Teleservices for Healthcare

Hot Industry Topics

Complaint Tracking Module

The Centers for Medicaid and Medicare Services (CMS) enacted the Complaint Tracking Module (CTM) to better assist the Centers with investigating cases of fraud and / or misleading practices by health providers. We are proficient in the CMS rules and design programs for our clients that limit potential legal and financial penalties. Our feedback and knowledge of each health plans’ member systems helps identify member issues that would otherwise end up as a CMS complaint. We break down barriers within the health plans and help facilitate communications within the organization itself. Our agents are trained to escalate any concerns to the proper party for handling to ensure a quick and proper resolution. At DialAmerica Healthcare Solutions, our agents develop an intimate understanding of client health plans and their data systems to help ensure a first call resolution. We pride ourselves on maintaining high standards of accountability and preventing a concern from being entered into the CTM system.

Five Star Rating

The Centers for Medicare and Medicaid Services (CMS) rates the relative quality of the private plans that are offered to Medicare beneficiaries through the Medicare Advantage program. How exactly does a call center impact a five star rating? Here are just some of the ways an effective call center like DialAmerica can help contribute to the five star rating for a health plan:

  • Scheduling routine and chronic care screenings and tests
  • Assisting with booking appointments and helping callers quickly find care
  • Limiting complaints to the Medicare CTM system
  • Delivering accurate information to members when they call the health plan
  • Providing TTY/TDD Services and Foreign Language Interpretation

Find out more information about DialAmerica’s Star Rating Initiative

Secret Shopping

CMS secret shoppers—supplied by outside companies—rate agents who sell Medicare Advantage and Part D plans. They are hired to look out for misleading information about the plans, and to report whether the agent was clear and honest in all their dealings. All Medicare programs are subject to CMS secret shoppers. Our comprehensive quality assurance program is no match for a secret shopper. We design customized secret shopper plans of our own to ensure our programs meet all Medicare compliance requirements. Because our agents are properly trained and participate in refresher courses at regular intervals, our programs are guaranteed to meet any test by a secret shopper.

Teleservices for Healthcare

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