These programs, for our Medicare Advantage clients, support their compliance efforts in key areas:
Medicare Compliance
Complete services from the senior market experts
DSS provides a number of services to MA plans including various forms of telephone mystery shopping – What are agents telling prospective enrollees? What are network physicians telling your members? Our largest programs relate to Outbound Enrollment and Verification (OEV).
CMSOutbound Enrollment and Verification (OEV) calls to all new enrollees are outlined in section 70.6 of the Medicare Marketing Guidelines. They can be found at http://www.cms.gov/ManagedCareMarketing/03_FinalPartCMarketingGuidelines.asp. The calls must be interactive, no automated calls, each attempt must be documented and the process must be completed within 15 days.
DSS works with you to ensure that your plan complies with the most current CMS requirements related to enrollment verification.
As you know, the purpose of the OEV program is to contact recently enrolled members to:
- Confirm their intent to enroll in the plan.
- Make sure they understand the plan type they chose.
- Verify that the selling broker/agent properly explained the plan correctly.
We have conducted Outbound Enrollment and Verification (OEV) work for multiple carriers and plan types since 2006. DSS addressed OEV requirements for 1.1 million new enrollees in 2010.
We have a proven system that meets current CMS requirements. Our ‘Warm Transfer’ system allows you to immediately talk with members who are considering disenrollment to address misunderstandings and improve retention rates.
How it works:
- You send us the necessary contact records for all new enrollees and we handle the following:
- Load the records into our record management system and conduct a daily quality review.
- Records missing phone numbers are moved to the mail process.
- We begin calling records with phone numbers with the approved script within 24 hours.
- Send the approved enrollment verification letter to all who are supposed to receive a letter under the rules.
- Scan and email any returned mail pieces containing member requests or comments to your customer service department.
- Store all returned mail pieces on our premises.
- Initiate a “Warm Transfer” to your customer service department for members considering disenrollment.
- Make audio recordings of all calls and store them as required.
- Provide online reports detailing agent infractions, survey responses and other metrics.
- Complete the entire ‘Call-Letter-Call-Call’ process within the required 15 day window.
With DSS you get:
- Program integrity that comes from third party verification.
- Extensive experience in OEV work.
- Twenty-five years experience in conducting phone interviews with the senior population.
- Everything done in-house to insure data security, accuracy, control of timing and control of costs.
- Continuous online Reporting Tool that provides daily feedback.
Contact DSS
For more information or to request an OEV proposal contact us or call 800-989-5150 and ask for the Medicare Team.
