In response to increasing pressure to control costs and reorganize operations, many
states are electing to streamline eligibility and enrollment operations. AHS is
committed to helping states realize this vision, by working closely with our contracting
partners to implement enrollment and eligibility centers. As a natural extension
of our enrollment broker experience, AHS moved into providing enrollment/eligibility
center contracts in 2008. Our solutions encompass the full spectrum of operations
and include systems development, customer service, document imaging and processing,
mailings, and outreach. AHS was actively involved in the implementation of Wisconsin’s
BadgerCare Plus program. As envisioned by Wisconsin’s Governor Doyle, Childless
Adults – who historically accessed BadgerCare Plus (SCHIP expansion program) through
county welfare offices – were the first to access services through the new, centralized
Enrollment Services Center (ESC) that handles intake and application services, Health
Plan enrollment, program outreach and technical support. Working side by side with
the State, we provided enrollment and eligibility services for the State of Wisconsin
AHS’ Enrollment/Eligibility Center Contracts
2011 – Present
St. Louis Regional Health Commission
Gateway to Better Health Project
2008 – 2010
Department of Health Services
BadgerChoice Support Center Project
Additional information about these contracts is provided below.
St. Louis Gateway to Better Health Demonstration Project
AHS is actively working with the St. Louis Regional Health Commission to implement
the St. Louis Gateway to Better Health program, a pilot program in which eligible
uninsured Childless Adults can be enrolled in a program through which disproportionate
share hospital (DSH) funds are reallocated to pay for two tiers of care provided
through participating health centers. In the first tier of care enrollees receive
primary, preventive, specialty and urgent care, and in the second tier of care enrollees
receive only urgent and specialty care. This program serves as a stepping stone
and model for future efforts for the State in terms of its activities and programmatic
changes expected under the Affordable Care Act (ACA).
In fact, as part of our responsibilities, AHS is actively developing processes to
streamline eligibility for individuals that will be covered under the ACA. As part
of our work for this Project, among numerous other tasks, we:
- Developed a pre-enrollment process,
- Developed and deployed a secure online enrollment module,
- Determine appropriate outreach strategies,
- Developed outreach and enrollment materials, and
- Provide customer service support via a multilingual Call Center.
As part of the St. Louis Gateway to Better Health Demonstration Project, AHS provides
a robust, full featured-referral and prior authorization system that enables participating
health centers to communicate with each securely and in real-time other concerning
patient care issues. Using the portal, providers and administrative staff can create
new referrals, check member eligibility, check on their existing referrals, create
and update appointments, log consult notes and share them with other providers,
and more. The system acts as a meta-EHR (Electronic Health Record) for the Gateway
to Better Health Program, as health centers use the application with their own EHR
that feeds data and receives output files from the system. This system has helped
improve patient care by eliminating the knowledge gap between various providers.
To further support continuity of care, AHS also provides a Hospital-Patient Notification
system. Using this system, upon learning of a patient who has been admitted to a
hospital, we are able to immediately notify the PCP in order to ensure timely follow-up
Wisconsin Enrollment Services Center
In 2008, AHS was selected to assist the State of Wisconsin in the development and
implementation of an enrollment services center called the Enrollment Services Center
As the central resource for application assistance, eligibility and membership inquiries,
benefit plan details, Health Plan choice, and provider billing and as the ESC contractor,
AHS was responsible for assisting the State with launching:
Complete intake and eligibility processing services for Childless Adults applying
for or interacting with BadgerCare Plus and other related programs.
Comprehensive Health Plan Enrollment Services for the BadgerCare Plus for Childless
Adults program, the BadgerCare Plus for Children and Families program and for the
Medicaid SSI Managed Care program.
- Enrollee Services for BadgerCare Plus for Childless Adults.
Centralized application and payment processing for the BadgerCare Plus for Childless
Adults Employer Buy-Up program.
Electronic premium payment processing from applicants, enrollees, employers and
other entities associated with BadgerCare Plus.