Medicare Advantage Programs

Operational Support and Plan Implementations

Whether you are implementing a new Medicare Advantage health plan or developing your existing operation, CODY® seasoned consultants can guide you through these complex processes.

Lack of compliance with Medicare coupled with insufficient processes pose the greatest challenge and risk many health plans face. From systems development, operations management training, and quality assurance—it’s essential to have customized support based on a firm understanding of CMS regulations and industry best practices.

CODY® Operations Consulting supports all government healthcare operations—systems, assessments, implementations, and transformations. Wherever your company is in the development process, we provide end-to-end services to address operational gaps, maintain compliance, and grow your business.

  • Plan/System Expansions and Implementation services
  • Operational Assessments and Remediation services
  • Interim professional consulting services and support
  • Vendor assessments, contracting, on-boarding and oversight
  • Comprehensive strategies and solutions for new and existing plans
  • Maintain a better standing in CMS’s Five Star Quality Ratings
  • Evaluate workflow and implement process improvements
  • Project management for Communications initiatives
  • Strategic Assessment of Marketing and Communications Plan
  • Quality review of Communications to ensure regulatory and business standards are met


CODY® Functional Expertise supports operational implementation, integration, and improvement – launch a Medicare Advantage line of business, bring a delegated function inhouse, re-design processes to support new systems or requirements. Our experts have worked with plans to support operational implementations and transformations across functional areas including:

  • Website, Marketing and Beneficiary Materials
  • Fulfillment Operations and Mail Room
  • Finance and Accounting
  • Compliance
  • Sales and Broker Set Up
  • Customer Service/Call Center
  • Enrollment, Premium Billing, and Reconciliation
  • IT Infrastructure, Reporting, and Data Connectivity with CMS
  • Utilization Management and Case Management
  • Quality Improvement
  • Pharmacy Operations and PBM Oversight
  • Appeals and Grievances
  • Risk Adjustment and Encounter Data Submissions
  • Provider Contracting and Network Adequacy
  • Application and Bid Support

Client Testimonial:

“Please accept our enormous gratitude. Your team spent a lot of time making sure that we had a clear track to fix flaws or issues on a permanent manner, and in such a way that it can withstand future CMS scrutiny.”

General Counsel, Midwest Medicare Advantage Plan

Operations Support