Behind every health plan are a number of policies and procedures that serve as a framework for the organization and the care of its members. These policies include all aspects of operation, from payment and authorization to coordination of benefits.

Yet, despite the importance of these documents, the challenging and archaic process of updating them has left many health plans with outdated policies that do not serve its members well.

These mismanaged policies and procedures can have a number of costly effects on health plans, including:

  1. Poor customer service for plan members

On the most basic level, inaccurate or out-of-date policies and procedures will result in poor customer service for the health plan’s members. With no formal protocol in place for managing processes such as mailing member ID cards, members may take notice and file complaints.

  1. Corrective action plans from state auditors

As state auditors begin reviewing health plans’ policy and procedure documents, errors and gaps in management may result in corrective action plans from the state. These plans will provide detailed notes on where these gaps occurred and how they must be reconciled. It is then up to the health plan to prove that these actions have been taken.

  1. Fines from CMS

For health plans that do not follow through with their corrective action plans, the state may institute fines as a penalty. In some cases, these fines may be large enough to shut down the health plan if it does not have hefty reserves to pay them.

To help health plans overcome these challenges, Cody Consulting has developed the CodySoft® Policy and Procedure Module™. This module will effectively streamline the creation, distribution and certification of a health plan’s policies and procedures documents and reduce the risk of costly fines and unhappy members.

If you’d like to receive more information about the Policy and Procedure Module™ when it’s available, please sign up for our e-mail list.