Sectors We Serve

Unique Solutions, Unified Approach

Convey Health Solutions offers healthcare-specific technology and services that:

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Simplify and strengthen complex member relationships in the Medicare and Medicaid markets

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Provide a suite of administrative solutions that improve operational efficiencies

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Drive compliance and quality while meeting industry and regulatory demands

5 OF the top 10

Health Plans are
Convey Clients

Discover how we serve the following sectors through comprehensive, end-to-end member management solutions:

Government-Sponsored Health Plans

Convey Health Solutions serves government-sponsored health plans through a combination of purpose-built member management technology and comprehensive outsourced service solutions

Our expertise and understanding of regulatory requirements allow your health plan team to focus on driving new business and not on the day-to-day administrative responsibilities that can distract from your core strategic objectives.

At Convey, we understand the value your health plan provides to your members. We have built our technology and services specifically to meet the regulations of government-sponsored health plans, and we continually refine our solutions to strengthen your relationship with your members. As a partner to your health plan, we manage your members with precision, adaptability, and compliance in this highly regulated and ever-changing environment.

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Eligibility and Enrollment Processing

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Customer Service

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Premium Billing and Payment Processing

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Over-the-Counter Benefit Administration

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Grievance Processing

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Reconciliation

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And other related services

Medicare

Medicare Advantage Plans

The Medicare Advantage (MA/MAPD) landscape is one of the fastest growing and most competitive markets in the health insurance industry. As the Medicare population grows and value-based reimbursement models take hold, health plans are facing even more challenges. Knowing that flexibility is critical, Convey offers a variety of solutions that can easily be deployed in order to strengthen your health plan’s Medicare Advantage service offerings.  Whether your health plan is seeking a technology-only solution or a comprehensive technology and service model, Convey works with you to develop the most cost-effective and compliant solution.

Convey offers both Software as a Service (SaaS) or outsourced solutions for the following plan types:

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Health Maintenance Organization (HMO)

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Preferred Provider Organization (PPO)

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Medicare-Medicaid Plan (MMP)

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Special Needs Plan (SNP)

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Private Fee-For-Service Plan (PFFS)

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Over-the-Counter (OTC) Benefits

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And more

Individual Prescription Plans (PDP)

To be successful in today’s Medicare environment, Prescription Drug Plans are seeking better, more cost-effective solutions to increase member satisfaction while improving their responsiveness to regulatory changes. Convey Health Solutions understands these challenges and has built its operations and solutions to reduce cost and improve performance.

With high fixed costs, low margins and an intensive regulatory environment, the Medicare Part D market is a challenge for any health plan.  Having participated in Medicare Part D since its inception, Convey combines purpose-built technology, an experienced Part D service organization and CMS-compliant processes to rapidly respond to the demands of the Part D market and population.  As your partner, we will tailor the most cost-effective solution, allowing your health plan to provide superior service at lower cost.

Employer Group Waiver Plans (EGWP)

The Medicare Employer Group Waiver (EGWP) market is one of the most challenging markets within Medicare.  In addition to having to manage in a highly regulated environment, health plans also must face complex group-specific requirements that can create risk and add layers of manual processes and workarounds.

Traditional EGWP solutions combine multiple technologies and services that can result in disconnected processes and poor responsiveness.  Convey provides a fully integrated, single platform and service model to enhance your EGWP administrative program and deliver optimal service levels and higher member satisfaction scores.  Convey’s EGWP solutions and services can manage groups of any size or scale and serves some the largest, most complex EGWP programs in the industry today.

Medicaid

For State-based Medicaid or Managed Medicaid Plans including Special Needs Plans, Convey provides a variety of services to help you. These include:

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Member enrollment services

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Over-the-Counter Benefit Administration

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Outbound education and verification

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Customer satisfaction surveys

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Compliance and audit services and support

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Health education reminders and reporting (multi-channel)

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Retention support

Provider-Sponsored Health Plans (PSP)

Provider or Health System sponsored plans (PSP) have continued to grow and are well suited to serve the Medicare population. For these organizations, speed-to-market is crucial and finding a cost-effective solution while minimizing risk is even more critical. Convey Health Solutions enables PSPs to offer a comprehensive solution to the government programs market through a fully integrated member administration and billing platform that includes robust quality and compliance capabilities and services.

As your partner, Convey can offer a total solution combining a full suite of member administration technology along with fully trained call center staff or can tailor a technology-only solution to meet your health plan’s needs.

To learn more about our solutions for government-sponsored health plans, contact us at BusinessSolutions@conveyhs.com.

Pharmacy Benefit Managers (PBM)

As Pharmacy Benefit Managers (PBM) take on the role of Plan Sponsor, they are often challenged to meet the needs of their clients with their existing technology and services. Today, Convey Health Solutions serves some of the leading PBM providers.

Convey offers these solutions either through Software as a Service (SaaS) or as an outsourced technology and call center service model.  With Convey as your partner, you can select from a variety of services and solutions in order to meet the demands of your clients and the market.

 

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Eligibility and Enrollment Processing

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Customer Service

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Premium Billing and Payment Processing

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Over-the-Counter Benefit Administration

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Grievance Processing

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Reconciliation

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And other related services

Questions?

Contact one of our sales representatives to learn more.
They will quickly get you in touch with the subject matter experts and ensure your detailed questions are answered.

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