There are a variety of government programs. such as SSI and QMB (Qualified Medicare Beneficiary Program), which are available to help individuals with limited incomes. Typically these programs require assistance to enroll, and many patients do not apply for benefits for themselves. Enrollment in these programs can also have a significant impact on revenue received in a managed care plan. The capitated rates to manage these patients may either be driven up and/or fees may be reduced in plans by high cost members who are subsequently required to transfer to other plans. Our expert eligibility services are valuable to both Medicaid and Medicare Advantage Plans.
A significant number of Medicaid Managed Care members qualify for Supplemental Security Income (SSI) benefits. Chamberlin Edmonds experts navigate through complex eligibility requirements to identify and qualify those members most likely to be eligible for federally funded disability benefits. We have developed a customized program to maximize results for Medicaid Managed Care which includes utilization of a proprietary system that identifies potential disability from medical claims files. We reach out to members where a significant number of the disabled are children. We find that children are often approved for government benefits quicker than the adult population. Most SSI recipients receive from $500 to $800 a month to cover their living expenses. By increasing the value of the managed care plan to its patients, Chamberlin Edmonds also helps improve member retention and reduce turnover costs.
Typically, up to 25 percent of Medicare members will also benefit from enrollment in QMB (Qualified Medicare Beneficiary Program), SLMB (Specified Low-Income Medicare Beneficiary Program), and Q1-1(Qualified Individual Program). However, these members don't receive the benefits because they lack information or the skills in getting approved. By identifying and qualifying these individuals who are covered under dual eligibility, Chamberlin Edmonds can help the Medicare Advantage Plan obtain and maintain higher capitated rates. Qualifying members also benefit from dual eligibility since these programs help Medicare beneficiaries of modest means pay all or some of Medicare's cost sharing amounts, such as premiums, deductibles and copayments.
Our professional staff has thousands of years of experience in the Medicare, Medicaid, Supplemental Security Income and Social Security Disability arenas. They are ready to help your MCO benefit from this underutilized opportunity. Now is the time to call in the specialists from Chamberlin Edmonds.
