Abstract:
A computerized system and method for tracking applications and other information for “dual eligible” members of a health insurance plan. The users of computerized system and method are associates of a health benefits provider that offers Medicare Advantage insurance plans to individuals who also may qualify for additional health benefits under another program such as Medicaid. The associates may use the computerized system and method to track activities and interactions with members to qualify them for and to assist them in enrolling in state Medicaid programs. The computerized system and method support tracking of interactions using voice activated technology (VAT) as well as direct mail efforts. The computerized system and method further support recording a member&#39;s contact preferences to facilitate additional communications with the member that may be required to complete the eligibility evaluation and for members that are eligible, the enrollment process.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    None. 
       BACKGROUND OF THE INVENTION 
       [0002]    The Medicare program is a governmental health insurance program that provides healthcare benefits to millions of individuals. The program is comprised of four parts: 
         [0000]    
       
         
               
             
               
               
               
             
           
               
                 TABLE 1 
               
               
                   
               
               
                 Medicare Insurance and Benefits 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                   
                 Part A 
                 Hospital Insurance 
               
               
                   
                 Part B 
                 Medical Insurance 
               
               
                   
                 Part C 
                 Medicare Advantage Plus 
               
               
                   
                 Part D 
                 Prescription 
               
               
                   
                   
               
             
          
         
       
