The Health Plan
The CODY® client provides or administers health coverage to more than 375,000 members in the Pacific Northwest. It offers insurance for commercial groups, Medicare, Medicaid, individuals and families. The plan has been recognized nationally for providing members with excellent health care and has received numerous awards that honor its services.
Prior to 2018, the plan was working with an East Coast-based First Tier, Downstream and Related Entity (FDR) that provided print and fulfillment services for their Annual Notice of Change (ANOC) mailing, as well as other services. Like many others, the plan was experiencing challenges with the timeframe for mailing the ANOC document to members by the CMS (Centers for Medicare & Medicaid Services) deadline of September 30, which put the plan at risk.
“Our previous vendor was on the East Coast and they had a very short window for us when it came to deadlines for the ANOC after final CMS guidance came out,” said the plan’s Marketing Program Manager. The vendor’s lack of experience with health plan-specific projects also presented challenges. “They weren’t proactively leading us. Being in reactive mode was a consistent issue.”
The plan had been working with the CODY team of document experts for a number of years to build their ANOCs and EOCs, and were introduced to the CodyPrint® division in 2018. After reviewing and assessing the plan’s challenges with print and fulfillment, CodyPrint experts stepped in with solutions that would provide a single source solution for these critical compliance documents, from document development through fulfillment (including operational/controls audits and reporting for HPMS upload of actual mail dates (AMDs)).
In 2018, CodyPrint managed the printing and mailing of the plan’s contract year 2019 ANOC packages that must be delivered to members’ homes by September 30th, as well as continued ANOC mailings for members with October 1, November 1, and December 1 effective dates. CodyPrint also designed and implemented a solution for variable data programming and geocoding of Provider and Pharmacy Directories (personalized Directories based on a radius around each member’s home), as well as an on-demand print and fulfillment program for member-requested books, such as EOCs, Formularies and Directories.
ANOC materials for contract year 2019 were completed in CodySoft® and transferred directly to CodyPrint after final approval, without delay. The ANOC postage was estimated and requested based on a preliminary member file to avoid delays in postage receipt. The result – all ANOC packages were printed and fulfilled without error, within budget, and arrived into homes by the September 30th deadline.
Between CODY’s project management expertise, and the CMS rule change allowing plans additional time for development of both ANOCs and EOCs, the entire process was much easier than before. “CodyPrint provided a realistic deadline for artwork, which helped immensely,” said the plan’s Marketing Program Manager. “Also, their process for getting postage in advance was made easier and quicker, and we are currently using an imprest account for our 5x a week fulfillment mailings.”
The plan is seeing real benefits from working with CODY. CODY truly understands the nuances and complexities of working within CMS guidelines for creation and fulfillment of member materials like the ANOC package.
“Our other vendor didn’t understand that Chapter 2 and Chapter 4 of the Medicare Managed Care Manual don’t get released until a certain date and that affect[ed] our timeline. With the CodyPrint team, that understanding was already there. I didn’t have to tell them that I was waiting for Chapter 2 guidance, because they already knew. They know the document creation side as well as the print and fulfillment process, which was super helpful.”
The plan’s Marketing Program Manager sees CODY as a true partner. CODY provides document development expertise and a consulting background with a greater breadth for understanding issues and "a wider lens". “Whereas the previous vendor was just print-only, CodyPrint experts understand CMS guidance and proactively bring up questions and make recommendations. For example, when we found out this year that the EOCs [Evidence of Coverage] were removed from the ANOC mailing requirement, the CODY team was a partner in helping us figure out how to move forward.”
For member-requested materials such as EOCs, Formularies and Directories, CODY now provides the plan with an infrastructure for producing and mailing materials on demand. When a member calls and requests a printed book from the plan’s customer service or marketing department, CODY prints and mails the requested book to the member within CMS’s required timeline, without any preprinted inventory. This saves the plan both time and money, while meeting the tight turnaround mandated by CMS.
CodyPrint’s on-demand geocoded Provider and Pharmacy Directory program saves the plan money on printing and postage, as well as improving the member experience. When a member requests a directory, a personalized geocoded directory is generated for the member, with listings of providers, pharmacies and facilities within a plan-specified geographic radius from the member’s home. Without geocoding, the plan was sending the members a “complete” standard directory each time, with some books being over 600 pages. Since these standard directories cover large regions, many of these listings were too far from the member’s home to be relevant, limiting their usefulness. With the geocoded directories, members now receive a book that is a fraction of the size, making it easier to handle and listings more relevant, providing an overall better member experience.
“The CodyPrint team provides collaborative, informed and expansive coordination of services,” said the plan’s Marketing Program Manager. “Now that we’ve gone through the first year and know what to do, each year we will work with CODY to continually improve and streamline the process to address any remaining issues. That’s what a really good collaborator like CODY does – notes the bumps to address next year and keeps moving forward.”