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Engage Baker Tilly to help your organization address these new market imperatives

Proactive member engagement

Support your organization with transforming and optimizing member engagement plans and strategies to achieve effective, clear, and timely emergency response communications.

  • Identifying and appropriately engaging high-risk members
  • Relaying benefits available as a result of policy changes
  • Sending additional helpful recourses for preventing spread and becoming more informed
  • Communicating existing supplemental benefits for Medicaid and Medicare Advantage members, such as transportation and meal services

Provider triage support

Vendor or internal team coordination and support to help deploy newly developed COVID-19 triage solutions for network providers.

  • Work with identified vendors or internal teams to help develop, deploy, and maintain digital solutions that are helping network hospitals mitigate an influx of patients seeking advice about the COVID-19 pandemic

Expanded use of telehealth services

Support health plan expansion of telehealth services and define reimbursement for those services in network contracts.

  • Support efforts to evaluate and implement policy changes to allow increased use of telehealth services across provider specialty types
  • Update network contracts to enable reimbursement for newly expanded Telehealth services
  • Develop a communication plan to membership to understand services are available and covered in network benefits
  • Ensure membership and group benefit administration systems are updated to account for newly available Telehealth services
  • Ensure policy, pricing, and provider reimbursement systems are enabled to approve and pay newly available Telehealth services

Policy, benefits and claims administration

Enhancements and configuration updates to various health plan systems required to support new COVID-19 diagnostic tests, treatments, and eventual vaccines, and any related voluntary or state/federal mandated policies.

  • Ensure claims processing, pre-authorization, medical policy, contract pricing, and provider reimbursement systems are enabled to approve and pay any new COVID-19 related billing codes, including the new COVID-19 diagnostic test CPT code.
  • Ensure membership and group benefit administration systems are updated to account for any new COVID-19 related services, including the suppression of member co-payments for the COVID-19 diagnostic test
  • Support financial reconciliation to help address any reimbursement or billing issues caused by rapidly changing policies, delayed code releases, and delays in system enhancements and configuration updates

Provider cash flow support

Payment programs modeled off of Medicare's Periodic Interim Payments (PIP) program may be able to provide a financial lifeline to the provider community as COVID-19 creates an increasing disruption on the provider utilization patterns and cash flows.  This lifeline could also help secure the strength of health plans' provider networks, and establish a set of partnerships that could be built-upon as the crisis recedes.

  • Support both Health Plans and Providers in conducting financial modeling around proposed program designs, opening conversations on this topic, gaining agreement on methodologies, establishing contracts to support program adoption and establishing capabilities to execute program operations
  • Support Health Plans in establishment "PIP-like" programs, including identification of what types of providers could be considered for eligibility, business rules to establish valuation of advance payments, creation of capabilities to administer payment and reconciliation processes and integration of processes with ASO clients

Provider Cash Flow Support

Network contract analysis

Network provider contract analysis and financial modeling to help quantify the financial impact of COVID-19.

  • Evaluate existing network provider contracts to identify any contract terms or clauses that allow changes based on unforeseen circumstances such as COVID-19
  • Support the financial modeling of potential implications including provider lump sum payments or cost support resulting from unforeseen circumstances terms or clauses
  • Support contract renegotiation as prioritized

As your organization addresses new government mandated and market driven changes, Baker Tilly can support you to successfully manage through these challenges. 

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