As the leading provider of Medicare Advantage marketing, sales and enrollment workflow automation solutions, we have extensive experience with plans ranging from start-ups to national and “Blues” organizations. Below are a few key considerations and common problem areas for existing and new Medicare Advantage Organizations (MAOs) in compressed and competitive timeframes like AEP.

Workflows:

Literature Kits | First impressions are everything and there’s nothing worse than beginning an interaction with potential members by sending them incorrect or irrelevant plan information. During AEP, you’re marketing 2023 products to your 10/1/2023 - 12/1/2023 effective members, and 2024 products to shoppers, switchers, and 2024 age-ins. It’s crucial that employed and third-party sales agents can clearly delineate what literature kit they’re requesting. This process requires even more attention if you’re offering different literature kits by state, region, or county.

Fulfillment Process | Test, test, test! Make certain that your literature kit request mapping is exporting accurately to your fulfillment department or vendor. Continue to run tests regularly throughout AEP to measure both accuracy and timeliness. One easy test mechanism is placing various marketing and sales staff in your CRM and order kits to their home addresses throughout peak times in AEP.

Provider Directories | This is an area that has drawn CMS scrutiny as well as monetary penalties. MAOs must update provider directories rapidly so the latest information is available during a beneficiaries decision-making process. Version control is essential which is why we recommend one source that feeds all others; i.e. - a single web link that’s publicly available or a single source that feeds every API. Make sure you have mechanisms in place to capture updates to your provider directory.

Agent Training (Employees & Third Parties):

Language Lines | CMS conducts outbound calls to sales and member services lines and audits various metrics such as hold times as well as the ability to reach translation services. Be sure that your employed and third party call center agents fully understand your language line services and how to warm transfer. Practice makes perfect!

Credentialing | Cavulus clients utilize our central hub called AgentHQ to easily manage and track broker credentialing, training, testing, and other areas such as corrective actions. Our solutions aside, you’ll need a reliable and transparent way to verify this information and be able to easily provide in the face of an audit. At a minimum, make certain:

• Licenses haven’t lapsed.
• Errors & omissions insurance is valid.
• Annual GHG or AHIP training is completed.
• Internal CY2024 product training is completed.‍

New CMS Requirements for 2024 | Have you built and tested new processes for the introduction of a mandatory minimum 48-hour Scope of Appointment (SOA) ‘cooling off’ period. Do you have the new CMS Pre-Enrollment Checklist incorporated into your enrollment processes? It’s important to think about new requirements in 360 degrees and be sure you train and monitor across all sales channels and call centers. 

Connect with us anytime to gain insight on your marketing, sales and enrollment operations!

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