As Health Plans know well—planning, building, maintaining, and fulfilling accurate mandated member and provider materials requires alignment of all departments and months of coordinating and managing internal and external dependencies and deliverables to meet AEP timelines. Dates like September 30th and October 15th are ingrained in memory, and summers become a head-down race to deliver hundreds, if not thousands, of approved, 100% correct documents. A true End-to-End (E2E) Communications Suite can help—here’s why…
Ultimately, this year’s upgrade to the new CMS web-based benefit submission tool should make the process easier, however, there is a significant amount of complexity in the new JSON format. And given changes to coding within the new Plan Benefit Package (PBP) module, the transformation of benefit data back into readable benefits for ANOCs, EOCs, and SBs is a major change from the previous XML-based format.
AEP team leaders must also manage downstream workflows to incorporate variable-data publishing, context-based programming logic, and database configurations for incorporating plan and benefit data into the CMS Model documents.
Further down the timeline, there are considerations for translation memories, custom term bases, localization, human vs. computer-aided translation, and AI when selecting language services and alternate format vendors. And then, there is the W3C, WCAG2.0AA, and the incorporation of required Section 508 accessibility standards into all published and electronically distributed materials. Add in project planning and cost estimates from offset and variable digital print vendors, impacts from supply chain delays, lettershop processes and automation, postal regulations, and lots more, and you have a perfect storm of acronyms, terminology, processes, and dependencies that are not just interrelated, but critical to ensuring the successful creation and dissemination of thousands of versioned materials to members and providers. And, of course, they must all be perfect. Needless to say, it’s a lot to manage, and time is critical.
CODY’s Single-Source Solution is a Game-Changer
Leveraging a Single-Source Solution from benefit submission through the delivery of materials to members and providers is a game-changer. Having an expert partner that’s been in your shoes, understands your needs, and can help your team create a plan is essential. That partner is CODY®.
CODY’s team has hundreds of years of collective experience working with or for managed care health plans, CMS, and industry-specific FDRs. CODY® is uniquely positioned to help your team understand options, make informed decisions, and manage complex compliance, operations, and communications workflows. We work with over 70 Medicare Advantage, Medicaid, Commercial, and ACA health plans nationwide, and our clients will attest to our team’s knowledge, understanding of their needs, and the effectiveness of our solutions.
Because we understand the landscape and the potential pitfalls inherent in using multiple FDRs for the various aspects of the AEP document development and fulfillment process—CODY® developed a true end-to-end Communications Suite. This comprehensive suite of CodySoft® products and services offers plans a compliant, integrated, and scalable managed solution to support the entire contract year lifecycle – from automated PBP extract and transformation into a final benefits language, to easy-to-use CMS model document development and versioning tools, Provider & Pharmacy Directory programming and updates, managed care specific translation services, 508 PDF remediation, and finally, member materials order processing, production, and fulfillment services.
We do not believe in one size fits all – each client’s unique needs and requirements are mapped to CODY’s software and service offerings to provide the most cost-effective and efficient integrated solution. Our Enterprise Platform also features comprehensive suites to support Compliance and Operations including, Appeals and Grievances, Enrollment, Billing, Reconciliation, and Member Correspondence, which seamlessly integrates with the Communications suite.
To summarize, the CodySoft® Communications Suite offers both large and small plans the ability to control the entire member communications process from beginning to end while benefitting from centralized data and asset management, as well as distributed fulfillment functions.
The CodySoft® Communications Suite includes:
- PBP benefit submission, transformation, formatting, and integration to Communications, Compliance, and Operations suites
- Mandated Materials Development and Variable Data Composition using transformed Plan and benefits data
- Provider & Pharmacy Directory programming, monthly updates, and fulfillment
- Translation of required materials into 80+ languages
- Website Accessibility Analysis and Section 508 PDF Remediation
- API Integration with Plan and CMS database systems for composition and fulfillment of over 200 member and provider Letter types
- Fulfillment of ANOCs
- Fulfillment of ID Cards, New Member Kits, and Member Request books to Plan service areas with redundant operations backups and automated Disaster Recovery and Business Continuity cutover
- Digital document fulfillment support (e-Presentment)
- Project Dashboards, Reporting, and Analytics for managing Project Schedules and tracking of Mandated Member Materials fulfillment
Contact us today to learn more or schedule a demo. We’re here to help make CY2024 AEP less stressful, more efficient, and better organized. We’ll work with you to develop the solution you need at a cost you can afford. Best of all, you’ll gain a true partner who values responsiveness and hands-on support and delivers on promise 100%.
About us: Founded in 2006, CODY® is an Industry leader in Governance, Risk, and Compliance (GRC) Solutions designed exclusively for health plans. We enable over 70 government-funded, commercial, and ACA health plans across 50 states and Puerto Rico to mitigate compliance risk, maximize efficiencies, and improve outcomes. Our Enterprise technology and innovative solutions reduce administrative costs, increase accuracy, ensure regulatory compliance, and provide a better experience for plan members and providers. www.codyconsulting.com