     
         [0003]    The federal government has established guidelines to determine eligibility for program benefits. Individuals at least 65 years of age are generally eligible for the Medicare program. Although Medicare Parts A and B cover most of the medical expenses that individuals are likely to incur, they do not cover all medical expenses. For example, under certain circumstances, covered individuals are responsible for out-of-pocket costs such as prescription drugs or services that are not fully covered. For low income individuals, these costs may be covered under a Medicaid Savings Program (MSP), the federal government&#39;s state-based health program for low income individuals and families. Individuals that qualify for Medicare Parts A and B, as well as certain MSP benefits, are considered “dual eligible.” The procedure for determining benefits for a “dual eligible” individual involves numerous health and income considerations. 
         [0004]    Individuals who are eligible for Medicare may choose to purchase a “Medicare Advantage” (Part C) insurance plan that covers medical costs under Parts A and B. Such plans may also include prescription drug coverage (Part D). Medicare Advantage plans must comply with government requirements and regulations but are provided by private insurance companies. In many instances, the providers offer extra coverage for vision, hearing, and dental claims and for wellness programs. Although providers that offer Medicare Advantage plans must follow rules established by Medicare, each provider has its own enrollment and benefits administration procedures as well as levels of coverage for “extras.” Therefore, qualifying individuals are free to “shop” for the plan that best meets their needs. 
         [0005]    Under current rules, US citizens are eligible for Medicare as soon as they reach age 65. There are no income or other requirements that must be met. Individuals that become eligible for Medicare and are concerned about associated out-of-pocket costs or services that may not be covered may choose to contact a private insurance company to purchase a Medicare Advantage insurance plan. What they may not realize when they decide to contact a private insurer is that they may actually qualify for MSP benefits that will cover various medical costs not covered by Medicare under a Medicare Advantage insurance plan. In other words, they may not realize they are considered “dual eligible.” Even if they know they are “dual eligible,” they may not understand the procedures for enrolling in and obtaining benefits under both programs. Furthermore, circumstances for members of a Medicare Advantage plan may change such that an individual that was previously ineligible for MSP benefits may later become eligible. Therefore, it is beneficial to individuals to periodically reevaluate their eligibility. 
         [0006]    Private insurers that offer Medicare Advantage plans are in a unique position to help their members that may also qualify for state MSP benefits. Insurance company associates may assist individuals with understanding MSP benefits requirements as well as directing them to the appropriate resources and assisting them with completion of eligibility and enrollment procedures. Because Medicaid is a needs-based program and the requirements may vary from state to state, enrolling members for MSP benefits can be complex and may require the submission of a substantial amount of information and documentation to one or more agencies. Tracking eligibility applications may require tracking a substantial amount of information and documentation as well as interactions with the potential beneficiary and agencies. For insurance company associates that may be assisting numerous Medicare Advantage plan members, tracking such details for a large number of individuals can quickly become overwhelming. There is a need for a computerized system and method for tracking applications and other information for “dual eligible” members of a health insurance plan. 
       SUMMARY OF THE INVENTION 
       [0007]    The present disclosure relates to a computerized system and method for tracking applications and other information for “dual eligible” members of a health insurance plan. The users of the computerized system and method are associates of a health benefits provider that offers Medicare Advantage insurance plans to individuals who also may qualify for additional health benefits under another program such as Medicaid. The associates may use the computerized system and method to track activities and interactions with members to qualify them for and to assist them in enrolling in state Medicaid programs. The computerized system and method support tracking of interactions using voice activated technology (VAT) as well as direct mail efforts. The computerized system and method further support recording a member&#39;s contact preferences to facilitate additional communications with the member that may be required to complete the eligibility evaluation and for members that are eligible, the enrollment process. 
         [0008]    The computerized system and method provides a user with a comprehensive view of member interactions as well as the status of a member&#39;s eligibility evaluation and application or enrollment process. Access to information regarding the requirements and enrollment process for numerous programs is provided so a user can quickly determine the additional steps that a member may need to take to complete the eligibility evaluation and application or enrollment process. The tracking details and member preference data allow a user to determine efficiently and effectively the additional information from the member that is required and the most appropriate method of communicating with the member to obtain the needed information. The computerized system and method further supports ending the eligibility or enrollment process under certain circumstances. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0009]      FIG. 1  is a sample “member selection” screen according to an example embodiment; 
           [0010]      FIG. 2  is a sample “member validation and activity” screen according to an example embodiment; 
           [0011]      FIGS. 3A-3O  illustrate activity tab functionality for an example embodiment; 
           [0012]      FIGS. 4A-4E  are sample screens for call tracking features according to an example embodiment; 
           [0013]      FIG. 5  is a sample contact history screen according to an example embodiment; 
           [0014]      FIGS. 6A-6C , are sample alternate information screens according to an example embodiment; 
           [0015]      FIGS. 7A-7H  are sample screens for tracking spousal information according to an example embodiment; 
           [0016]      FIGS. 8A-8B  are sample caseworker screens according to an example embodiment; 
           [0017]      FIG. 9  is a sample “today&#39;s members” screen according to an example embodiment; 
           [0018]      FIGS. 10A-10O  are sample “add new member” screens according to an example embodiment; and 
           [0019]      FIGS. 11A and 11B  are sample “activity search” screens according to an example embodiment. 
       
    
    
     DETAILED DESCRIPTION 
       [0020]    The computerized system and method of the present disclosure is a “dual eligible” software tracking application that stores member contact information as well as detailed status information for member applications to enroll in a supplemental health benefits program. The software tracking application provides features and functionality for comprehensive member case management. It supports the entry and recording of activity data related to efforts to qualify a “dual eligible” member for MSP benefits and to complete the enrollment process. A member&#39;s “dual eligibility” may initially be identified in connection with a member “dual eligibility outreach” (DEO) effort in which associates of a health benefits provider contact Medicare Advantage clients and screen them for possible dual eligibility. 
         [0021]    The screens of the software tracking application provide dual eligibility outreach associates with access to the current status of a member&#39;s case. The application tracks “call batch files” into which member data is loaded so that an associate can make thorough and accurate updates to the information after every call made during an outreach effort. The screens also allow an associate to access information about program requirements so that the associate can provide members with accurate information and assist them in enrollment. If eligibility or enrollment efforts must be discontinued for any reason, the screens also allow the associate to record details and reasons for the change. 
         [0022]    In an example embodiment, the software application provides access to:
       Member demographic data   Member provider data   Member health plan data   Member CMS data   Member predictive modeling scores   Member no contact requests   Referral source data   DEO member mailings   DEO-VAT call attempts and outcomes   DEO-DMS call attempts and outcomes   A history of contact and activity completed by the DEO staff   DEO user and access rights data   Customized activity reports       
 
