Day 0–30: Nail the Basics and Eliminate Friction

1) Get ID cards and required materials out—on time, every time. New enrollees must receive required materials (e.g., EOC, ID cards) within 10 calendar days of CMS confirmation of enrollment or by the last day of the month before the effective date, whichever is later. Automate these timelines and monitor mail file dates in HPMS.

2) Guarantee continuity of care for active treatment. If a member is in an active course of treatment when switching plans, you must provide a minimum 90-day transition period and honor existing prior auth approvals for as long as medically necessary. Communicate this clearly to members and providers during onboarding.

3) Warm handoffs after any inpatient stay. Stand up a Transitions of Care (TRC) workflow: share the discharge report with the PCP within 2 business days, engage the member within 30 days, and complete medication reconciliation on the date of discharge through 30 days post-discharge. These HEDIS elements are foundational in the first month.

4) Make access and attribution obvious. Publish clean provider choices, office hours, and next-available appointments. Keep your online provider directory current (update within 30 days of change) and confirm PCP attribution with the member (and the PCP) in writing and via portal/app.

5) Book the Annual Wellness touchpoint. Members enrolled in Part B for >12 months are eligible for a Yearly “Wellness” visit; align the appointment with plan-of-care onboarding. For newer Part B enrollees, schedule the IPPE (“Welcome to Medicare”) then queue the subsequent AWV.

Experience moves to deploy now

• “Day-10 welcome call” script tied to ID-card receipt and benefits overview.
• One-tap PCP selection + appointment booking in the app/portal.
• Nurse navigator outreach for members with open transitions (discharge, DME, home health).

Early KPIs

• % required kits/cards mailed within CMS window
• % members with confirmed PCP attribution
• % members with scheduled AWV/IPPE
• % inpatient discharges with med rec and PCP notification within measure windows

Day 31–60: Coordinate Care and Close Early Gaps

6) Prior auth done right (and member-friendly). Reinforce to care teams and call centers: active treatment continues without new PA in the 90-day window; approvals remain valid as long as medically necessary. Escalations should be time-boxed and tracked.

7) Medication safety + benefit awareness. Pair medication reconciliation with a benefits check: low-cost pharmacy options, mail order, MTM eligibility, OTC allowances, transportation, and dental/vision extras. (Experience weight changed, but benefit clarity still influences CAHPS responses and complaints.)

8) Risk adjustment with purpose. Use the AWV/IPPE as the anchor for problem list accuracy and care-plan documentation; prompt for chronic conditions and social risks that influence treatment. (Do not “code hunt”; align to clinical documentation integrity and member goals.)

9) Provider engagement for first-episode services. Coordinate DME, home health, and specialist referrals with tight SLAs. Confirm deliveries/starts and survey members after first use (“Was equipment delivered? Working? Do you know whom to call?”).

In-flight KPIs

• % PA appeals within CMS timeliness; % resolved on first contact
• % members using supplemental benefits at least once
• % AWV/IPPE completed; % with care plan documented
• TRC completion rates (information to PCP, engagement, med rec)

Day 61–90: Lock in Relationships and Prevent Complaints

10) CAHPS-oriented coaching. Coach service reps and provider offices to say the quiet parts out loud: “You do not need a new authorization for that ongoing treatment during the transition period,” and “Here’s how to schedule your wellness visit today.” These moments reduce “getting care quickly” and “plan information” pain points that drive CAHPS.

11) Proactive outreach to likely detractors. Use signals (confusing bills, network changes, delayed DME) to trigger supervisor callbacks and provider-to-plan scrums before a grievance appears.

12) Close the loop with brokers and partners. Send a 60- and 90-day status pack to the writing agent: PCP confirmed, AWV status, benefits used, open service tickets, and “what to say next” coaching points—without PHI beyond permissions. This aligns expectations and reduces unnecessary disenrollment.

Stability KPIs

• 90-day retention and avoidable disenrollment
• Grievance rate per 1,000; time to first resolution
• CAHPS “Getting Care Quickly,” “Getting Needed Care,” “Plan Information,” “Customer Service” early pulse

Compliance Guardrails You Can’t Miss

• ID cards/EOC & required materials: deliver within 10 days of CMS confirmation or by the last day of the prior month (whichever later). Track HPMS mail dates.
• Continuity of care: honor existing treatments for ≥90 days when a member switches plans; do not require new PA during that period; approvals valid as long as medically necessary.
• Provider directory hygiene: complete online updates within 30 days of receiving new information.
• Transitions of care: meet TRC windows for information to PCP, member engagement, and medication reconciliation (discharge day through 30 days).
• Preventive visits: align AWV/IPPE scheduling to Medicare eligibility rules to avoid denials and confusion.
• Stars context: member-experience weights changed for 2026/2027; calibrate performance dashboards accordingly.