We Understand a Health Plan's Pain Points
Health plans are bogged down with everchanging regulations, time-sensitive mandates, understaffed or undertrained teams, and limited technology, and they are looking for solutions to lighten the load. Our value comes from a deep understanding and ability to successfully alleviate pain points for health plans. Here are a few common challenges:
- Inefficient processes and workflows
- Lack of resources, expertise, or technology
- Low visibility, lack of control, risk management issues
- Increased volume, document complexity, and on-demand fulfillment
- Time management issues, fire drills, missed deadlines
- Compliance risks from errors
- Oversight of multiple vendors with minimal healthcare experience
- Lack of downstream processes, quality issues, and uncontrolled costs
- Lack of a comprehensive Risk Management program, system, process, or strategy
- Increased volume of HPMS memos and Compliance Correspondence requirements to manage
- Difficulty managing complex investigations and other compliance issues
- Version control issues leading to costly erratas, corrective actions, non-compliance
- Compliance oversight among multiple first-tier and downstream entities
- Ineffective processes, lack of detailed protocols, policies, and procedures
- Insufficient Compliance training, readiness reviews, and risk assessments
- Loss of revenue due to enrollment and premium billing data discrepancies and outliers
- Lack of resources, expertise, and training aligned with current regulatory guidance
- Insufficient processes, tech-enabled tools, or systems
- Operations management/team training, development, and quality assurance
- Deficient operational assessments and remediation services
- New Plans, expansions, system implementations, and transformations across numerous functional areas
Getting Down to Business
As consultants, we’ve successfully partnered with numerous health plans to support a variety of challenges. The needs and goals of each client are unique, requiring a customized approach. Whatever your challenge is, we have the expertise and tools to address gaps, maintain compliance, and support all government healthcare operations for new and existing plans. Here are a few examples of how we can help you:
- Implement CodySoft® Enterprise Solutions, our comprehensive suites of proprietary software, to streamline, automate, and manage Member/Provider Communications, Compliance, and Operations from end to end.
- Integrate workflows to control all Member/Provider Communications from document creation through fulfillment.
- Establish an Enterprise and Compliance Risk Management system with customized and configurable workflows.
- Develop a Compliance Program that meets regulatory requirements; identify high-risk areas; detect, correct, and prevent confirmed and potential violations.
- Build and/or support Operational and FDR oversight - Audits, and Audit Support.
- Launch a new Medicare Advantage health plan, bring a delegated function in-house, redesign processes to support new systems or requirements.
- Ensure data integrity, elevate star ratings, strengthen Member & Provider engagement.
- Leverage our Communications BPO industry expertise, best practices, and technology to create, manage, and complete your ANOCs, EOCs, SBs, and other required materials to increase accuracy and efficiency.
- Maximize your operations and outcomes with our Membership BPO to perform Enrollment, Premium Billing, Reconciliation, MSP, COB, and Recovery operations to increase accuracy, profitability, and member satisfaction.