Policies and procedures are essential tools for any organization.

By clearly articulating the requirements established by external oversight bodies and internal standards, they are an effective control to support consistency, accountability, and compliance. To be effective, policies and procedures should be:

  • Designed as tools that help employees make decisions related to their assigned tasks/responsibilities;
  • Clear, thorough, and easy to understand;
  • Up-to-date to reflect current requirements and organizational expectations;
  • Distributed and easily accessible; and
  • Enforced.

Keeping up with policies and procedures on a continuous basis is not only an important component of an effective operational environment, but it demonstrates a commitment to compliance and will ensure that you are audit-ready. Auditors will request policies throughout the audit process to establish the organization’s operating standards and will expect the organization to operate in accordance with those policies. This includes CMS program audits, accreditation reviews, and delegation oversight audits.

policies and proceduresMaintaining policies and procedures is labor-intensive and time-consuming. An effective process:

  • Identifies areas where policies may need to be created;
  • Establishes expectations for periodic review and revision;
  • Coordinates with regulatory communications to identify and act upon updates when they occur;
  • Includes version control to track content changes, reason for change and dates;
  • Defines approval requirements; and
  • Documents dissemination to applicable employees and constituents.

Penalties for noncompliance are too costly to ignore. For health plans in search of a proven solution, CODY offers a comprehensive suite of software modules to streamline and support compliance-based operations.

The CodySoft® Policy and Procedures Module® is compliance-driven and specifically designed for health plans. It’s a full-service tool to help streamline the creation, approval, distribution, communication, comprehension, and certification of a health plan’s policies and procedures. Best of all, the Policy and Procedures Module® will help you reduce administrative costs and be audit-ready—all the time.


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