An Inside Look at PBP Health plans have a variety of uses for plan benefit information:

CMS bid review and approval, Medicare Plan Finder, member materials (such as ANOCs, EOCs, and SBs), customer service, sales, appeals and grievances, claims, and more. However, this information is typically housed in multiple locations and managed independently with “no centralized source of truth”, making updates and accuracy difficult to ensure.

The PBP module was developed to provide health plans with a single Centralized Source of Truth and allow for real-time, enterprise-wide benefit data retrieval to be used for a wide range of applications and multiple formats. The module enables direct upload of PBP XML reports and companion data captured and stored from various sources.

Top Reasons Why Clients’ Say This PBP Tool is Essential

We asked two clients, one from a leading Health Plan in the Northeast, and the other from a leading Health Plan in the Southwest, to assess their experience using our CodySoft® Plan Benefit Package Module® and give us their candid feedback. Here’s what they had to say based on our questions:

Q: How has your use of the CodySoft® PBP module changed your Health Plan’s operations and business practices?

NE: “Front-end work of building transformational rules decreased the overall review time of the documents, making it less complex and labor-intensive. The module was designed specifically for health plans, so it transformed our benefit data to how we manage it, how we present it to our members. Having a single source of truth eliminated the need for multiple versions of the benefit grid and provided the version control that was critical.”

SW: “CodySoft has allowed us to easily identify variations in the PBPs. For example, Prior Authorizations. It has also helped identify where we have benefit inconsistencies but should not. The PBP also allowed us to create standard benefit language across all PBPs. Having the comparison from one year to the next makes the generation of draft materials even quicker.

Q: What improved efficiencies have you gained from using the module?

NE: “The time-consuming manual review of the benefit grid has been eliminated. Now we have a structure and a format that is timely and accurate. Because it’s pre-configured, all the benefits information is in one place, ready to be presented in multiple ways depending on the purpose.”

SW: “The ability to write rules that update all the projects at the same time means you don’t have to go into each template to make an update. We also have added new plans to our product offering and the PBP module allowed for easy integration of those data points into an existing template. Because the PBP module is standard with language and how benefits are presented, it makes reviewing the information for our partner departments much easier and faster which moves us into production much faster as well.”

Q: How easy or difficult was it to integrate the module into your existing workflow?

NE: “The module was easy to integrate into our existing workflow as it precedes the document creation process. Building the rules was a new process but we soon realized that it was an innovative way of managing our benefit data.”

SW: “Our organization used the PBP module from day one and it was very easy to populate. Each Medicare season, I update information in the PBP module to reflect CMS changes or internal changes and then move on to the Collateral Management (CM) module.”

Q: Are you using the direct “single source of truth” from CMS’s HPMS application for multiple marketing materials or only for ANOCs/EOCs/SBs?

NE: “We are currently using the single source of truth (SOT) for the regulatory materials, as well as customizing it for Member Services. We do see the possibility of utilizing the SOT for our Friendly ANOCs. The SOT can be shared across the entire enterprise which makes it so essential.”

SW:We use it for the ANOCs, EOCs, and SBs. I do see how this module could be used for one-page snapshots for a high-level plan comparison that members or consultants might want.”

CODY® continues to find and develop new innovative uses for the PBP tool—for example in the creation of Employer Group Waiver Plans (EGWPs) that do not get uploaded into CMS’s HPMS system but often contain much of the same information as plans that do go through the bid submission process.

To find out how CODY® can help you navigate the ever-changing healthcare landscape please contact us today for a consultation or a software demo.

About CODY: CODY® works with more than 60 government-funded, commercial, and ACA health plans across 45 states and Puerto Rico. We help align internal operations with CMS guidelines to improve regulatory compliance and streamline member/provider communications across the enterprise. CodySoft®, our proprietary suite of software, is designed specifically for health plans.   www.codyconsulting.com.