         [0036]    Referring to  FIG. 1 , a sample “member selection” screen according to an example embodiment is shown. A computer user may enter search criteria in a top portion of the screen  100 . Search results are displayed in a bottom portion of the screen  102 . Member data includes a unique member identifier (UMID), Medicare identifier, social security number (SSN), the member&#39;s name, telephone number, date of birth, address, member status, and last status date.  100  as well as. 
         [0037]    Referring to  FIG. 2 , a sample “member validation and activity” screen according to an example embodiment is shown. The screen comprises a member search box  120  for entering search criteria and performing a search. The screen further comprises a “member data” section  122  for displaying a member&#39;s personal information, contact information, dual eligibility status, Medicaid program data, and spousal information. The member data section  122  contains a number of data elements that are useful in the MSP screening and qualification process. In an example embodiment, the member data section may have a different color background as a visual cue for different groups of members. The standard background may be a gray color that represents all active members except those that reside in a particular state. A different color background may be used for a state that has, for example, an income rule applicable only to married couples. The background color serves as a reminder that there is a rule that only applies to married couples in the particular state. Another color may be used to indicate inactive members and yet another color may be used to indicate non-members. Different color background may serve as visual indicators for a variety of rules. 
         [0038]    Details of the member data section are as follows. 
         [0000]    
       
         
               
             
               
               
             
           
               
                 TABLE 2 
               
               
                   
               
               
                 Member Data 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 MEMBER 
                 “MEMBER PERSONAL INFO” area contains the member&#39;s 
               
               
                 PERSONAL 
                 UMID, SSN, Medicare identifier, name, date of birth, gender, 
               
               
                 INFO 
                 address, city, state, and zip code. If necessary, a corrected SSN, 
               
               
                   
                 DOB, and/or gender may be entered in the empty boxes labeled 
               
               
                   
                 “Alt.” The “SAVE MBR CHANGES” option saves any data 
               
               
                   
                 entered in these boxes. The original data remains in the same 
               
               
                   
                 positions after entering corrected data and the corrected data 
               
               
                   
                 appears in the boxes labeled “Alt”. 
               
               
                 CONTACT 
                 “CONTACT INFO” area contains Original Phone Number, 
               
               
                 INFO 
                 Override Phone Number, Preferred Call Time, and Language 
               
               
                   
                 preference. An alternate phone number can be entered in the 
               
               
                   
                 “Override Phone#” box and if needed an extension can be 
               
               
                   
                 entered in the “Ext” box. The “Preferred Call Time” box is 
               
               
                   
                 available under certain conditions. If the member has received a 
               
               
                   
                 mailing, returned an attached postcard, and the search included 
               
               
                   
                 the “Mail ID” number contained on the postcard, the user may 
               
               
                   
                 enter the preferred call time noted on the postcard. This 
               
               
                   
                 information is used when creating a VAT call file for members 
               
               
                   
                 asking for a callback from the mailing campaigns. When 
               
               
                   
                 searching on any criteria other than “Mail ID,” this box displays 
               
               
                   
                 data but is grayed out and unavailable for data entry. The “SAVE 
               
               
                   
                 MBR CHANGES” option saves any information entered in this 
               
               
                   
                 area. 
               
               
                 DUET 
                 “DUET INFO” area contains the Member Type and the Member 
               
               
                 INFO 
                 Status. The Member Type is based on the member&#39;s current and 
               
               
                   
                 past MSP status. The type listed on DUET will be either “N”, “R”, 
               
               
                   
                 or “U.” 
               
               
                   
                 N - This means this member is not currently on MSP and has 
               
               
                   
                 not been on MSP within the past year. 
               
