The Centers for Medicare & Medicaid Services (CMS) purchases health care for an estimated 79 million people through Medicare and Medicaid. On behalf of these beneficiaries, CMS works to ensure high quality health care at a reasonable price and to provide information about benefits, health promotion, and choices. CMS is responsible for accurate, timely, relevant, understandable, and easily accessible information that will help beneficiaries evaluate health plan options, nursing home options, and make decisions on their individual health care needs. The Centers for Medicare & Medicaid Services (CMS) is required to broadly disseminate information to people with Medicare (and prospective people with Medicare), as well as, consumers in the Federally Facilitated Marketplace (FFM). CMS provides a broad range of information including the coverage options available, prescription drug information and General Medicare & Healthcare information.
In order to meet national program missions and strategies as well as legislative mandates (Balanced Budget Act of 1997 and Medicare Modernization Act of 2003), CMS operates a toll-free, nation-wide, 24x7x365 contact center with multiple sites to provide customer service and address inquiries. In addition to this, with new reform and regulations, and with the implementation of the Affordable Care Act (ACA), calls and inquiries also include issues regarding the Affordable Care Act (ACA), consumer health choices or other Federal programs and Department of Health and Human Services (DHHS) initiatives.
The Next Generation Desktop platform (NGD), owned by CMS, is a mission-critical system which has been designed to provide a single front-end interface for Customer Service Representatives (CSRs) to address beneficiary and marketplace consumer needs, and operates as the core application that drives all communication channels supporting the Virtual Contact Center Strategy, or VCS (Contact Center Operations, MyMedicare.gov, Speech Interactive Voice Response, Computer Telephony Integration, National Data Warehouse). CMS is responsible for providing consistent, reliable, and accurate information to Medicare beneficiaries, marketplace consumers, state, local, and federal agencies, and other customers. This includes responding to direct inquiries from beneficiaries and marketplace consumers as well as referring the caller to the appropriate CMS agent/partner. CMS communicates to these stakeholders via publications and through various contact channels such as phone, web chat, written correspondence, fax, and the web portal. A common denominator for these channels is that initial contact is usually made through a Customer Contact Center (CCO) where CSRs rely on NGD when communicating with the beneficiary and marketplace consumer. The level of service experienced when contacting CMS and the consistency of the information received is directly affected by the performance and reliability of the NGD.
Currently, CSRs respond to comprehensive telephone inquiries, written correspondence, e-mail and Web Chat for a wide range of Medicare and FFM topics for beneficiaries and consumers. NGD enables up to 20,000 concurrent Customer Service Representatives (CSR) to access Medicare claim and entitlement information from various sources in a consistent and standard manner. Types of information include but are not limited to: CMS entitlement information, CMS Managed Care information, Social Security Administration (SSA), premium information, Prescription Drug plans and Legislation information, Medicare Appeals information, and Coordination of Benefits information. In addition, claims information from Medicare Part A Intermediaries (including Regional Home Health Intermediaries for home health and hospice claims) and Part B carriers (including Durable Medicare Equipment claims) is accessed and provided. CSRs also provide general information on Medicare & ACA policies and take requests for Medicare publications through the NGD.
