The Health Plan

A leading Medicare Advantage & Commercial Group Plan, located in the Southwest with 52 hospitals, more than 800 patient care sites, 7,300 active physicians, and over 49,000 employees—partnered with CODY® to help manage the entire lifecycle of all plan documents from document creation through fulfillment with limited internal resources.

The Challenge

The health plan’s Marketing department of 3 was responsible for document creation and material fulfillment for over 480 unique plans, including 13 Medicare Advantage plans, 93 Individual and Family (on and off-exchanges), 91 Small Group, and nearly 300 Large Group plans. This included all sales-related collateral and member-mandated communications across plan websites, member portals, and other print & mail channels.

Prior to CODY®, the health plan worked with two vendors who misrepresented their capability and failed to achieve the automation needed to develop these documents and benefit grids. Each document must be created and managed accurately, distributed, and fulfilled timely for producers, providers, and members.

These documents included Medicare Advantage-specific Annual Notice of Change (ANOC) booklets, Evidence of Coverage (EOC) books, Summary of Benefits booklets, Formularies, Provider & Pharmacy Directories, Benefits of Membership brochures, Compliance Letters, and more. For the Individual and Family and Small and Large Group plans, the Marketing department produced EOCs, Certificates of Coverage (COC), Benefits Booklets, Custom Group documents, and other required materials.

The Solution

By leveraging our CodySoft® Enterprise Solutions, including the Collateral Management Module®, Plan Benefit Package Module®, and CodySoft Recon™ bundled with integrated solutions for translations, 508 remediation, Directory programming and composition, and daily print and fulfillment services—the plan eliminated eight different vendors. Our enterprise solution significantly reduced the plan’s delegated oversight responsibilities, saving them time and money.

CODY’s state-of-the-art technology and best-in-class solutions also helped maximize efficiencies, increase accuracy, mitigate compliance risk, and provide a better overall experience for the plan’s members and providers.

CODY® continues to manage the entire lifecycle for all Medicare Advantage and Commercial Group plan documents by leveraging the integrated solutions listed below. Our team continuously updates a library of Medicare Advantage and Group digital print assets totaling over 24,000 documents. Through programmed crosswalks and mapping tables, each document is assigned to production, insertion, and mailing workflows for specific fulfillment request types. We print and mail ANOC packages for all members, as well as Post-Enrollment Kit and Member Request book fulfillment for Medicare Advantage and Group plans. We support their Medicare Advantage reconciliation operations, create member-mandated materials, and own all operations related to Medicare Secondary Payer (MSP) and Coordination of Benefit (COB).

The CodySoft® Collateral Management Module® provides an end-to-end project management tool to automate the development of ANOCs, EOCs, SBs, and SBCs for their Medicare Advantage (MA) and Commercial Group (Group) Divisions.

Our Plan Benefit Package Module® automates the development of their benefits grids across the same lines of business by using a single Centralized Source of Truth®, saving time, improving accuracy, and reducing compliance risk.

CodySoft Recon™ provides a reconciliation of daily and monthly transactions based on the Center of Medicare and Medicaid Services (CMS) files, including member correspondence management through transactions received on the Daily Transaction Reply Report (DTRR) and for MSP/COB. Each month the system ingests the monthly files related to CMS’ MA membership and payment data for systematic reconciliation processing (includes MMR, MPWR, LEP, and LIS). Attestation Reporting produced monthly supports the plan in resolving incorrect data that may result in erroneous monthly capitation and/or member billing payments. CodySoft Recon™ also performs Out of Area (OOA), Enrollment Data Validation (EDV), and Retro Processing Contractor (RPC) tracking and management.

As a delegated entity for this health plan’s Medicare Secondary Payer (MSP) and Coordination of Benefits (COB) operation, CODY’s Business Process Outsourcing (BPO) team utilizes our CodySoft Recon™ MSP and COB modules to process the CMS files and validate all actionable records to make appropriate updates when needed.

The CodySoft® Allied Central Dashboard™ (ACD) plays an integral part in maintaining control over their complex fulfillment process. It provides visibility and insight into daily document production, mailing, and reporting.

CODY’s Translation Services and Section 508 Remediation are integrated seamlessly into the document development process—including ANOC, EOC, SB documents, and CODY’s programmed Provider & Pharmacy Directories.

The Provider & Pharmacy Directory Module™ provides an efficient programming and composition solution to produce monthly updated Directories that are accurate, 508 remediated, and ready for website use. Our Directory solution includes the ability to create and output custom/personalized “Geo-coded” Directories On-Demand for Member Request fulfillment. Geo-coded Directories offer a better member experience which is also cost-effective. Plans save on shipping costs with smaller personalized Directories, which include only providers and facilities within a reasonable distance from the member.

The Results

By working smarter and leveraging CODY’s state-of-the-art technology and comprehensive solutions, the team of 3 achieved astonishing results with remarkable efficiency, accuracy, and timeliness.

“With CodySoft® CM & PBP modules, our team was able to develop & fulfill over 46,000 plan documents for over 480 unique plans—Individual & Family (on & off-exchange), Small & Large Group plans.”

“An efficient process is essential for all Plan documents—SBCs, EOCs, COCs, Benefits Booklets, Medicare & Custom Group documents—to ensure accuracy & compliance with State & CMS regulations.”

CODY® provides a single-source opportunity to maximize operational efficiencies, mitigate compliance risk, and optimize outcomes from end to end. So, health plans can better serve their valued plan members, reduce administrative costs, generate new revenue, and thrive in a highly competitive, regulated marketplace.

The Experience

Overall: “We have a great relationship. We struggled before coming to CODY®. Every year gets easier and easier. We had a lot more use of CODY® this year because our portfolio grew and we’re managing a lot more complexity and volume. On the whole, performance and response have been quite good, system performance is right on, and it meets our needs. It was a great year!”

Functionality: “Base functionality works for us. Because of the complexity we experienced this year we’ve really learned a lot. Previous enhancements really helped us out.”

PBP Module: "We like the PBP module a lot. Uploading XML data to create a Centralized Source of Truth® document—cuts time in half.”

Support: “You guys do a great job. Whenever I have a question, you do your best to answer questions quickly. Support is amazing—you even take calls on weekends! The team holds our hand all the way through, and we really appreciate that. We’re very pleased! Same for the Commercial side. The team responds very quickly. Likewise, if I have a question on the Business Process Outsourcing (BPO) side, the responses are quick; I’ve had a positive experience on both fronts.”

Print & Fulfillment: “We have a really great team. Our account manager is amazing. The team addresses questions right away and they help me get back in line when I can’t get my act together. We have nothing but good things to say.”

Out of Area (OOA): “I work Out of Area a lot and really like the OOA set-up. I think it works great, and the Out of Area tracking screen gives you the ability to see from a high level where you’re at with your items.”

Business Process Outsourcing (BPO): “If you look at where we are today vs. where we were when we started the first couple of years, complete turnaround!”

Positive Outcome: Through their willingness to speak about their positive experience, this health plan is one of our key referral clients. They played an instrumental role in helping us gain two additional clients.