4 Circulation features that help power Medicare Advantage Plans

Last month we shared the news of the CMS’ updated policies regarding supplementary health benefits for Medicare Advantage Plans. The finalized policies broaden the definition of “primary health related” to include supplemental benefits that address social determinants of health — such as access to transportation.  However, for health plans or providers that want to implement new transportation benefits, managing those benefits can be an administrative nightmare. Understanding this dilemma, Circulation has developed a Transportation Benefits feature that empowers healthcare organizations to maintain supplemental benefit plans with ease.

By managing transportation benefits within the Circulation platform, plan administrators can define an unlimited number of plans to match the benefits available to their patient base.  These plans are highly customizable, encompassing a range of criteria:

Benefits by appointment types

As part of the standard Circulation platform, restrictions are already in place regarding the types of appointments for which a patient is eligible to receive rides.  Now you can set specific thresholds for one or more appointment types to ensure the patient is not scheduled for rides outside of their eligibility. Patients are then bound by the appointment types associated with their plan.

Varied thresholds

As shown here, for each appointment type included in a benefit plan, you can define not only the threshold value, but the type of threshold in place. For instance, Number of Allotted Rides allows you to specify the number of rides allowed for each appointment type, while cost of allocated rides allow you to specify a total cost not to be exceeded for rides of a given type. These thresholds are customizable between Benefit Plans, even including the option to define patient-specific overrides.

Flexible authorization periods

The thresholds you define may be set for any timeframe within your Benefit Plan, whether weekly, monthly, annually, or some other measure of time based on your plan period.  You can align all appointment type benefits to fall within the same period, or define them individually by Appointment Type. For example, you may have an annual benefit plan that allows for 10 ‘“Dialysis” rides per month, and $50 worth of “Physical Therapy” rides per week, for the duration of the plan.

Real-time benefit management

Best of all, once a patient is associated with a specific benefit plan, Circulation automatically monitors their eligibility in real time.  Checks are made at the time of booking to ensure a ride doesn’t exceed eligibility for the given period in which the ride falls. This holds true whether booking an on-demand ride or a series of recurring trips over the course of several months!  Furthermore, you can view patient metrics from their rider profile to determine where they stand with their benefit utilization.

Interested in learning how Circulation can help you better launch, manage and/or track your transportation benefits? Request a demo.


Bonnie is a Product Manager at Circulation.