               
                   
                 R - This means that the member is a Recert, which means they 
               
               
                   
                 were on Medicaid or MSP at some time in the past two years 
               
               
                   
                 and may still be on the program. 
               
               
                   
                 U - This means the member is either a new member or a non- 
               
               
                   
                 member and the Medicaid or MSP status is unknown. 
               
               
                   
                 The Member Status is “Active”, “Inactive”, or “NonMember.” The 
               
               
                   
                 Member Status indicates whether the individual is currently 
               
               
                   
                 enrolled in a benefits plan (Active) or was enrolled in a benefits 
               
               
                   
                 plan in the past (Inactive), or the person is not a member 
               
               
                   
                 (NonMember). The “NonMember” status may also be shown for 
               
               
                   
                 new members that have not yet been added to software 
               
               
                   
                 application. 
               
               
                 Save ALL 
                 This section contains the “SAVE MBR CHANGES” button. 
               
               
                 Member 
               
               
                 Info 
               
               
                 MMR INFO 
                 This area displays information from the CMS Monthly 
               
               
                   
                 Membership Detail Data file relevant to dual eligible status. The 
               
               
                   
                 “Medicaid Program” listed in the MMR, if any, is displayed. The 
               
               
                   
                 “MMR Month” indicates the ending date of the MMR&#39;s coverage 
               
               
                   
                 month from which the information came. The “MMR Medicaid 
               
               
                   
                 Ind” displays a “Y”, “N,” or is blank. If the indicator is “Y,” CMS 
               
               
                   
                 data currently lists the member as on some type of MSP. If the 
               
               
                   
                 indicator is “N,” CMS data indicates the member is not on any 
               
               
                   
                 type of MSP. If this area is blank, the MMR did not contain a 
               
               
                   
                 Medicaid Indicator value. There is a time lag from the time a 
               
               
                   
                 state issues a program determination and notifies CMS and from 
               
               
                   
                 this notification to the updated information being included in the 
               
               
                   
                 MMR. This time lag can span multiple months so the MMR 
               
               
                   
                 Medicaid indicator does not necessarily reflect a member&#39;s 
               
               
                   
                 current MSP status. 
               
               
                 SPOUSAL 
                 This area contains information about the member&#39;s spouse, if 
               
               
                 INFO 
                 any has been entered by the DEO group. The section contains 
               
               
                   
                 the member&#39;s Marital Status, the spouse&#39;s UMID, SSN, 
               
               
                   
                 Medicare ID, Name, and DOB. 
               
               
                   
               
             
          
         
       
     
         [0039]    Referring to  FIG. 2B , a sample postcard according to an example embodiment is shown. 
         [0040]    Referring again to  FIG. 2A , the screen also comprises an activity history section  126  with information related to one or more activities for confirming a member&#39;s dual eligibility. The screen allows a user to enter new status information and a new status date related to additional activities for confirming dual eligibility  124 . Finally, the screen comprises a number of tabs  128  for accessing different functions associated with the member data. In an example embodiment, the following functions are accessible: Activity; Call Tracking; Contact History; Alternate Info; Spouse Info; Caseworker; and Today&#39;s Members. 
         [0041]    Referring to  FIGS. 3A-3O , activity tab functionality for an example embodiment is shown. In an example embodiment, the activity tab is the default tab and is displayed when a user initially selects a member. The activity section is used to enter outreach statuses and note outreach activity steps completed for the member. This section contains an “Add New Status” area  130  and an “Activity History” area  132 . The “Add New Status” area  130  is used to log activity related to the MSP application process. The “Activity History” area  132  displays a history of any activity logged in the “Add New Status” section. The activity history displays in descending order. 
         [0042]    Referring to  FIG. 3B , a sample screen comprising a list of available statuses is shown. The list displays when the user selects an arrow at the right side of the New Status box. The available statuses are determined by the last activity record entered. When no prior activity has occurred for a member, the available statues are: 
         [0000]    
       
         
               
             
               
               
             
           
               
                 TABLE 3 
               
             
             
               
                   
               
               
                 Status Codes 
               
             
          
           
               
                 Status 
                 Description 
               
               
                   
               
               
                 Comments/ 
                 Information about a previous note or an entry for a call that 
               
               
                 Additional 
                 does result in a material change of a member&#39;s case status. 
               
