Expediting BCMP Enrollment through Collaboration, Technology, and Engagement

To provide the best customer service and support for Medicare beneficiaries who wish to enroll in Medicare’s Beneficiary Care Management Program (BCMP), Livanta worked with Provider Resources Inc. (PRI), the BMCP contractor, to engineer and deploy two new solutions: the automated transfer of current appeals case data to the BCMP contractor and early intervention through education and telephone transfers of targeted referrals.

With these solutions, Livanta equipped PRI with real-time case information to provide efficient and timely care management support to certain types of Medicare beneficiaries, their families, and caregivers who are being discharged by a hospital or are transitioning to a lower level of care. Before release of these solutions, Livanta’s appeals staff sent referral reports to the BCMP once a day using labor-intensive, manual processes. The original workflow required staff to produce reports from Livanta’s case review system and transmit the files daily to PRI using a Managed File Transfer (MFT) protocol.

In addition to sending referral reports by automated means in real time, Livanta took the extra step of educating beneficiaries and families about care management and connecting them by a telephone transfer to the BCMP. Now, when processing active Weichardt and Beneficiary Improvement Protection Act (BIPA) appeals, for eligible participants* who are available for a telephone conversation, Livanta’s clinical staff introduces the BCMP by discussing potential positive benefits of receiving BCMP services. If the eligible Medicare beneficiary is interested in the program, the telephone call is transferred immediately to PRI to expedite access to the desired care management services.

Answering questions and helping the patient understand the benefits of care management allows the beneficiary, their family, or caregiver to make the best-informed decision about choosing to participate in the BCMP. This collaborative approach with PRI has significantly reduced the potential for delay in Medicare beneficiary access to care management services.

*Weichardt appeals are filed by Medicare beneficiaries when disputing their hospital discharge notice. BIPA appeals are filed by Fee-For-Service (FFS) beneficiaries when disputing their service termination notice from skilled nursing facilities, home health agencies, hospices, or comprehensive outpatient rehabilitation facilities. BCMP services are available to FFS Medicare beneficiaries who file a Weichardt or BIPA appeal.