Maximize Operations and Outcomes

Staying current and compliant with policy changes and up-to-date with Enrollment, Billing, Reconciliation, and Claims processing can be overwhelming—especially with a growing plan, an understaffed team, and limited technology. Processing every component is complex and time-consuming. With administrative costs on the rise, it’s essential to minimize duplication, increase efficiency, and maximize outcomes to ensure appropriate actions are taken on each member’s enrollment and coverage, while containing costs.

CODY® Membership BPO supports Medicare Advantage and Medicaid health plans by providing experienced, cross-trained analysts to process transactions in accordance with Federal and State regulatory guidelines. We leverage our industry expertise, best practices, and state-of-the-art technology to analyze data, process transactions, and deliver quality results with high efficiency, while reducing the total cost of operations.

  • Stay up-to-date and compliant with enrollment, premium billing, and reconciliation with CMS files and claims processing
  • Use our proprietary software, Membership Suite or yours—or a combination of both
  • Integrate CodySoft Enroll™, CodySoft Bill™, and CodySoft Recon™ with existing tools
  • Scalable to grow with you and tailored to support your plan size and operation
  • Achieve operational efficiency, profitability, and member satisfaction
  • Monitor CMS updates, SLAs, MARx Calendar, and FTP jobs
  • Process enrollment, billing, reconciliation, and MSP/COB tasks
  • Perform outreach to obtain relevant information from beneficiaries and/or insurance carriers as necessary
  • RPC & EDV Packet QA and Submission
  • Achieve operational efficiency by leveraging our expert analysts

Our focus not only aligns with CMS regulations, but we also create operational systems that increase efficiency, drive revenue, and deliver a better experience to serve plan members.

Use our proprietary software or yours – or a combination of both!

  • Integrate CodySoft Enroll™or CodySoft Recon™ with your existing tools and processes
  • Augment areas where you don’t yet have operational tools in place

We support all Government Program Sponsors including Medicare, Medicaid, and Healthcare Exchanges.

Success Story:

By implementing CODY’s CodySoft Recon™ MSP module and BPaaS solutions, one health plan client with an average membership of 30,800, saw a net revenue gain of $1.5 million in MSP adjustments over a 3-year span.

Leading Not-for-Profit Healthcare System in the Southwest