Knowing a patient's current Medicare plan and whether they have a subsidy is integral to helping them perform a plan comparison. Amplicare has developed an algorithm to automatically detect some of the plans and subsidies for you!

Current plan detection 

Medicare plans only have one unique identification number; the CMS Contract and Plan ID. Here's an example: "S1234-123". This unique identifier is not needed to bill  insurance, which is why Amplicare doesn't receive this information from your dispensing software.

Insurance claims use BIN, PCN, and/or Group numbers to identify and bill plans. This is the information that Amplicare receives from your pharmacy management system with each drug refill. Several different plans have the same BIN, PCN, and Group numbers, so it's impossible to detect a specific plan with just this information alone.  

Amplicare analyzes the patient's copay history, along with the plan's BIN, PCN, and Group numbers to attempt to identify a specific plan.

In the patient's profile in Amplicare you can see whether a current plan was properly identified for a patient. In "Edit Profile" there will be a yellow flag to "Review" and the plan will be flagged "Detected". You can hover your mouse over the yellow eye icon to read the tool-tip. This will provide you with more information on the detection itself. 

Subsidy Detection

Patients that are dual eligible receive a subsidy for their Medicare plan so that their drug copays do not exceed certain thresholds. Similar to current plan detection, Amplicare analyzes each patient's copay history to attempt subsidy detection.

You can identify whether a patient was detected to have a subsidy by going into "Edit Profile":

Patient identification

You can run a report in Amplicare to identify all detected patients on a certain plan and/or all detected subsidy patients by going into the "Patients" tab and filtering by Medicare Plan Name and/or Medicare Subsidy.

Note: If you're looking to do an outreach campaign for Open Enrollment specifically, we recommend you use these same filters in your Open Enrollment Eligible worklist.

What’s Next?

Even if a plan or subsidy is detected, it's best to always double check a patient's plan & subsidy information before patients complete a new plan enrollment. Learn how.

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