Member Benefits Frequently Asked Questions

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.

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 a 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 proactive retention strategy is critical to minimizing the impact.

Centauri has been working with Medicare Advantage plans for over 30 years throughout the United States.

All states except Puerto Rico.

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+ 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.

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.

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.

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.

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.

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.

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

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

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.

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.

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.

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.

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.

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.

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.

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

All messages are transmitted using secure Direct protocols, digitally signed, and verified through the DirectTrust trusted network

Yes. Every alert is fully auditable, with traceable delivery confirmations and exportable documentation that supports CMS and internal compliance reporting.

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.

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.