Medicare Advantage Support Services for Health Plans
Improve Enrollment Efficiency, Member Experience,
& Population Health with Medicare Advantage Plan BPO & Member Support Services
Medicare Advantage plans operate in a performance-driven environment shaped by CMS STAR Ratings, Quality Bonus Payments, and strong competition for member retention. Operational quality is critical. STAR Ratings influence billions of dollars in bonus payments each year, and member experience measures account for more than half of the total score. Plans must deliver accurate, empathetic, and CMS-compliant member interactions at scale. When communication fails or service quality drops, plans face financial risk and reputational damage.
Ameridial provides Medicare Advantage plan BPO support through trained senior-member engagement teams, CMS-aligned workflows, and AI-powered quality monitoring. We assist MA and D-SNP plans with AEP and OEP enrollment support, member onboarding, HEDIS and CAHPS outreach, care gap closure campaigns, and risk adjustment coordination. Our teams also support utilization management communication, appeals, and grievance intake, and year-round member inquiries. This approach helps Medicare Advantage plans protect STAR performance, improve retention, and reduce administrative pressure.
Service Offerings for Medicare Advantage Plans
Ameridial provides end-to-end Medicare Advantage services designed to support enrollment accuracy,
improve member experience, and enhance Stars and CAHPS outcomes.
AEP/OEP enrollment & eligibility support
Manage peak enrollment volumes during AEP and OEP with trained agents and CMS-compliant documentation, scripting, and eligibility verification workflows.
Member onboarding & welcome programs
Deliver structured welcome outreach, benefit walkthroughs, ID card support, and portal navigation to help reduce early disenrollment and improve CAHPS scores.
HEDIS, STARs & CAHPS program support
Conduct targeted outreach to close care gaps, improve quality measure performance, and support CMS STAR Rating satisfaction metrics.
Risk adjustment & HCC outreach support
Support accurate HCC capture through member engagement, annual wellness visit scheduling, and condition-specific outreach aligned with risk adjustment programs.
Appeals, grievances & utilization management
Manage Medicare Advantage appeals and grievance intake, documentation, and escalation while supporting prior authorization and utilization management processes.
Chronic condition & population health outreach
Deliver condition-specific outreach to support medication adherence, preventive screenings, wellness visits, and care gap closure for MA members.
SNP & D-SNP member support
Provide specialized engagement for Special Needs Plans and Dual-Eligible Special Needs Plans, supporting members with complex healthcare needs.
Provider network & referral navigation
Help members locate in-network providers, understand referral requirements, and navigate prior authorization rules within Medicare Advantage networks.
AI Solutions to Improve Member Experience with Exceptional Medicare Advantage Plan Support
Ameridial integrates advanced AI technologies to strengthen compliance, improve
member communication, and support high-volume MA cycles.
Why Choose Ameridial for
Medicare Advantage Support Services
Ameridial delivers CMS-aligned, high-touch Medicare Advantage operations that improve experience, compliance, and quality outcomes.
Deep Medicare Advantage domain expertise
Our teams understand MA plan structures, STAR Rating mechanics, CMS marketing rules, SNP requirements, and the communication needs of senior member populations.
STAR Rating–aligned quality monitoring & outreach
AI-powered monitoring and targeted CAHPS and HEDIS outreach programs support STAR-sensitive measures and improve member experience performance.
AEP/OEP surge capacity with compliance maintained
Scale enrollment support quickly during peak AEP and OEP periods while maintaining CMS documentation standards and empathetic member communication.
Risk adjustment & HCC capture support
Outreach programs encourage annual wellness visits, support condition identification, and improve accurate HCC documentation for stronger risk adjustment performance.
SNP & dual-eligible specialist engagement
Provide specially trained agents for SNP and D-SNP populations, delivering patient-centered communication for vulnerable member groups.
Comprehensive STAR & operational reporting
Monitor STAR-related interaction metrics, care gap closure rates, enrollment performance, CAHPS outreach progress, and risk adjustment campaign outcomes in real time.
PCI DSS 4.0.1
ISO 27001:2022
HIPAA Compliant
SOC 2 Type II
MBE
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Frequently Asked Questions (FAQs)
Explore answers to common questions about Ameridial’s Medicare Advantage support services.
What Medicare Advantage services does Ameridial provide?
Ameridial supports MA and D-SNP plans with AEP and OEP enrollment assistance, member onboarding, HEDIS, STARs, and CAHPS outreach, risk adjustment support, appeals and grievances handling, chronic condition outreach, and year-round member engagement—within CMS-aligned, HIPAA-compliant workflows.
How does Ameridial support STAR Rating improvement for MA plans?
Ameridial conducts CAHPS-focused outreach, care gap closure campaigns, and HEDIS measure–specific engagement. AI-powered quality monitoring helps ensure consistent, compliant member interactions that support STAR Rating performance and Quality Bonus Payments.
Does Ameridial support Special Needs Plans (SNPs) and D-SNPs?
Yes. Ameridial provides specially trained agents for SNP and D-SNP member populations, using communication approaches designed for the complex needs of dual-eligible and chronically ill members.
Can Ameridial support risk adjustment and HCC capture programs?
Yes. Our outreach programs support annual wellness visit scheduling, condition-specific member engagement, and coordination with risk adjustment teams to improve HCC documentation and coding accuracy.
How does Ameridial protect MA member data and maintain CMS compliance?
All Ameridial MA operations run within HIPAA-compliant, PCI DSS 4.0.1-certified, and SOC 2 Type II-audited environments. Workflows align with CMS communication, documentation, and marketing compliance standards.
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