Managed Care and Medicare Part D Forum

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  • Hi -  I am in search of a robust compliance checklist for running a Medicare Advantage Call Center. As context, I work for a company that will be opening  an internally run call center that will handle enrollments for consumers who would prefer ...

  • Nichole, The calculation is found in each year’s Medicare Part C & D Star Rating Technical Notes. For 2019: [ (total # of all complaints logged into the CTM) / (Average contract enrollment) ] * 1000 * 30 / (# of days in period). # of days in period ...

  • With regard to complaint tracking through HPMS, I know CMS reviews # of complaints per 1000 members, which then determines your outlier status in comparison with other plans.  It's been my experience that plans aren't aware they are an outlier until receiving ...

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