Page 9 - CATA_Proposal_2020

Capital Area Transportation Authority

Data Integration

1. Eligibility file scrubbed for enrollment and mailing process (initial enrollment file and for
annual “Soon to be 65” eligible members).
2. Eligibility file scrubbed for Call Center System application.
3. Eligibility file scrubbed for Billing System application.
4. Eligibility file scrubbed for File upload to carriers in secure environment (HIPAA compliant).
5. CMS Eligibility file transfer protocols.

Customer Care Center

1. Set-up Customer Care Center workbench with:
a. Intranet access to benefits and rates.
b. Eligibility files to verify participant eligibility.
c. CMS information and phone numbers.
d. Printable enrollment kits.
e. Provider look-up features.
f. Other documentation and business rules.
2. Train Customer Care Center representatives to handle all inbound calls.
3. Assign plan provider liaison for retirees.
4. Track and monitor call quality, wait times and service levels.
5. Follow up with non-respondents to initial mailing and ongoing annual “Soon to be 65” eligible
retirees and spouses.

Benefits, Plan Administration and Claims Support

1. Dedicated relationship manager contact for day to day plan administration.
2. Initial and ongoing benefit support to retirees, spouses, and other family members designated
to act as authorized representatives for the retiree.
3. Provide assistance to retirees with claims adjudicators to resolve claims issues for medical and
pharmacy benefits.
4. Provide assistance to retirees with their providers of service for both medical benefits and
pharmacy benefits. Work directly with providers as needed.
5. Pharmacy Benefits team provides assistance with transitional overrides, prior authorization
requests, and coverage issues.

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