
Member-centric, end-to-end management
Use behavioral science to engage, earn trust and activate members for dual enrollment. Provide a better member experience with live, empathetic advocates and full support for completing and submitting Medicaid applications.
Scalable, experienced team
Follow up on submitted applications, provide direct member advocacy for appeals and overturning denials, and review processes to meet state requirements.
Key benefits
Achieve proactive identification while improving the member experience.
Increase dual-enrolled population
We use industry-leading predictive models to help enhance dual-eligible enrollment identification.
Improve CAHPS* scores and Star ratings
Support advanced industry ratings by adding member benefits to help manage chronic conditions.
Support members with live advocates
Our well-trained team uses techniques that are based on behavioral science practices and real member feedback.
Related healthcare insights
Case study
See how AI-powered technology and personalized member engagement are helping to identify and enroll more members into Medicaid programs.
Case study
A health plan increased in-home assessment rates for their Medicare Advantage members by working with Optum to increase member engagement.
White paper
Discover 5 strategies that will help your health plan be prepared to factor risk adjustment data into Star Ratings.
Product information and resources
Complementary solutions
Member Engagement Solutions
Member Activation
Multi-channel outreach delivers health education and care assistance, helping to improve outcomes and close gaps in care.
Social Care Assistance
Assess social determinants of health (SDOH) needs and provide referrals to community-based organizations equipped to address those needs.
* Consumer Assessment of Healthcare Providers and Systems (CAHPS) is a program of the Agency for Healthcare Research and Quality, U. S. Department of Health and Human Services.