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Accountability and Compliance for Midwestern Medicare Advantage Plan

Overview

Creating stronger partnership to build accountability and compliance into Medicare Advantage communications and payment processes.

As a Medicare Advantage plan, this health plan needed to be able to quickly customize their EOBs to align with CMS standards. They also needed a communications partner who could meet stringent audit accountability while keeping costs low. Looking forward, their management saw an advantage to having ID cards, claims communications and provider payments with one vendor – so they turned to RedCard.

Challenge

  • Required enhanced audit accountability for stringent government regulations
  • Needed to customize EOBs and other communications for Medicare Advantage members
  • Sought to increase member electronic payment adoption

Solution

  • Built business partnership to identify opportunities for optimization and savings
  • Redesigned EOBs to new Medicare Advantage standards
  • Gained ability to access new and innovative payment solutions

30%

Cut operational spend by more than 30% from previous vendor solution

Clearer EOBs have improved member satisfaction, faster electronic payments have increase provider satisfaction, and an improved internal audit process has improved our internal satisfaction – all thanks to RedCard.

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