New Payment Integrity Program: Social Security Disability Insurance

The Payment Integrity department is partnering with a vendor, Cognizant, to implement a pilot program related to Social Security Disability Insurance. The goal is to help qualifying Premera members transition their primary coverage from Premera to Medicare through targeted outreach.

Key details 

Program scope:

• Less than 600 members
• Fully insured Premera Blue Cross and Premera Blue Cross HMO members
• Members under age 65 with end-stage renal disease (ESRD) diagnosis

Impacts to existing ESRD programs:

• Premera currently sends letters to qualifying members
• Going forward, Cognizant will handle member identification and outreach for the fully insured population only
• Premera will continue to monitor members’ COB records for Medicare coverage
• Premera will reimburse Medicare Part B premiums for eligible members
• Cognizant will not reference Medicare Part B premium reimbursement in any outreach

Member benefits:

• Switching to Medicare offers qualifying members immediate healthcare coverage (when not working) and coverage after a waiting period if working
• Little to no out-of-pocket expenses with Medicare Part B at out-of-network providers accepting Medicare

30-month waiting period:

• Members approved for Medicare but choosing to remain employed stay on commercial insurance for up to 3 years

COB period starts from the date of ESRD diagnosis