Posts Tagged ‘HPMS’
Risk Management for Health Plans – Part 3
In Part 2 of our Risk Management for Health Plans series, we provided a high-level understanding of how to approach risk management from a tactical perspective. This week we will provide you with a strategic framework to apply to your program. The 5 Pillars of Risk Management Keep in mind, Risk Management is a continuous…
Read MoreRisk Management for Health Plans – Part 2
In Part 1 of our Risk Management for Health Plans series, we focused on risk culture. This week we will get more tactical and breakdown the operational approach to risk management. Organizational Approach to Identifying & Managing Risk The day-to-day operational approach to risk management requires people, processes, and systems for any organization to properly…
Read MoreRisk Management for Health Plans – Part 1
Recently, CODY® conducted, through our partnership with the Association for Community Affiliated Plans (ACAP), a webinar titled Identifying & Managing Risk. These are a few of the questions regarding risk management for health plans that we considered: How effective is your organization at identifying and managing risk within your health plan from an operational and…
Read MoreCMS’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…
Read MoreHow to Ensure a Successful Triennial Network Adequacy Review
CMS monitors compliance with Network Adequacy Standards on a triennial basis. Every three years CMS requires a plan to upload its full-contract-level network into the Network Management Module (NMM) in Health Plan Management System (HPMS). When selecting contracts for the triennial review period, CMS pulls from the list of active contracts—primarily based on when the…
Read MoreMedicare Communications & Marketing Guidelines (MCMG)—CMS Updates Warrant a Thorough Review
Last month, CMS published a new MCMG, and it looks quite different! Not only is it much shorter, 51 pages compared to the previous 84 pages, it now has CFR references for all sections. Upon review, CMS has removed several details, seemingly anything without a CFR reference which accounts for the slimmed-down version, and it…
Read MoreAn Inside Look at Plan Benefit Package (PBP) Software
Health plans have a variety of uses for plan benefit information: CMS bid review and approval, Medicare Plan Finder, member materials (such as ANOCs, EOCs, and SBs), customer service, sales, appeals and grievances, claims, and more. However, this information is typically housed in multiple locations and managed independently with “no centralized source of truth”, making…
Read MoreAn Advance Look at Medicare Advantage Benefits Changes for CY2022
Every year, the Centers for Medicare and Medicaid Services (CMS) updates its Plan Benefit Package (PBP) Software that Medicare Advantage (MA) and Part D plans use as part of their bid submissions. The PBP Beta Software is released in late January to allow plans to test and provide feedback before the full version is available…
Read MoreSix Reasons Why Consolidating Software Applications Makes Sense
In today’s rapidly changing environment, health plans operating in silos or with dated legacy systems are struggling to keep up. As competition increases and technology evolves, companies are searching for answers—should they purchase software applications individually or buy a suite or bundle? IT purchasing managers face difficult challenges as business needs grow, software solutions change,…
Read MoreCan Artificial Intelligence (AI) Change the Future of Healthcare Operations?
Artificial Intelligence (AI) will become a larger factor in all facets of life soon… …in everything from self-driving cars to industrial manufacturing to the way we entertain ourselves. These changes will impact every part of healthcare also, from diagnosis through treatment and even into administrative and operational functions. CMS has started two initiatives directly related…
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