Every day, Medicare patients arrive in your office or at your counter with a coverage problem already in their chart — often before they know it themselves. Patient Coverage Connect gives you a trusted, compliant place to send them — available as a simple web-based tool that works alongside any EHR, or as a fully embedded EHR integration with automated gap detection.
And the ones who are in the right plan? Your advisor tells them that too. Patients stop asking every year. Your staff stops fielding questions they can't answer.
Every clinical setting is confronted daily with coverage failures that slow care, harm outcomes, and burden staff. Your practice already tries to help — someone on your team knows to ask about Extra Help, knows to flag a formulary problem, knows when a patient is in the wrong plan. The problem isn't knowledge. It's that this work is unsystematic, time-consuming, and not what your staff is there to do. Patient Coverage Connect makes it instantaneous, documented, and handled.
A formulary change moved their statin to Tier 4. They're rationing doses. Their adherence is failing. You prescribed the right medication — the wrong plan is making it inaccessible. The clinical record already shows which patients face this. The problem is acting on it before the damage is done.
Physician · PharmacyYour referral is written. The appointment is made. The patient won't find out their plan doesn't cover it until they get a bill they can't pay — and call you to ask why.
Physician · SpecialistYour patient is approaching Medicare eligibility. They're making expensive, irreversible decisions without guidance. They don't know where to turn or who to trust. Now there's a systematic answer — from an advisor they can trust because your practice arranged it.
Physician · PharmacyYour team already navigates Extra Help, LIS subsidies, and pharmaceutical patient assistance programs for qualifying patients. The process is fragmented and time-consuming. Patient Coverage Connect can handle this through the same referral channel — or work alongside your existing efforts. You decide how much to hand off.
Physician · PharmacyA patient with diabetes or COPD may be in a general Medicare Advantage plan when a Chronic Special Needs Plan would cover their medications, their specialists, and their care management far more completely. The diagnosis is in their record. Without this platform, it stays there.
Physician · Health SystemThe plan is leaving the service area. PCC knows about plan terminations before the clinic does — and in PCC Integrated, automatically identifies every affected patient in your practice before the letters go out. Now there's a systematic answer, not a reactive one.
All SettingsPatient Coverage Connect is available as a simple web-based tool that works alongside any EHR — or as a fully embedded EHR integration with automated detection. Both tiers route referrals to the same certified advisor network, generate the same clinical brief, and operate under the same compliance framework. The difference is how the clinical data gets in and whether the system finds the gaps for you.
Works alongside any EHR in Chrome, Edge, Brave, Opera, or DuckDuckGo on desktop — not Firefox or Safari. No IT involvement. Live in under an hour.
Open PCC Direct in Chrome, Edge, Brave, Opera, or DuckDuckGo on the workstation where you export CCD files. No separate login, no IT setup. The practice is live in under an hour.
Staff downloads the patient's standard clinical summary (CCD) from the EHR and attaches it to the referral. One download, one attach. Takes seconds.
Staff confirms the patient consents to be contacted — documented with a timestamp. Selects the coverage question type: formulary, network, eligibility, plan termination, or subsidy.
The referral routes instantly. The advisor receives the patient's medications, diagnoses, current plan, and coverage question before making contact. Total staff time: approximately 30 seconds.
Embedded directly in the EHR. Clinical data transfers automatically — no CCD download. Adds automated detection: T-65 events, low-performing plans, SNP eligibility, plan terminations, formulary disruptions — flagged before the patient arrives. Configurable for staff review before any referral goes out.
PCC Direct works alongside your existing EHR in a Chromium-based desktop browser (Chrome, Edge, Brave, Opera, or DuckDuckGo) with folder access for clinical summaries — not Firefox or Safari. No IT involvement, no integration project, live in under an hour. PCC Integrated embeds directly inside your EHR for practices that want automated detection and seamless data transfer. Either way, staff don't learn a new system from scratch.
