PATIENT ADVOCACY
FOR MEDICARE REFERENCE-BASED PRICING
In response to the increasing self-funded market interest In Medicare reference-pricing plans, CareValent, a Payer Compass Company, has developed a rigorous Patient Advocacy program to support members of these plans.
We designed the program to educate both employees and providers about unique self-funded plan challenges and the rationale behind employers moving to Medicare reference-pricing plan designs.
Our offerings include a full service advocacy and support system to serve all stakeholders: third-party administrators (TPAs), employers, plan administrators, brokers, patients, and providers.
CareValent has extensive experience with managing Medicare reference-based pricing Patient Advocacy programs. We are ahead of the industry in establishing a successful track record in dealing with member and provider questions and issue resolution.
It's our belief and practice to take a proactive approach to Patient Advocacy. We recommend that all plans considering a Medicare reference-based pricing plan design implement a Patient Advocacy program to assist and support TPAs, plan administrators, employers and their members, and providers. To be most effective, plans should make Patient Advocacy services available at the time a plan change is announced and continue throughout the program term.
Program Highlights:
Member Liaison:
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Educates members about Medicare reference-based pricing
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Refers members to an accepting provider and performs outreach to members' providers, and
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Supports members during plan transition and beyond
Provider Liaison:
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Educates providers about Medicare reference-based pricing and encourage acceptance
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Provides support and guidance for accepting providers, and
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Communicates group plan information to providers
Balance Bill Support:
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Coordinates with TPAs
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Performs outreach to providers for reimbursement acceptance
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Keeps members updated on status, and
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Negotiates with providers at a client's request
Client Liaison:
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Includes an integrated Patient Advocacy system with a client portal
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Provides clients with member education materials
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Maintains a safe-harbor list of accepting providers
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Provides detailed, ongoing reporting, and
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Provides continued support and guidance