Healthcare Call Center Services for State Government Health Benefit Exchanges and “Navigators”
Healthcare Call Center Services for Exchange Navigators
With all the changes occurring with national healthcare and the healthcare law, insurers and state governments are more focused than ever on delivering cost effective coverage options, broad availability to healthcare insurance coverage, and enhancing member services. Recent healthcare reform has prompted several changes within our healthcare system that will change how business is done. State governments or the Federal government, will be offering some form of Health Benefit Exchange (HBE) to support this changing healthcare landscape. The HBEs will be a marketplace for healthcare insurance benefits to their employees. HBEs will change access to health insurance and the way insurance is purchased for millions of Americans.
All constituents involved with the HBEs (insurers, healthcare providers, government agencies, the insured) will need a simple and easy way to navigate the HBE’s eligibility requirements and guidelines. Of course there will be a website nevertheless, as with any new complex program; there will be lots of questions and some confusion. There will be millions of enrollees, perhaps several dozen of insurance providers, government agencies, insurance representatives, healthcare providers, and others involved with the HBE.
How can some of this complexity be managed from a constituent support point-of-view? Community organizations that have relationships with broad segments of people in their state, may be eligible for grants to facilitate the education and enrollments.The community organizations, and in some cases, nonprofit organizations supported by universities, will serve as healthcare “Navigators” to help inform and enroll. This could be a daunting task for even the largest organizations to respond to the demands of citizens needing member services with a brand new healthcare program.
Part of the solution is a partnership with a healthcare call center that offers a comprehensive set of services and one that has healthcare experience and certifying their employees in HIPAA which can is a key component in the healthcare field.
In regards to delivering services for a Health Benefits Exchange, an experienced healthcare call center will:
- Become your focal point for the required Navigator program (Section 1311(i)) of Affordable Care Act
- Answer questions regarding eligibility and program parameters
- Answer premium and payment questions
- Process complaints and forward to appropriate agencies or departments
- Process appeals
- Handle USPS mail requests
- Provide information that’s culturally and linguistically accurate
- Record every communication and store every transaction – phone, email, audio, video
- Provide member surveys – capture the voice of your healthcare consumers
- Enroll HBE participants – businesses and individuals
- Support the certifications and renewals of insurers
- Provide reports and feedback on HBE performance
- Provide reports on the Navigator’s performance
- Integrate with the State’s HBE applications
- Support HBE website communications
- Support multilingual and TTY communication services – phone, email, website response, direct mail, chat
- Provide a secure environment for data
- Provide redundancy for clients in the event of a disaster
This probably isn’t a comprehensive list but it’ll get you started on thinking about the communications your state can be expected to deliver when the HBE goes into effect.
Benefit of a HBE Call Center Approach:
- 24/7/365 level of coverage if requested – especially at the beginning of the process
- Coverage of the languages important to a state – ongoing support
- Consistent delivery of constituent services – enrollment, member services, issues resolution
- Program metrics useful for measuring HBE and Navigator success – for continuous process improvement
- HIPAA compliance – partner that understands healthcare and its processes
- Consistency in the level of customer services
Having an outsourced HBE and Navigator call center could be a very effective way to quickly adapt to the changes that will happen in healthcare over the next few years. The idea of having to outsource your call service might seem a bit daunting, but keeping your outsourced call center in the USA makes the transition much smoother. Ultimately, your healthcare call center should not only be your partner but should be a seamless extension of you!
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