               
                 Info 
               
               
                 Qualified 
                 Member&#39;s total gross income is below the income and/or asset 
               
               
                   
                 limits for their state. 
               
               
                 Not Qualified 
                 Member&#39;s total gross income exceeds the income and/or 
               
               
                   
                 asset limits for their state. 
               
               
                 Closed-Not 
                 Member states he/she does not wish to participate in this 
               
               
                 Interested 
                 program. 
               
               
                 Closed-Member 
                 Member states that he/she is already on MSP. (User may then 
               
               
                 Already on MSP 
                 be instructed to ask the member to mail or fax a copy of the 
               
               
                   
                 MSP approval letter. If the member does not have it, the user 
               
               
                   
                 may be instructed to order a COLA letter so that the member 
               
               
                   
                 can ensure that a part B premium is not currently deducted 
               
               
                   
                 from their Social Security check.) 
               
               
                 Member requested 
                 Member states he/she does not wish to be contacted. 
               
               
                 DO NOT CALL 
               
               
                   
               
             
          
         
       
     
         [0043]    Referring to  FIG. 3C , a sample screen comprising a selected status of “qualified” is shown. Additional entry boxes appear on the screen as a result of the “qualified” status selection. An “add status” option  134  is also visible on the screen. The Status Date defaults to the current date but may be changed. A Medicaid Program box is displayed and has the options as shown in  FIG. 3D . The Medicaid Program box  136  identifies the member&#39;s dual eligibility category. The categories include: 
         [0000]    
       
         
               
             
               
               
             
           
               
                 TABLE 4 
               
             
             
               
                   
               
               
                 Dual Eligibles Categories 
               
             
          
           
               
                 Category 
                 Description 
               
               
                   
               
               
                 Qualified 
                 Individuals entitled to Medicare Part A, have income of 
               
               
                 Medicare 
                 100% Federal poverty level (FPL) or less and resources 
               
               
                 Beneficiaries 
                 that do not exceed twice the limit for SSI eligibility, and 
               
               
                 without other 
                 are not otherwise eligible for full Medicaid. 
               
               
                 Medicaid 
               
               
                 (QMB) 
               
               
                 Specified 
                 Individuals entitled to Medicare Part A, have income of 
               
               
                 Low-Income 
                 greater than 100% FPL, but less than 120% FPL and 
               
               
                 Medicare 
                 resources that do not exceed twice the limit for SSI 
               
               
                 Beneficiaries 
                 eligibility, and are not otherwise eligible for Medicaid. 
               
               
                 without other 
               
               
                 Medicaid 
               
               
                 (SLMB) 
               
               
                 QMBs with 
                 Individuals entitled to Medicare Part A, have income of 
               
               
                 full Medicaid 
                 100% FPL or less and resources that do not exceed 
               
               
                 (QMB Plus) 
                 twice the limit for SSI eligibility, and are eligible for full 
               
               
                   
                 Medicaid benefits. 
               
               
                 SLMBs with 
                 Individuals entitled to Medicare Part A, have income of 
               
               
                 full Medicaid 
                 greater than 100% FPL, but less than 120% FPL and 
               
               
                 (SLMB Plus) 
                 resources that do not in exceed twice the limit for SSI 
               
               
                   
                 eligibility, and are eligible for full Medicaid benefits. 
               
               
                   
                 Medicaid pays their Medicare Part B premiums and 
               
               
                   
                 provides full Medicaid benefits. 
               
               
                 Qualified 
                 Individuals lost their Medicare Part A benefits due to their 
               
               
                 Disabled and 
                 return to work. 
               
