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 — a simple web tool that works alongside any EHR today, with a fully EHR-embedded tier in development.
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.
See what the research says →A formulary change moved their statin to Tier 4. They're rationing doses. Their adherence is failing. And it's getting worse: the average Medicare Advantage drug-plan deductible nearly quadrupled in a single year. 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 SystemIn 2026, roughly 1 in 10 Medicare Advantage enrollees — about 2.9 million people — are being forced to change plans as insurers exit their counties. When a plan leaves, PCC identifies every affected patient in your practice and flags which ones can move now, under a Special Enrollment Period, rather than waiting until fall. A systematic answer, not a reactive one.
All SettingsPatient Coverage Connect gives your practice a compliant channel to connect Medicare patients with certified advisors — with a full clinical brief, documented consent, and no cost to your location. PCC Direct works alongside any EHR today. PCC Integrated, the EHR-embedded tier with automated detection, is in development.
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.
EHR-embedded tier: automatic clinical transfer and automated gap detection (T-65, SNP eligibility, plan terminations, formulary disruptions), with configurable staff review before referral.
Load the patient's clinical summary and PCC Direct surfaces more than 20 types of Medicare coverage gap — formulary disruptions, plan terminations, chronic-condition (SNP) eligibility, subsidy openings, and enrollment windows — so your staff refer the patients who need it, with the reason already attached to the brief. Provisional patents filed.
Every referral carries the patient's medications, relevant diagnoses, current plan, and the coverage question your staff identified — where the clinical record has it. The advisor starts with solutions, not discovery.
Your administrator sees every referral, outcome, and advisor assigned to your patients. If an advisor is ever inappropriate with a patient, you remove them from your practice immediately — one request, no argument.
Free to participating provider locations — no subscription, no per-referral charge. Subsidy navigation (Extra Help, LIS, patient assistance) can run through the same channel when you want it handed off.
Every year, Medicare patients ask whether they should change plans. Most of the time the answer is no — and someone in your practice probably already knows that. Patient Coverage Connect makes that answer systematic: an advisor reviews coverage annually, tells patients who are fine that they're fine, and helps the ones who aren't. Your staff stops fielding the question. It's documented.
Formulary change, plan termination, specialist out of network — the advisor connects them to the right plan in the right enrollment window, before it becomes a crisis in your office.
Confirmation that their plan still covers medications, doctors, and care needs — from someone who checked. They stop asking every year.
Coverage questions that used to land on your staff go to the advisor. Same help your team was already trying to give — systematic, documented, 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.
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 Direct runs in your web browser, alongside your EHR — one simple web tool, not a system to install or log into separately. Staff are submitting referrals the same day. Your administrator controls reporting, alert settings, and advisor access from day one.