CMS’s Plan Benefit Package (PBP) Software—Technical Redesign Coming to HPMS

CMS is modernizing its Plan Benefit Package (PBP) bid submission module for Contract Year (CY) 2024

Going live on April 7, 2023—the new web-based Plan Benefit Package (PBP) Software Technical Redesign will live within the Health Plan Management System (HPMS) and include updates to the user interface and data entry workflow.

In previous years, users had to download the Plan Benefit Package (PBP) software, save bids locally, and then upload submission files to HPMS. With the new software, these functions are all within HPMS.

Impacts on the User Experience:

• The updated interface enhances the user experience providing a more modernized look and feel, a user-friendly data entry process, and a top-down approach.
• Plans and authorized consultants have the option to submit Plan Benefit Package (PBP) data using an application programming interface (API).
• Multiple users can access and complete data entry for each Plan Benefit Package (PBP) (PBP “super user” concept has been removed).
• The Plan Benefit Package (PBP) software data report format has changed from XML to JSON. In addition to JSON data reports, users can download reports in Excel and HTML formats.

Changes to the Data Entry Workflow:

• Dynamic picklists for prior authorization, referral, supplemental benefit selections, etc.
• Benefit data entry pages that do not apply to the plans will not be displayed.
• Real-time data validation enhances the workflow.
• Out-of-network groups increased from 15 to 25.
• A dedicated section for optional supplemental benefits streamlines the data entry process.

To help with the transition, CMS provides two industry training webinars on the new software. Located within HPMS, the test environment is available to registered users from January to March. It allows users to kick the tires using their contract-plan-segment IDs to create sample bids. Before Alpha testing, CMS migrated plans’ final CY2023 PBP bids into the module where users can copy the PBPs for CY2024 data entry testing.

During Alpha and Beta testing, users are encouraged to provide feedback to CMS as fine-tuning of the software continues. At the end of each week, CMS provides testing updates of fixed and open issues within the Documentation section on HPMS’s home screen. Other documentation includes PBP Access-to-JSON mapping, sample PBP JSON files, API documentation, and the new Plan Benefit Package User Guide.

The PBP modernization changes do not impact the Bid Pricing Tool (BPT), which continues in the current Excel-based format.

We’re Here to Help

CODY® has led the industry for decades—and we have the tools and expertise to help. Our proprietary software is built by industry veterans with first-hand experience. We continue to test the new software, adapt quickly, and mitigate issues before they arise. Our updated CodySoft® Plan Benefit Package Module®, Collateral Management Module®, ANOC and EOC templates, and data sources offer a fully-integrated automated solution—from bid intake to final documents.

To learn more, contact us today for a consultation or a software demo.

About us: Founded in 2006, CODY® is an Industry leader in Governance, Risk, and Compliance (GRC) Solutions designed exclusively for health plans. We enable over 70 government-funded, commercial, and ACA health plans across 50 states and Puerto Rico to mitigate compliance risk, maximize efficiencies, and improve outcomes. Our Enterprise technology and innovative solutions reduce administrative costs, increase accuracy, ensure regulatory compliance, and provide a better experience for plan members and providers. www.codyconsulting.com