               
                 Working 
               
               
                 Individuals 
               
               
                 (QDWIs) 
               
               
                 Qualifying 
                 Annual cap on the amount of money available may limit 
               
               
                 Individuals (1) 
                 number of individuals in group. Individuals are entitled to 
               
               
                 (QI-1s) 
                 Medicare Part A, have income of at least 120% FPL, but 
               
               
                   
                 less than 135% FPL, resources that do not exceed twice 
               
               
                   
                 the limit for SSI eligibility, and are not otherwise eligible 
               
               
                   
                 for Medicaid. 
               
               
                 Qualifying 
                 Annual cap on the amount of money available may limit 
               
               
                 Individuals (2) 
                 number of individuals in group. Individuals entitled to 
               
               
                 (QI-2s) 
                 Medicare Part A, have income of at least 135% FPL, but 
               
               
                   
                 less than 175% FPL, resources that do not exceed twice 
               
               
                   
                 the limit for SSI eligibility, and are not otherwise eligible 
               
               
                   
                 for Medicaid. 
               
               
                 Medicaid Only Dual 
                 Individuals entitled to Medicare Part A and/or Part B and 
               
               
                 Eligibles (Non QMB, 
                 are eligible for full Medicaid benefits. 
               
               
                 SLMB, QDWI, QI-1,or QI- 
               
               
                 2) 
               
               
                   
               
             
          
         
       
     
         [0044]    Referring to  FIG. 3E , a sample screen with a referral source box is shown. The user identifies the referral source for the Medicaid program for which the member is qualified. Referring to  FIG. 3F , a sample screen with an “add notes” option  138  is shown. The user may add notes relevant to status information for the member. 
         [0045]    The ability to add notes related to member interactions allows dual eligibility outreach associates to provide important details that may not be discernible from standardized status codes. Examples of notes that may be entered in the notes sections of various screens include the following: 
         [0000]    
       
         
               
             
               
               
             
           
               
                 TABLE 5 
               
             
             
               
                   
               
               
                 Example Comments 
               
             
          
           
               
                 Category 
                 Description 
               
               
                   
               
               
                 Members and 
                 If applicable, note spouse&#39;s name and UMID. For example, Jane 
               
               
                 Spouse 
                 Doe (H12345678). If member&#39;s spouse is not a member of the 
               
               
                   
                 health benefits provider, indicate the spouse&#39;s name and non- 
               
               
                   
                 member status. For example, Jane Doe (non member). 
               
               
                 Resend 
                 If member requests another application, note that address was 
               
               
                 Application 
                 verified. If the address was incorrect, note the correct address in 
               
               
                   
                 the comment field and check other databases to confirm it is 
               
               
                   
                 incorrect. If it is incorrect, transfer member to customer service so 
               
               
                   
                 member can change address. 
               
               
                 Blank 
                 If member requests a blank application, indicate “Qualified” for the 
               
               
                 Application 
                 member and spouse. Also indicate “sent blank application to 
               
               
                   
                 member” in the comment field. 
               
               
                   
               
             
          
         
       
     
