Member Insights Frequently Asked Questions

What differentiates Centauri from others in the marketplace?
Centauri enables payers to proactively support members’ clinical and financial needs. Centauri provides superior compassionate outreach based on exceptional analytics and targeting which allows us to focus on the right members in your population who are most likely to need these additional benefits.  Centauri also has demonstrated our ability to be nimble and responsive to changes which occur in the complex payment model and changes that CMS implements from time to time.

What differentiatesthe Member Insights program from other eligibility programs?
Centauri provides superior compassionate outreach based on exceptional analytics and targeting which allows us to focus on the right members in your population who are most likely to need these additional benefits.  Centauri also has demonstrated our ability to be nimble and responsive to changes which occur in the complex payment model and changes that CMS implements from time to time. Additionally, Centauri continuously monitors relevant health events for members, such as hospital admission or discharge so members can be proactively engaged, ensuring strong continuity of care. No other eligibility program vendors support members from both a clinical and benefits perspective.

Why is is eligibility outreach retention of duals important?

For the member: Eligibility outreach and retention of dual-eligible individuals is crucial because they represent a high-need population requiring coordinated healthcare support. Ensuring continuous enrollment helps members avoid coverage gaps that interfere with their ability to access care and create unexpected financial burdens. Preventing these disruptions protects members from both health setbacks and costly out-of-pocket expenses.

For the health plan: Because Dual Eligibility is based on concurrent payment model any member who loses benefit eligibility during the year can mean immediate loss to your premium dollars as well as to the member.  Ensuring a pro-active retention strategy is critical to minimizing the impact.

How long have you been working with Medicare Advantage plans?
Centauri has been working with Medicare Advantage plans for over 30 years throughout the United States.

What states do you have experience in?
All states except Puerto Rico.

Do you use predictive analytics in your targeting?

Yes, we use a proprietary predictive model that allows us to identify current non duals with the highest probability to gain dual status.  The current model overall can identify nearly 99% of duals within the top four deciles of the non-dual population allowing us to identify the members who are most likely to be dual eligible within a population.  We also run analytics on the current partial dual population to identify those members who are most likely to qualify for full dual status.

 

Social Service+

What is Social Service+?
Social Service+ is a social service referral and support program that utilizes a social determinants of health (SDoH) assessment model. Social Service+ (SS+) assists Medicare Advantage plan members by conducting an assessment, identifying local resources to solve problems, providing resources, assisting them in connecting with those local services and following up to ensure they have received the services needed.

How can you help our members? 
Utilizing two web-based tools, SS+ Specialists will screen and assess your members' needs to identify likely local/state/federal benefits eligibility and identify other needs that can be met  from community social service organizations.

What kind of programs will you refer our members to? 
Assisting members to determine likely eligibility for benefits and entitlements is only one part of the solution to a problem of financial, environment and/or social insecurity. Directing and helping them to locate assistance from within their local community is at the heart of the service provided by Social Service+. Based on an individual assessment, we frequently refer members in need to Food Pantries, Home Delivered Meals, Senior Case Management Agencies, Subsidized Transportation agencies, etc.

Are you going to be providing the services to our members? 
SS+ Specialists provide members with verbal and written information about eligibility and application processes, support direct access to benefit enrollment and community programs to meet life challenges as defined within models of social determinants of health.

Will you be completing applications for members?
While completing the actual application remains the member's responsibility, the SS+ Specialist will help guide them with direct connections to local community support agencies. Our Specialists will continue to call to check in on how their application submission is going. We are dedicated to making sure we are helping your members as much as possible so that they can receive the benefits/services needed.

Event Monitoring

How does Centauri detect that a health event has occurred for a member subscribed to the Member Insights solution?
Centauri performs real-time monitoring for Admission, Discharge, Transfer (ADT) events for all members on the subscription roster. If an ADT event for a member is identified, the system immediately sends a notification to the member’s care team.

Can these ADT events be filtered by type?
Yes, customers can choose whether to be notified by any or all Admission, Discharge,
Transfer events based on the event type.

How are health event notifications sent and how is PHI protected?

Event notifications are encrypted and sent using Direct Secure Messaging, ensuring that only the designated recipient can decrypt and process the notification messages.

How are health event notifications processed within a care provider’s existing clinical workflow?
Because all certified EHRs support the DirectTrust Direct Secure Messaging standard, all notification messages will be processed for viewing within the provider’s EHR. In most cases, the notification is automatically matched to the member/patient’s record within the EHR so it can be viewed within context by the clinical user.

Are the HL7 ADT transactions able to be natively processed by the receiving EHR?
Centauri transforms the HL7 ADT message into a CCD document that is attached to the notification event Direct message. These CCD documents can be natively processed by most EHRs so they can be easily added to an individual’s electronic chart.

Solution Technology

How does the system help health plans monitor member activity and risk events?
The platform provides real-time member event notifications (admissions, discharges, transfers, and other high-risk encounters) across hospitals and care settings nationwide. These alerts allow care managers to intervene early, support transitions of care, and reduce avoidable readmissions.

Can the solution handle data from multiple sources and formats?
Yes. The system can receive and normalize data from hospitals, HIEs, and EHRs in multiple formats (HL7, CCD/XML, FHIR, PDF, or text), ensuring consistent member monitoring regardless of source.

Does the technology integrate with existing care management platforms?
Yes. Alerts can be routed directly into care management workflows, case management tools—no portal logins required. Integration supports automated member assignment and case tracking.

Can the solution scale beyond basic event alerts to include broader member insights?
Yes. It supports expansion beyond ADT events to include chronic condition triggers, lab results, and care gap notifications—helping plans address population health, quality, and Stars performance.

How quickly can health plans implement the solution?
Deployments can be completed in as little as 30–45 days with minimal IT lift. Configuration options include member roster uploads, automated NPI matching, and flexible delivery preferences for downstream systems.

 

Solution Security & Compliance

Is member data protected and transmitted securely?
Yes. The solution is HITRUST® CSF certified and DirectTrust™ accredited, meeting all HIPAA and ONC interoperability requirements for privacy and data protection.

How is data integrity maintained when transmitting across multiple networks?
All messages are transmitted using secure Direct protocols, digitally signed, and verified through the DirectTrust trusted network

Can the system support compliance audits or CMS documentation requests?
Yes. Every alert is fully auditable, with traceable delivery confirmations and exportable documentation that supports CMS and internal compliance reporting.

Does the platform align with CMS Conditions of Participation (CoP) and data-sharing rules?
Yes. It satisfies the CMS CoP 42 CFR 482.24(d) requirements for timely notifications and adheres to ONC/ASTP data-sharing and information-blocking rules.

How does the solution manage access to external or out-of-state providers?
The platform leverages a nationwide provider directory (2.8 M+ Direct addresses) and enforces strict identity validation and permission-based routing to ensure that notifications reach only authorized care partners.