Determined Care
Two Problems. One Systematic Solution.
Your members are missing SSDI benefits they earned. Your plan is absorbing millions in unreimbursed care costs. Determined Care solves both — simultaneously.
Determined Care exists to ensure all those who are eligible for coverage are approved seamlessly and aligned to appropriate levels of quality care — so people get the coverage they qualify for, and plans and providers are paid appropriately for the care they deliver.
Problem 1: Paperwork Over People
Only 36% percent of claims are initially approved, with most only gaining approval after appealing to hearing
Problem 2: Payment Does Not Match the Care Being Delivered
Payment is tied to a single point in time, and does not match a member’s changes in health or disability
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Through a Four-step process, Determined Care solves both of these problems by separating members based on if they have an existing SSDI award or should be classified as medically frail from scratch
01
Identify
Route each member correctly
Cross-reference SSA data (BENDEX/SDX) and claims history: who already has an SSDI/SSI award, and who’s a medically-frail candidate without one.
02
Document (MF path only)
Prove the case only where needed
Build the functional-impairment file from clinical records and provider attestation — only for members without an existing SSA award, who skip this step.
03
Submit & Reconcile
Fix eligibility + align payment to care
File the SSA award (fast path) or the completed MF file (documentation path); calculate the payment rate that matches actual care needs.
04
Re-attest
Right the cost for each member’s path
Medically-frail status needs fresh proof every 6 months; SSDI/SSI status is just re-confirmed via an SSA data match.
ANY QUESTIONS?
