Are you actively identifying and enrolling dual eligible beneficiaries?

Dual eligible beneficiaries, compared to their non-dual counterparts, typically live with significant health issues that lead to a higher cost of care. Without proper identification, enrollment and reenrollment of these members, Medicare Advantage (MA) plans will not be fully reimbursed for these additional costs.

Pareto Intelligence offers the Dual Eligibility Identification Model and Enrollment Services as part of our Premium Integrity Solution to help health plans improve premium accuracy by identifying, engaging and enrolling dual eligible beneficiaries.

5M

estimated MA beneficiaries that qualify for dual eligible status

$230 to $600

additional premium revenues for partial and full dual eligible members

20%

higher risk weights for full dual eligible members

$100M+

in recoveries for Pareto’s Premium Integrity clients

Manage Dual Eligible Beneficiaries

Failure to correctly manage individuals eligible for both Medicare and Medicaid benefits causes several problems for MA plans, including understated risk scores by 20% on average and underpayment of premium revenues by up to $600.

Pareto Intelligence’s Dual Eligibility Identification Model identifies the members in your plan likely to qualify for full or partial dual eligibility and predicts dual status with up to 95% accuracy on average. Our analytics consistently outperform the competition by identifying more members with higher precision and continuously monitoring enrollees to initiate timely recertification, resulting in more accurate reimbursements.

How it Works

  • Identify: Apply Pareto’s proprietary suspecting model to analyze and predict a member’s dual eligible status with expert precision.
  • Report: Deliver model outcomes on a secure, web-based platform with prioritized worklists to focus internal or Pareto-led outreach on the members most likely to be dual eligible, as well as those members requiring recertification in the near future.
  • Engage: Outreach to members to assist with enrollment and reenrollment by using Pareto’s analytics to empower internal resources or by using Pareto’s skilled outreach experts to interface with the member and guide them through the enrollment and recertification processes.

Why Pareto?

Flexible

We offer multiple delivery models and present our results in a way that works best for you.

Member-Focused

Our processes are centered around ensuring members receive the benefits they are entitled to, which delivers value to members and health plans.

Unmatched Experience

20+ years of experience supporting premium-related initiatives with health plans makes Pareto the ideal partner.

See it and Believe it

Our demos say it all. Tell us about your challenges and we’ll show you how we can help you overcome them.

Schedule a Demo