The Bridge — Volume 12

Madena™ and CODY® Merge to Expand Technology and Consulting Capabilities

Cody ConsultingCODY® Acquires Madena

Madena has been acquired by CODY®, a leading healthcare technology and consulting firm. The combined offerings and decades of industry expertise provide Medicare, Medicaid, and Commercial health plans an ‘end-to-end integrated solution’ previously unavailable in the marketplace.

CODY® works with over 60 government-funded, commercial, and Affordable Care Act (ACA) health plans to help ensure regulatory compliance, enhance operations, and improve member/provider communications across the enterprise, utilizing CodySoft®, their proprietary suite of software.

Driven by an escalated enforcement and rising penalties for non-compliance, health plans are searching for better ways to operate more efficiently, mitigate risk, and deliver a better experience to serve plan members. The merger also supports clients’ desire to work with a trusted, single-source provider to accomplish that and more.

The acquisition is an exciting move forward for both companies. It enables us to grow stronger together as we broaden our capabilities and expand our offerings to further support the commercial and government-sponsored health care markets.

Deb Mabari, CODY’s founder and CEO, and Denyse Wise, former founder and CEO of Madena, have been industry colleagues for years. “We have shared a similar orientation to the culture and vision of our companies. We couldn’t have asked for a better fit,” said Deb. “Now we’ve come together holistically,” said Denyse.


 

Synchronicity™ BIC-BEQ

On February 1st,2021, Madena deployed our first customer implementation of Synchronicity™ BIC-BEQ. Working closely

with our client, we integrated CMS’ new BIC-BEQ API service with our Synchronicity™ Enroll APIs. This design allows us to streamline the BEQ response from CMS, evaluate the BEQ response against sophisticated enrollment business rules, and provide high-quality results in near real-time.

Synchronicity™ BIC-BEQ allows our clients to use the CMS Batch Processing, migrate to the BIC process, or use a hybrid of both approaches.

 


 

How to Mitigate Compliance Risk & Improve Operations—An A-to-Z Approach

This evergreen post from CODY’s Insights blog highlights compliance and operational best practices that are applicable at any time.

 As the Centers for Medicare and Medicaid Services (CMS) increases its scrutiny and escalates enforcement, Compliance managers are on guard to ensure regulatory standards are met and fines, sanctions, or even termination from CMS programs, are avoided. How can Compliance and Operations managers mitigate compliance risk and improve operations?

The best way to avoid compliance errors is to implement a fully integrated end-to-end solution that works across an enterprise. What constitutes an end-to-end approach? A comprehensive, holistic system should consider several key strategies.
Read more ….

 


 

HPMS Memo Summary

Sarah King

Sara King, Senior QA Tester & Account Manager
Sara’s round-up of the most critical HPMS memos.

HPMS Memo: Medicare Advantage/Prescription Drug System (MARx)
February 2021 Payment – INFORMATION

 

Monthly Membership Report Adjustment Reason Codes (ARC 02 and ARC 03)

There was an error in a regular update to the Medicare Advantage Prescription Drug system (MARx); the February MMR will include two extraneous line items for each beneficiary for the month of January 2021.

Portal Migration: EIDM to IDM

Users of the following applications: Medicare Advantage Prescription Drug system (MARx), Electronic Retroactive Processing Transmission (eRPT), Eligibility Medicare Online (ELMO), and Coordination of Benefits (COB). The Enterprise Identity Management (EIDM) system is being replaced by a new system called CMS Identity Management (IDM) on February 15,2021. The migration will occur over the weekend of February 12 – February 14, and the new IDM system will be operational starting Monday, February 15. Users will still use portal.cms.gov to log in to the new IDM system.

2021 Frailty Score Update

The 2021 frailty score results will be posted in HPMS and incorporated into payment on or around May 2021. Once the scores are applied to the payment calculation, retroactive payment adjustments back to January 2021 will appear on the Monthly Membership Report (MMR) using Adjustment Reason Code (ARC) 18 – Part C Rate Change.

To find out how the CodySoft® HPMS Memo Module® can streamline the entire management process—from memo intake, distribution, and review to response and reporting, please contact us.