         [0046]    The notes sections may be used to record specific details related to user-member interactions. For example, if the member returns a phone call and the user discusses with the member requirements for a specific Medicaid program, the user may record details of the conversation such as which documents the member plans to submit and when as well as the additional documents that the member may need to obtain before completing the program requirements. The ability of the user to record details of every interaction and to determine what has been done as well as what needs to be done for each member allows the user to assist many members in the eligibility and enrollment processes. The detailed information also assists users in assuming responsibility for cases that are in various stages of completion. 
         [0047]    After completing each of the data fields and selecting the “add status” option,” a “qualified” status record and an “Application &amp; Document Checklist sent to Member” record are added to the activity History section as shown in  FIG. 3G . Based on the updated activity history, the available status codes are shown in  FIG. 3H . If the user selects the “APP and/or Docs Received” option as shown in  FIG. 3I , the Medicaid Program and Notes boxes display. The Medicaid Program that is displayed is the program selected when the member was qualified but it may be updated if necessary. Following this selection, the available status options are shown in  FIG. 3J . 
         [0048]    If the user selects the “APP &amp; Docs Under Review” option, the statuses shown in  FIG. 3K  are available. If the user selects the “DE Sent to state Complete” option, the activity history is updated as shown in  FIG. 3L  and the available status options are shown in  FIG. 3M . Selection of the “STATE Approved” option causes additional entry boxes to display as shown in  FIG. 3N . The user is prompted to enter a Medicaid effective date, a Medicaid expiration date, and a case number for an approval record  140 . After providing the additional information, the activity history section is updated as shown in  FIG. 3O . 
         [0049]    As indicated in the examples of  FIG. 3A-3O , the available statuses are dynamic and are based on the prior status and the sequencing of the MSP qualification process. A user&#39;s options on every screen change in relation to the user&#39;s prior selections. A different series of selections results in a series of different screens and options. One of skill in the art would understand that user selections on every screen may be used to determine the content and presentation of subsequent screens. 
         [0050]    Referring to  FIGS. 4A-4E , sample screens for call tracking features according to an example embodiment are shown. Call tracking functionality allows DEO associates to log details of manually dialed outbound phone calls to members. The user accesses the call tracking feature by selecting the call tracking tab as shown in  FIG. 4A . Initially, the user selects the appropriate call type from the call type menu as shown in  FIG. 4B . Next, the user selects a call outcome as shown in the call outcome menu of  FIG. 4C . The user may enter a reason for calling the member and then select the “add call” option as shown in  FIG. 4D . The call is then added to the call history as shown in  FIG. 4E . If multiple calls have been made to a member, the details are shown in the call history section in descending order. 
         [0051]    Referring to  FIG. 5 , a sample contact history screen according to an example embodiment is shown. The contact history screen displays a history of member contact generated through VAT calls, DMS calls, or mailings. The contact history is accessible from the contact history tab and presents details as shown in  FIG. 5 . Contact history details according to an example embodiment comprise the following: 
         [0000]    
       
         
               
             
               
               
             
           
               
                 TABLE 6 
               
               
                   
               
               
                 Contact History Details 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 Sent to VAT: 
                 Date a member was included in a VAT or DMS 
               
               
                   
                 call file 
               
               
                 Program: 
                 Type of call file 
               
               
                 VAT Call Date: 
                 Date the member was called 
               
               
                 Program: 
                 Program type of the call 
               
               
                 Outcome: 
                 Result of the call to the member 
               
               
                 Mail File Date: 
                 Date a member was included in a mail file 
               
               
                 Program: 
                 Program type of the mailing 
               
               
                 Mailed Date: 
                 Date the letter was mailed to the member 
               
               
                   
               
             
          
         
       
     
         [0052]    If the “Sent to VAT” section is blank, the member has not been included in a VAT or DMS file. If the “Sent to VAT” section is not blank but the VAT Call Date section is blank, then either no calls have been made or no results from the VAT or DMS have been received. If the “Mail File Date” section is blank, the member has not been included in a mail file. 
         [0053]    Referring to  FIGS. 6A-6C , sample alternate information screens according to an example embodiment are shown. The alternate information section allows entry of alternate or additional addresses and phone numbers. This section also displays a history of any alternate addresses. The user accesses the alternate information section by selecting the “Alternate Info” tab as shown in  FIG. 6A . Referring to  FIG. 6B , a user completes the following steps to enter a new address: 
         [0000]    
       
         
               
               
             
           
               
                   
               
             
             
               
                  9) 
                 Select the address type from the dropdown menu. The available types 
               
               
                   
                 are: Living; Mailing; Power of Attorney; and Temporary. 
               
               
                 10) 
                 Enter the name (the member&#39;s name is entered by default). 
               
               
                 11) 
                 Enter a phone number and extension if applicable. 
               
               
                 12) 
                 Enter an expiration date if applicable. If a temporary is entered, 
               
               
                   
                 an expiration date is required. 
               
