What Makes Medicare Transfers Billable?

A Medicare live transfer becomes billable when it meets the specific criteria outlined in your vendor agreement—typically a live, qualified Medicare beneficiary who remains on the call past an agreed buffer period and meets basic eligibility requirements. During AEP (October 15 – December 7), agents need clear, written billing rules before the season starts.

Which qualification criteria should a billable transfer meet?

A billable Medicare live transfer should meet age/eligibility (turning 65 or already enrolled), geographic licensing (caller resides in a state where you hold an active license), intent verification (caller confirmed interest in comparing plans), and minimum call duration (typically around one minute of live conversation).

Most vendors also require:

• No duplicate within a lookback window (e.g., same phone number not transferred recently)
• Valid contact information captured during the initial screening
• Consent language that meets CMS marketing guidelines and TCPA requirements
• Clear audio quality so the agent can conduct a compliant enrollment conversation

Get every criterion in writing, including how partial-call disconnects and wrong-number scenarios are classified. Ambiguity costs you money when disputes arise during the AEP rush.

How are disputed transfers handled?

Disputed transfers are usually reviewed by listening to call recordings against the agreed criteria, with the vendor either issuing a credit, replacing the transfer, or upholding the charge based on what the recording shows.

Strong vendors log every transfer with:

• Time-stamped call recording from initial contact through handoff
• Screen-capture or notes showing the caller's responses during qualification
• Agent notes documenting disconnect reason or qualification failure

During AEP, response times matter. Ask your vendor:

• What is the dispute window?
• Will you receive a credit, a replacement transfer, or a refund?
• Who reviews the recording—an account manager or a separate QA team?

If disputes exceed a modest percentage of volume, the qualification process likely needs tightening on the vendor side.

Should billable rules change during AEP?

No. Billable rules should remain consistent year-round so your cost-per-acquisition math stays predictable, but confirm in writing that your vendor will not alter qualification thresholds mid-season when volume surges.

Some vendors tighten or loosen qualification during AEP to manage capacity. For example:

• Loosening (shorter buffer, lighter intent verification) can increase volume but may hurt conversion and raise dispute rates.
• Tightening (adding extra questions, longer buffers) protects quality but may throttle your daily delivery.

Before October 15:

1. Review last season's dispute log and conversion data.
2. Negotiate any changes to qualification criteria in a signed amendment.
3. Set a weekly check-in during AEP to compare dispute rates against the agreed baseline.

Consistent rules let you forecast cost per enrollment and scale confidently when the market heats up.

How Tele Leads Agency handles this

Tele Leads Agency defines billable-transfer criteria in writing before any campaign launches, ensuring each Medicare live transfer meets age, geographic, intent, and duration standards that align with CMS marketing rules. The process includes a pre-season agreement outlining exactly what makes a call billable, live call recording for every transfer available for dispute review, daily reporting so you can track connect rates and dispute rates throughout AEP, and account support to resolve disputed calls quickly during the enrollment window. By locking in clear criteria before October 15, agents avoid mid-season surprises and can focus on closing enrolled beneficiaries rather than arguing over billing.

Frequently asked questions

What happens if the caller hangs up in the first 30 seconds?

Most agreements classify very short calls as non-billable if the disconnect happens before the agent completes an eligibility confirmation. Review your contract's exact buffer threshold.

Can a vendor bill for a wrong-number transfer?

If the original caller provided incorrect contact information and the vendor's recording shows proper qualification, some contracts hold the charge. Dispute policies vary, so confirm your vendor's wrong-number rule in writing.

Do billable rules differ between Medicare Advantage and Medicare Supplement transfers?

The core criteria (live, qualified, duration, licensed state) stay the same, but some vendors add product-specific questions (current coverage, health questions) that may adjust the qualification bar. Clarify any product distinctions upfront.

How often should I review dispute rates during AEP?

Check weekly. If disputes climb noticeably, schedule a call with your vendor to review call recordings and tighten the qualification script before you waste budget on low-quality transfers.

Are replacement transfers also subject to the same billable criteria?

Yes. A replacement transfer issued to resolve a dispute must meet every qualification standard that applies to the original purchase, ensuring consistent quality throughout the campaign.

Tele Leads Agency · teleleadsagency.com · (888) 603-5358