Each year, Medicare Advantage Organizations (MAOs), Part D Plans and Cost Plans are required to submit data on their Part C and D plans to The Centers for Medicare and Medicaid Services (CMS) for the previous calendar year.

Included in these reports is a section on “Plan Oversight of Agents,” which captures data elements regarding licensed agents and brokers who have been the subject of marketing violations during the reporting period.

Reporting this information can be a labor-intensive and extremely time-consuming process that presents a number of challenges to health plans, including:

1. Documenting all required data during the investigation

As required by CMS, these reports must be compiled in two data files. The first containing 18 data elements specific to the Agent/Broker and marketing investigation outcomes, and the second containing 16 data elements regarding beneficiary enrollments associated with an agent/broker.

If all agent/broker data is not captured during the process of investigating marketing complaints, manual intervention is necessary to gather and harmonize data – a laborious and time-intensive task.

2. Compiling data in a timely manner

Even if data is collected during the investigations process, it is not uncommon that it is stored in more than one place. Data on agent identifiers, compliance investigations and beneficiary enrollment generally reside in separate systems, and pulling data from these systems is a huge undertaking.

3. Staying abreast of changes in reporting requirements

As if compiling this data wasn’t enough of a challenge, CMS frequently updates its reporting requirements and technical specifications, usually annually and with multiple reiterations. Thus, adding to the stress of compiling and submitting the reports within the required timeframe.

The CodySoft® Incident Management Module® can help health plans overcome these challenges. It is the first-of-its-kind full-cycle tool that allows health plans to manage investigation issues, from reporting to resolution. Contact us today to learn more.