Envolve has decades of experience in business process outsourcing (BPO), providing member support tactics to ease the administrative burden on health plan payers, and engaging members to take control of their own health.
At Envolve, we process hundreds of thousands of inbound member and member calls a month on topics related to benefits and eligibility, appointment scheduling, access to social or service resources, and much more.
Our quality health plan member support services lead to improved plan satisfaction among members and help empower members to take better control of their own health outcomes.
By handling a variety of call topics, our healthcare experts can pass along these learnings to our clients, to become more knowledgeable about the types of concerns members may have about their health plans.
Along with our expertise in answering member phone calls, Envolve conducts thousands of outbound calls each month to help engage members in their health.
These calls cover a variety of topics, and may include:
We strive to provide excellent service with every member interaction by training our eligibility and enrollment services team to provide anticipatory service specific to the member's needs.
We ensure that every team member is focused on customer service excellence and improving the lives of members the first time they call.
Envolve’s eligibility and enrollment team always strives for first-call resolution and satisfying any concerns a caller may have about their current and future healthcare elections.
Our approach to member engagement is to meet members where they are. This means being culturally appropriate, person‐centered, and accessible to all individuals.
Our goal is to ensure members have the information and support they need (and give them a platform to voice any concerns related to the care or service they received. We always work to ensure your members are making the most informed choices about their health and healthcare.
Envolve’s enrollment team has a set of established policies and procedures in place to ensure accurate health plan enrollment while providing covered benefits in accordance with the individual’s eligibility group.
We coordinate with the state as needed for Medicare and Medicaid managed care enrollment procedures.
We make it easy to enroll covered individuals in the programs right for them. Along with discussing enrollment options with members, our team also:
Our rigorous healthcare enrollment processes enable us to resolve any discrepancies between eligibility files and internal membership records before processing is completed.
With our technical management capabilities, we gather, analyze, and report data to identify and act against inappropriate plan utilization.
By taking a proactive approach to fraud, waste, and abuse, we helped save affiliated health plans $1.2 billion in savings in 2016.
Experience has shown that the best approach to cost avoidance is to minimize the need to recover costs in the first place.
Our enterprise management information system ensures the provision of covered benefits in accordance with each member’s eligibility group. We work with the State and other stakeholders to ensure member data quality when working with Medicaid and Medicare plan payers.
Our integrated encounter system is configured to systematically extract claim data from our data warehouse into the encounter repository based on the claim paid date.
This helps minimize bottlenecks and the need for manual intervention, and ensures we meet timeliness requirements for encounter data submission. The encounter system is configured to submit encounter data that complies with all State standards for electronic file submission.
We also adhere to HIPAA, NCQA, AMA coding, UB-04 editor, and NCCI standards regarding the definition and treatment of critical data elements captured on claims. We produce Professional and Institutional Encounter files in the MMIS in HIPAA compliant 837P (Professional) and 837I (Institutional) format.
From ensuring your members have the knowledge they need to make better decisions about their health to knowing they are enrolling in the right programs for them, Envolve Health has member services covered.
Start today with Envolve Health. Contact us today!