               
                 13) 
                 Enter the address in the Address 1 box. 
               
               
                 14) 
                 Enter additional address information in the Address 2 box if needed. 
               
               
                 15) 
                 Enter the city, state, and zip code. 
               
               
                 16) 
                 Verify the data and select the ADD option. 
               
               
                   
               
             
          
         
       
     
         [0054]    The user is alerted if certain information is required before the record can be saved. After adding the record, the alternate information is displayed in the alternate address information history section as shown in  FIG. 6C . 
         [0055]    Referring to  FIGS. 7A-7H , sample screens for tracking spousal information according to an example embodiment is shown. The spouse information section allows a user to store information about the member&#39;s spouse. To access the spouse information section, the user selects the spouse information tab  170  as shown in  FIG. 7A . The user has the option of adding or updating information for a spouse or removing spouse data from the member&#39;s record. 
         [0056]    As shown in  FIG. 7B , the user is prompted to enter the spouse&#39;s UMID, Medicare ID, or SSN as search criteria  172 . The user selects the “SEARCH” option and if a matching record is found, it displays as shown in  FIG. 7B . 
         [0057]    If the correct spouse information is displayed, the user selects the “Choose” option under the Action column  174 . The display change as shown in  FIG. 7C  and the user may update the spouse&#39;s information if corrections are needed. The user selects the SAVE option to save the new information. Referring to  FIG. 7D , the spousal information section  176  is populated with the new information. 
         [0058]    As indicated in  FIGS. 7E-7G , a new spouse may be added by selecting the add spouse option, entering UMID, Medicare ID, SSN, Name, and date of birth information, and selecting the save option. Referring to  FIG. 7H , the spousal information section  178  is populated with the new information. 
         [0059]    Referring to  FIGS. 8A-8B , sample caseworker screens according to an example embodiment are shown. The caseworker section allows the user to store information about the caseworker assigned to the member&#39;s MSP application. The user accesses the caseworker section by selecting the caseworker tab as shown in  FIG. 8A . The user is prompted for caseworker information and the member record is updated as shown in  FIG. 8B . 
         [0060]    Referring to  FIG. 9 , a sample “today&#39;s members” screen according to an example embodiment is shown. The screen comprises a “today&#39;s members” section  180  identifying the members with which the user worked throughout the day. 
         [0061]    Referring to  FIGS. 10A-10D , sample “add new member” screens according to an example embodiment are shown. The user is prompted for member information as shown in  FIG. 10A  and may be alerted if required information is not provided as shown in  FIG. 10B . The user may further provide new status information by responding to prompts in the “add new status” section  200  as shown in  FIG. 10C . Referring to  FIG. 10D , after the user has provided the new member information, the user may receive a message indicating the new member was successfully added. 
         [0062]    Referring to  FIGS. 11A and 11B , sample “activity search” screens according to an example embodiment are shown. As shown in  FIG. 11A , the user may enter various search criteria. Referring to  FIG. 11B , a sample search results screen is shown. 
         [0063]    The computerized system and method allows associates of a health benefits provider to assist its “dual eligible” members with eligibility and enrollment procedures for other health benefit programs. The associates may access the information they need to identify members that are eligible for other health benefits programs and for eligible members, enroll them in the programs. The computerized system and method support numerous events from an initial contact with the member through conclusion of an eligibility determination, and if applicable, enrollment. The computerized system and method further support suspension of an eligibility evaluation or enrollment procedure for various reasons that may be recorded in the member&#39;s contact history. 
         [0064]    While certain embodiments of the present invention are described in detail above, the scope of the invention is not to be considered limited by such disclosure, and modifications are possible without departing from the spirit of the invention as evidenced by the claims. For example, elements of the user interface may be varied and fall within the scope of the claimed invention. Various aspects of data recording and presentation may be varied and fall within the scope of the claimed invention. One skilled in the art would recognize that such modifications are possible without departing from the scope of the claimed invention.