Eligibility and Enrollment

Managing enrollment for pharmacy plans requires in-depth knowledge of state eligibility regulations — and a deep commitment to service. At UHealthSolutions, we provide your clients with a positive experience as we answer their questions and determine their eligibility. With online access to real time information, we make determinations of eligibility based on types of coverage, location, health care services, and state regulations. We strive to maximize member and patient benefits through the enrollment process.

With expertise in health care and pharmacy programs, our enrollment analysts routinely work with people who are eligible for health insurance through Medicare, Medicaid, or a private insurer. And we are dedicated to recognizing — and overcoming — administrative details that can prevent them from completing the application process.

Our team makes sure that applicants understand application requirements and deadlines. And we don’t stop there. We call applicants back to facilitate the completion of the enrollment process.

Flexible services to meet your needs

Working closely with your team, UHealthSolutions identifies appropriate enrollment goals and benchmarks for your specific health care program. Together, we determine how your organization can most effectively make use of our enrollment and eligibility services:

  • Eligibility determination
  • Application processing
  • Membership re-evaluation and renewals
  • Billing support services
  • Contact center and outreach services
  • Ongoing reporting and analysis
  • Design of informational materials for members

Our enrollment and eligibility program also features the following:

  • Accommodation of the needs of special populations, including elders and people with disabilities
  • Quality assurance policies and procedures
  • Robust security and role-based access to enrollment and eligibility systems
  • Internal escalation process for priority requests
  • Coordination of benefits
  • Multilingual staff and a language interpretation service to ensure clear communication regardless of the language spoken

All of our services are available a la carte or as part of a full-service program.