Every referral includes the patient's medication list, relevant diagnoses, current plan, and the specific coverage question your staff identified — where available in the clinical record. The advisor doesn't start with discovery — they start with solutions.
Your administrator sees every referral, every outcome, and every advisor assigned to your patients. When PCC Integrated is available, you set which coverage events trigger automatic referrals and which require your review first. If an advisor is ever inappropriate with a patient, you remove them from your practice immediately — one request, no argument.
If your practice already navigates Extra Help, LIS, or pharmaceutical patient assistance programs for qualifying patients, Patient Coverage Connect can handle that workflow through the same channel — or work alongside your existing efforts. You decide how much to hand off.
Patient Coverage Connect is free to participating provider locations. Onboarding and staff orientation are coordinated as part of rollout. No subscription, no per-referral charge, no ongoing administrative burden.
Every year, Medicare patients ask their physician or their pharmacist whether they should change plans. Most of the time the answer is no — and someone in your practice probably already knows that. The problem is that this knowledge is unsystematic, undocumented, and takes time your staff doesn't have.
Patient Coverage Connect makes it systematic. Every patient in your practice has an advisor who reviews their coverage annually, checks their medications against the current formulary, and tells them what's changed — and what hasn't. The patients who are fine hear that. The patients who aren't get helped.
Your staff stops fielding the question. The advisor handles it. And it's documented.
A formulary change, a plan termination, a specialist who's left the network — the advisor identifies it and connects the patient to the right plan during the appropriate enrollment period. Before it becomes a crisis in your office.
Confirmation that their current plan still covers their medications, their doctors, and their care needs. A clear answer to the question they've been asking — from someone who actually checked. They stop asking every year.
Patients in the right plan take their medications, keep their appointments, and don't delay care. The coverage questions that have always come back to your staff go to the advisor instead. The work your team was already doing — now systematic, documented, and off their plate.
Every referral that results in the patient being in the right plan directly affects the HEDIS measures and Medicare STAR ratings that determine quality scores, bonuses, and reimbursement rates for Medicare Advantage plans — and increasingly, for provider quality metrics as well.
Patients who cannot afford medications in the wrong Part D plan fail adherence measures. A referral that moves a patient to the right plan — or activates Extra Help or pharmaceutical assistance subsidies — directly restores adherence and improves outcomes scores for both the plan and the provider.
Patients who delay care because of coverage problems get sicker and get readmitted. CMS increased the readmission measure weight from 1× to 3× for 2025 STAR ratings. Resolving coverage gaps before the patient deteriorates is direct readmission prevention.
Patients with diabetes who are not in plans designed for their condition miss care management support, medication coverage, and specialist access. Diagnosis codes in the clinical record identify these patients. A Chronic Special Needs Plan referral changes their coverage profile — and their plan's performance on diabetes care measures.
Coverage gaps that go unresolved accelerate functional decline and erode member experience — both tracked STAR measures. Connecting patients to correct plans, appropriate subsidies, and advisors who arrive knowing their situation improves both clinical outcomes and the patient satisfaction scores that increasingly affect provider reimbursement.
Complete our online registration — provider information and CMS model BAA — before any patient information is transmitted.
A 20-minute walkthrough with your clinical staff covers the referral workflow and what happens after a referral is submitted. Patient Coverage Connect is accessed directly from within the patient's EHR record — no separate system to learn. Staff are submitting referrals the same day. Your administrator controls reporting, alert settings, and advisor access from day one.
The annual wellness visit, the follow-up, the specialist consult — every encounter with a Medicare patient is an opportunity to identify a coverage gap. The clinical record is already open. The Coverage Referral panel is one click away.
The pharmacy counter is the front line of formulary problems. When a patient can't afford a prescription, the pharmacist is the first to know — and now the first to be able to act on it systematically.
Across outpatient clinics, specialty practices, and hospital-based provider offices — every touchpoint with a Medicare patient is a potential referral event. One integration. Every location that needs it.