CodySoft’s Plan Benefit Package Module – Revolutionizing the way health plans manage data

November 5th, 2018 | by site admin

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The Plan Benefit Package (PBP) Module® is the latest CodySoft® tool that will revolutionize the way health plans manage plan benefit and related data. The module allows plans to import data from multiple sources, including directly from the HPMS PBP tool via PBP xml Reports, into one centralized location.

The data can later be exported as an enterprise-wide data grid to support contract tables, LIS tables, marketing tables, operational data and more, all from one centralized system. The best part about the Plan Benefit Package (PBP) Module® is it allows for tight version control and provides a centralized source of truth for all plan benefit information and more.

“PBP information comes into a health plan in different formats from the state, federal government and various contracts — and nothing is consistent,” said CODY CEO Deb Mabari. “Our experience of over a decade working with health plan’s PBP data from across the country allows our team of document development experts to understand the challenges plans face and the intricacies of trying to manage this data. We developed the PBP Module to ingest data and transform it into member-facing text and a structured format that is usable enterprise-wide.”

Health plans can input PBP Excel Reports and companion data into the CodySoft PBP Module. After defining the data structure and writing rules to auto-transform the data, health plans can export the PBP Reports and Master Data Grids as Excel and PDF files.

“The PBP Module allows plans to easily process the most up-to-date data,” said Mabari. “This is a critical step in allowing health plans to manage PBP input changes as needed. The PBP Module database now becomes a single centralized source of truth that can be leveraged across the enterprise. Plans will no longer have to manage multiple data inputs where version control quickly becomes an issue.”

The PBP Module’s benefits include:

  • Mitigates enterprise-wide compliance risk of manually building and maintaining a centralized source of truth benefit grid
  • Saving health plans time and money through leveraging automation
  • Accurate member marketing materials (such as ANOCs, EOCs and SBs)
  • Medicare Plan Finder preview (easy format for review)
  • Call center benefit scripts and descriptions (consistent description of benefits to share with members)
  • Claims processing
    • Benefit set, system configuration (ability to verify that the claim programming matches benefits approved, cost-share, limits)
    • Delegate set up, testing and monitoring
  • Required Notices (ability to list the service, approval, reason for denial, e.g. limits, and member cost-share)
    • Integrated Denial Notices
    • Explanation of Benefits
    • Explanation of Payment or Remittance Advice
  • Member outreach (describe covered benefits, cost-sharing, tie to utilization reports)
  • Provider education (describe covered benefits, cost-sharing, utilization reports)
  • Financial and utilization reports (standard categories of benefits, reported consistently)
    • Risk adjustment (claims coded and categorized appropriately for service condition)
    • Product design (track benefit trends and costs)

“We are excited about launching CodySoft’s Plan Benefit Package (PBP) Module® because we feel it will be a more cost-effective and better designed solution as compared to the limited number of other products in the marketplace,” said Mabari. “There is nothing in the marketplace today that manages all the different data structures and provides it in a universal format. This is truly revolutionary!”

To learn more about CodySoft’s Plan Benefit Package (PBP) Module®, please contact us today.

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