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We Understand a Health Plan's Pain Points

Health plans are bogged down with everchanging regulations, time-sensitive mandates, understaffed or undertrained teams, and limited technology, and they are looking for solutions to lighten the load. Our value comes from a deep understanding and ability to successfully alleviate pain points for health plans. Here are a few common challenges:

Communication Challenges:

  • Inefficient processes and workflows
  • Lack of resources, expertise, or technology
  • Low visibility, lack of control, risk management issues
  • Increased volume, document complexity, and on-demand fulfillment
  • Time management issues, fire drills, missed deadlines
  • Compliance risks from errors
  • Oversight of multiple vendors with minimal healthcare experience
  • Lack of downstream processes, quality issues, and uncontrolled costs

Client Testimonial:

“With CodySoft®, one of the advantages is that once we have the information in just one template… We’re guaranteed to have standard language across all products… It also helped with version control, with different departments working on the materials.”

Leading Blue Cross Blue Shield Plan

Compliance Challenges:

  • Lack of a comprehensive Risk Management program, system, process, or strategy
  • Increased volume of HPMS memos and Compliance Correspondence requirements to manage
  • Difficulty managing complex investigations and other compliance issues
  • Version control issues leading to costly erratas, corrective actions, non-compliance
  • Compliance oversight among multiple first-tier and downstream entities
  • Ineffective processes, lack of detailed protocols, policies, and procedures
  • Insufficient Compliance training, readiness reviews, and risk assessments

Operations Challenges:

  • Loss of revenue due to enrollment and premium billing data discrepancies and outliers
  • Lack of resources, expertise, and training aligned with current regulatory guidance
  • Insufficient processes, tech-enabled tools, or systems
  • Operations management/team training, development, and quality assurance
  • Deficient operational assessments and remediation services
  • New Plans, expansions, system implementations, and transformations across numerous functional areas

Getting Down to Business

As consultants, we’ve successfully partnered with numerous health plans to support a variety of challenges. The needs and goals of each client are unique, requiring a customized approach. Whatever your challenge is, we have the expertise and tools to address gaps, maintain compliance, and support all government healthcare operations for new and existing plans. Here are a few examples of how we can help you:

  • Implement CodySoft® Enterprise Solutions, our comprehensive suites of proprietary software, to streamline, automate, and manage Member/Provider Communications, Compliance, and Operations from end to end.
  • Integrate workflows to control all Member/Provider Communications from document creation through fulfillment.
  • Establish an Enterprise and Compliance Risk Management system with customized and configurable workflows.
  • Develop a Compliance Program that meets regulatory requirements; identify high-risk areas; detect, correct, and prevent confirmed and potential violations.
  • Build and/or support Operational and FDR oversight - Audits, and Audit Support.
  • Launch a new Medicare Advantage health plan, bring a delegated function in-house, redesign processes to support new systems or requirements.
  • Ensure data integrity, elevate star ratings, strengthen Member & Provider engagement.
  • Leverage our Communications BPO industry expertise, best practices, and technology to create, manage, and complete your ANOCs, EOCs, SBs, and other required materials to increase accuracy and efficiency.
  • Maximize your operations and outcomes with our Membership BPO to perform Enrollment, Premium Billing, Reconciliation, MSP, COB, and Recovery operations to increase accuracy, profitability, and member satisfaction.