The Health Plan

The CODY^® client featured is a southern-region Blue Cross Blue Shield Plan offering Medicare Advantage, Individual and Family, and Employer Plans to more than 22,000 members.

The Challenge

Prior to 2014, the health plan created its Evidence of Coverage (EOC) documents manually.

“We’d been semi-successful doing our EOCs manually and hadn’t had any CMS corrective actions on them,” said the plan’s Manager of Medicare Operations. “At one time it was more manageable, but then we began adding products. We have PPO, PFFS, HMO products, and by 2014 we were doing around 18 EOCs.”

As manual document creation became more cumbersome, the plan tried an enterprise-wide document composition software tool. It almost overloaded the plan’s system and was not able to handle the complexities of EOCs or Annual Notice of Changes (ANOCs), particularly the population of the Chapter 4 table.

“We always had problems with creating the EOCs, worked long, hard hours on them. We were always able to produce them, but there was a lot of gnashing of teeth and crying. It was really hard on our resources. We wore out our staff.”

The plan was experiencing resource challenges, inconsistency and errors within benefit information, and struggles with finalizing ANOCs and EOCs on deadline. Also, version control was a “real problem,” including identifying the last version of a document.

“We had probably 10 people working on the documents. We kept them on a shared drive and there was no way to stop people from working on them at the same time. We had instances where we knew we had updated a document but the next time we opened it the changes weren’t there for some reason.”

In 2013, the health plan received three erratas from CMS.

“We knew we needed something, but we hadn’t found the right tool.”

The Solution

When Cody’s Senior Vice President of Sales and Marketing Brad Boyer contacted the health plan about its CodySoft^® product, meetings and demonstrations commenced.

“The initial email from Brad was intriguing. It made us want to look into the product to see if it could really help us streamline our process and produce accurate and timely documents. The demonstration showed that the tool could be invaluable in the ANOC/EOC process.”

CodySoft^® is a suite of web-based software products designed specifically for health plans and their complex environment. Given the health plan’s challenges, Boyer recommended CodySoft^®’s Collateral Management Module® to streamline creation of the ANOCs and EOCs.

CodySoft^®’s Collateral Management Module is the only application of its kind to incorporate project management, document creation, assets management, compliance tracking, reporting, and more – with added features that centralize all areas of the health plan environment, including compliance, IT, creative services and operations.

“Part of our Corrective Action Plan response to CMS in 2013 was telling them we were going to utilize CodySoft from now on to produce our ANOCs and EOCs, to ensure accuracy and compliance.”

As part of software setup, the CodySoft^® team assessed the health plan’s workflows and identified ways to implement best practices. This included identifying and reducing duplication of efforts, finding opportunities for synergies and recommending other strategies to make the overall document development process more efficient.

The Results

The benefits the health plan has experienced since using CodySoft^® include savings in time, money and resources, as well as a shortened production timeline and improved accuracy.

“Our goal used to be to have the documents done by Labor Day. Last year, using CodySoft^®, we were done around August 26, and this year we were able to shave off another two weeks. That’s due to being able to work in CodySoft^® and use the templates.”

While waiting for CMS to approve their bids, the Manager of Medicare Operations and the Part D Manager created the templates in CodySoft^® and populated the data grid with the new bid information. Once CMS approves the bid, they will update the data grid then, with the push of a button, easily version out the documents using CodySoft^®.

“Being able to create a template and then version the EOCs from the template using the data grid is a huge benefit. It reduces the time spent and improves the quality of the materials. Last year we took extra time to refine the language in the benefits grids to make the materials easier to understand. The end result is a benefit to our members—a better document.”

CodySoft^® also helps the health plan expose gaps in the workflow and shows when someone has been working on documents outside of the software. As a direct result of the increased efficiencies CodySoft^® brings, the health plan has reduced the staff that work on the EOCs from five to two people.

“It’s helped us establish a process, and we keep improving it every year so we use CodySoft^® to its maximum benefit. We’ve been able to reduce the time that staff has to touch the docs, which makes them more productive. They can continue with their operations, and we keep our business going while producing these really important documents for our members and making sure they’re accurate.”

Also, CodySoft^® made redundancies apparent, allowing the health plan to reduce the number of EOCs they were producing, thereby saving on printing and postage.

“CodySoft^®’s operational grid and benefit grid lets you see the language and benefits side by side. On some, we could see there were exact matches. It made us question why we were doing two or three EOCs when we could do just one.”

The Experience

In addition to providing CodySoft^® as a software tool, the Cody team takes service a step further than most software solution vendors by training health plans on how to use it for their unique needs.

“The initial onsite training that CODY^® provided was very good,” said the health plan’s Senior Counsel, Government Programs. “But then they also trained the trainer on our staff. It was more focused training designed for the way our plan, specifically, uses CodySoft^®, and that worked really well for us.”

CodySoft^® experts host weekly support calls with the plan to address questions and offer recommendations and best practices to help the plan maximize the effectiveness and benefits of CodySoft^®. Clients can submit questions through an online help portal, and CodySoft^® experts respond quickly, usually within a few hours during normal business hours. The plan can also access CodySoft^®’s video learning library and Microsoft Word formatting support at any time.

“They’re always available, always ready to answer questions, very knowledgeable and very hands-on with us,” said the Senior Counsel.

CODY^® is based in the United States, and all consulting work and CodySoft^® programming are managed in the country by experts with direct, hands-on experience in the managed care industry. The team’s ability to provide both consulting services and technology brings invaluable benefits and robust capabilities to clients. For instance, when health plan experienced workflow challenges in 2015 and faced extraordinary timeline pressures for developing their ANOCs and EOCs, the CODY^® team was able to step in to build documents and support the team to meet critical deadlines.

The health plan has recently renewed its CodySoft^® contract for an additional three years.

“CodySoft^® is worth it,” said the Manager of Medicare Operations. “It’s beneficial for the overall process, it’s beneficial for meeting CMS regulations, and it’s beneficial for your staff and yourself. It’s changed my life.”