VIEW THE VIDEO & READ THE BLOG
Managing Your Clients Continuity of Care
Hosted by Cristian Gallardo, VP of Sales
Protecting your client’s continuity of care is a critical step in the enrollment and onboarding process, let’s go through this step by step.
1. Ask about current providers and treatments. Are they seeing a doctor, specialist, or hospital? Are they in the middle of chemotherapy, dialysis, surgery recovery, or another active treatment?
2. Check the new plan’s provider network early—use the directory or tools to see if key doctors are in-network. If not, CMS gives a 90-day transition period starting from the plan’s effective date.
During those 90 days, the plan can’t require prior authorization for ongoing treatment—even if the provider is out-of-network. If the member has an existing authorization, notify the IPA or medical group.
You can do this two ways:
- The agent or member contacts the provider to inform them of the new plan and request resubmission of the authorization.
- The agent contacts the medical group or IPA broker support team to assist with the authorization process.
After 90 days, the plan may require in-network care or reassess authorizations, so guide clients on a smooth transition if needed.
The Bottom Line:
By discussing this upfront, documenting needs, and helping with transition requests or authorizations, you prevent disruptions and build trust. Remind clients: continuity of care protections are there to keep treatments steady.