AEP Best Practices – How to Produce Compliant & Effective Member Communications


Planning for AEP (Annual Enrollment Period)

As health plans prepare for AEP (Annual Enrollment Period), they face a multitude of challenges—ranging from compliance issues to mitigating risk related to timing, data, and documents. To help navigate these challenges, here are some key strategies and Best Practices for Compliant and Effective Member Communications we recently shared at the 2021 AEP MEDICARE READINESS SUMMIT.

From an operational and compliance standpoint, one of the biggest challenges leading up to AEP and a new coverage year is ensuring accurate information and approved plan benefits are implemented correctly. Many factors make this difficult—a compressed timeline and ever-changing data sets between bid submission and bid approval can lead to major issues with source data and multiple versions of documents. As the number of Plan Benefit Packages (PBPs) increases, so do the challenges.

Potential Compliance Risks

During AEP, compliance risks associated with Member Communications can reside in many places:

  • Misrepresentation of Benefits & Plan Rules during the Sales Process
  • Inaccurate or late Plan Documents distributed to members
  • Delayed or incorrect implementation of Approved Benefits
  • Ineffective coordination with FDRs and insufficient FDR Oversight

Risk Management & CODY® Solutions

To mitigate risk and address compliance issues related to plan and benefit data, the CodySoft® Plan Benefit Package Module® (PBP):

  • Creates a “single” Centralized Source of Truth™ to maintain PBP data in one place
  • Shares plan and benefit data in real-time and control enterprise-wide updates
  • Establishes a “Centralized Data Repository” for AEP & Contract Implementation

To mitigate risk and manage the marketing materials creation process, the CodySoft® Collateral Management Module® (CM) is the first-of-its-kind to:

  • Centralize & control the entire document creation process from development & approvals to compliance tracking & reporting
  • Merge stored plan data with EOC & ANOC templates developed from CMS model documents
  • Automate the development & expedite the finalization of ANOCs, EOCs, SBs/SOBs, SBCs, and other marketing materials

To mitigate risk and streamline the marketing materials fulfillment process, the CodySoft® Allied Central Dashboard™ (ACD) and distributed fulfillment network:

  • Provides an easy-to-use, web-based command & control system exclusively for health plans
  • Offers real-time workflow visibility from data through print
  • Incorporates review & approvals, production, tracking & reporting—an all-in-one integrated system accessible from any location
  • Integrates with one or multiple FDRs & production facilities to route print & mail orders

Unanticipated production or fulfillment delays

To prepare for severe weather, pandemic, IT system failure, machine breakdown, and other potential disruptions, CODY® CodySoft® Communications:

  • Maintains a “Disaster Recovery & Business Continuity” (DR/BC) Plan to avoid interruption in services and ensure compliant delivery of Member Communications
  • Supports redundant backup systems that include remote production facilities & process management, as well as contingencies for extended closures
  • Performs regular testing of the DR/BC cutover process to ensure a smooth transition in data processing and production workflows

Stay tuned for our next post! We’ll focus on how to produce AEP documents and manage plan benefits with compressed timelines.

To find out how CODY® can help your health plan operate more efficiently, mitigate risk, and deliver a better experience to serve plan members, contact us to learn more or schedule a demo.

About CODY: CODY® works with over 70 government-funded, commercial, and ACA health plans across 47 states and Puerto Rico. We help align internal operations with CMS guidelines to improve regulatory compliance, maximize performance, and streamline member/provider communications across the enterprise. CodySoft®, our proprietary suite of software, is designed specifically for health plans.