As you put the final touches on Plan Year 2025 implementation, it is crucial for Medicare plans to stay ahead of the game and be prepared for the changes that lie ahead. With the broad focus on readiness, including marketing materials, supplemental benefits, and Medicare Prescription Payment Plan (M3P), there is a significant risk in not testing your 2025 Part C and Part D benefits.
Here are a few things for you to consider as you prepare for 2025:
Interactive Voice Response (IVR) System
BluePeak recommends conducting a comprehensive test of every phone number and prompt related to Medicare business. The goal is to optimize the caller experience by minimizing the number of inputs required before reaching a live agent. It is crucial to ensure that callers are not disconnected while in the IVR system, so each entry or lack of entry should still route them to a live agent. By testing and refining your IVR system, you can ensure a seamless and efficient member or prospective member experiences.
Special Supplemental Benefits for the Chronically Ill (SSBCI)
Beginning in 2025, there will be an increased emphasis on plan delivery of Special Supplemental benefits. It is important for plans to document and obtain internal approval for the eligibility criteria. This information should be readily available to call center representatives, who should be knowledgeable and able to provide guidance to members who inquire about eligibility. Additionally, there should be a process in place for the call center to send the member’s information to the appropriate team for eligibility review and determination. This will ensure that members receive accurate information, and their eligibility is properly assessed.
Member Materials
Internal teams should review the Annual Notice of Change and be fully trained on plan designs for the upcoming year. They should be equipped to answer any questions from members regarding plan changes. Having a Frequently Asked Questions (FAQ) document available for call centers is essential in ensuring accurate and consistent messaging, particularly in cases of plan terminations or consolidations. This will help provide clear and reliable information to members and address any concerns they may have.
Many plans choose to make larger required materials, such as the Evidence of Coverage and Provider Directory, available electronically instead of mailing them. However, it is important to note that if a member requests these materials in electronic or print format, they must be mailed within three business days. Therefore, the call center should be well-informed about where to direct members or have a system in place to send the PDF via email. It is common for plans to lack a well-developed process for email communication with members, so this should be addressed. Additionally, it is crucial to test the process of requesting the 2025 material within the system and validate on the mail file that the document was sent within the required timeframe. This can be done by using employees’ names and addresses to confirm when they received the material and ensure it is the expected version.
Provider Readiness
Conducting informational sessions, both in person and online, can help providers stay informed about upcoming plan benefit and administrative changes. For instance, if prior authorizations for new members will be accepted in advance of 2025, it is crucial to document and communicate this information effectively. While not mandatory, this approach can help distribute the volume of requests received over a longer period, ensuring a smoother transition.
BluePeak can help!
While the above highlights only a few areas, it is important to remember that readiness isn’t just about getting sales and call centers prepared. It is important to conduct sufficient testing and ensure operational readiness across the board. BluePeak subject matter experts can assist in ensuring compliance and a smooth start to 2025. Email [email protected] today!
