General Updates
Colorado Appointment
Select Health is preparing to offer Individual and Medicare plans in Colorado beginning in 2024! Agents interested in becoming appointed should contact the Agent Experience team at 800-442-5306, option 3.
Agent License Renewal
Keep these in mind if your insurance license renewal is coming due:
- Each time you renew your license, be sure to review and update your contact information with the Department of Insurance. This includes your email address, phone number, and address.
- Complete continuing education credits in plenty of time to have the credit posted to the Department of Insurance website.
- Ensure you meet continuing education requirements, including credits required as in-classroom education and ethics courses.
- We will send a courtesy email reminder when your license is coming due. Be sure to keep your email address updated with us to ensure successful communication.
- A license lapse can impact commission payment. It’s imperative to keep it current.
For questions related to licensure, please contact the Agent Experience team at 800-442-5306, option 3.
Sales Materials
Sales materials both in electronic and paper versions can be found in the Agent Resources section of Link. Below the Agent Tools heading on the main landing page, choose Agent Resources. Utilize the filters in the left-hand column, or the search box at the top of the page to locate items. If you’re interested in picking up materials from our office, please contact your account manager.
Agent Experience Team – New Name, Same Great Service!
The Agent Relations team has recently been renamed the Agent Experience team. This change will allow us to expand the service we provide to you—our agent partners—through enhanced reporting, agent communication, and education. We will be increasing the use of surveys to learn how we can continue to provide the best service possible to you and your staff.
For more information, call our Agent Information Line at 800-442-5306, option 3, or use the direct contact information below.
Supervisor/Medicare Appointment & AORs
Stephanie.Crandall@selecthealth.org
801-442-7195
Project/Business Analyst/Agent System Access/PingID
Conner.Midgely@selecthealth.org
801-442-1126
The Basics of Risk Adjustment
What is risk adjustment?
Every year, the Centers for Medicare & Medicaid Services (CMS) compares patients’ illness severity across health plans, states, and the nation. This annual review helps to determine the funds that health plans receive according to the disease burden of the patients they insure.
Risk adjustment refers to the practice of tracking ICD-10 codes submitted on claims and using that information to determine the impact of a population’s health problems.
Why is risk adjustment important?
Risk adjustment programs allow health insurance carriers and CMS to properly fund coverage for those with the most resource-intensive conditions, while ensuring access to affordable coverage options for all members.
Who performs risk adjustments?
Health insurance carriers that offer government plans are legally responsible for performing risk adjustment. However, accurate and complete physician documentation and coding are critical to running a successful risk adjustment program.
How is risk adjustment calculated?
A health insurance carrier uses available data to project risk scores. Once diagnosis codes and projected scores have been submitted to CMS, a Risk Adjustment Factor (RAF) score is generated based on contributing chronic conditions and the member’s demographic score (e.g., age, gender, Medicaid eligibility). This is then combined with the approximate cost of care for the member’s chronic conditions contingent on geographic region.
The RAF score determines how much money CMS pays the insurance carrier for the care of each patient. These funds are used to pay for claims, in-patient stays, medications, and additional benefits.
Each year on January 1, CMS resets the RAF calculation. It is up to the health insurance carrier to ensure each patient is seen and coded in the current year to establish accurate payment.
What can agents do?
When you meet with clients and prospective members, encourage them to meet with their Primary Care Provider (PCP) yearly. These annual visits provide valuable opportunities for members to discuss their health and any concerns they may have with their PCP, while allowing for vital data to be collected that can be used in projecting risk scores.
Risk adjustment ensures that Select Health can continue providing exemplary service and care for our members. Thank you for partnering with us as we work to help our members live the healthiest lives possible.