Posts Tagged: health plansWhat Sets CODY Apart from Other Consulting Firms
Health plans have many options when searching for a consulting partner to help streamline operations and/or outsource key business functions – and not all of them are created equally. There are certain traits to look for when hiring a great consulting partner and many will check most or all of these boxes.
So, what sets CODY apart from others in the field? Read more »
Posts Tagged: health plans6 Traits of a Great Consulting Partner
In the world of Medicare and Medicaid, choosing a consulting partner to help streamline your health plan’s operations can be tricky. While a company or individual may be well-versed in best practices for project management or operational efficiency, they may not understand the unique requirements of the payer market – making them less than effective at addressing your needs.
With that in mind, below are six traits to look for when choosing a consulting partner to work with your health plan: Read more »
Posts Tagged: health plansCodySoft® Adds Part C and Part D Reporting Feature
CodySoft® has added a new feature to its Investigations Module®, making it easier for health plans to pull their Part C and Part D reports on plan oversight of agents.
Even though the Centers for Medicare & Medicaid Services (CMS) no longer requires this report in the annual Part C and D reports, health plans cannot afford to be lax in their reporting and monitoring of the sales force and marketing activities. The regional CMS office can require health plans to submit this report at any time.
Posts Tagged: health plansThe Secret to Simplifying Health Plans’ Member Marketing Material Translations: A Parallel Project Path
We’ve seen first-hand the frustrations health plan project managers experience in translating their member marketing materials – including Annual Notice of Coverage (ANOC), Evidence of Coverage (EOC), Drug Formulary and Summary of Benefits (SB) – to additional languages.
The question for our CodyPrint® team became: What would give project managers visibility to the translation process, minimize the production timeline, and eliminate the iterative processes that increase the opportunity for errors in these materials?
The answer was a parallel project path for creating both the English and Spanish versions of these materials in lockstep. Rather than the conventional model where the health plan gives a translation company an English document to translate, the translation company does its work and then sends the translated document back, we developed a different methodology to create and revise English and Spanish documents in parallel.
Posts Tagged: health plansIndustry Alert: Is Your Health Plan the Target of CMS’s New Audit Focus?
Vikki Ahern, CMS Director for Medicare Part C/D Oversight and Enforcement Group (MOEG), spoke at this week’s 2017 HCCA Managed Care Compliance Conference. It served as a wake-up call for compliance professionals in attendance.
Although an explanation of CMS’s reasoning was not provided, Vicki Ahern stated that CMS will specifically target small parent plans for 2017 program audits. CMS will begin sending plan sponsor program audit notices on February 21, with audit start dates in April.
Posts Tagged: health plansHow Accurate ANOCs and EOCs can Help Health Plans Retain Members
The Henry J. Kaiser Family Foundation recently published an Issue Brief on its website titled “Medicare Advantage Plan Switching: Exception or Norm?” The brief shared that 11 percent of Medicare Advantage plan enrollees in 2013 voluntarily switched to another plan in 2014. It also addressed various factors that impacted switches to other plans, such as the members’ age, rate increases and coverage changes.
In addition, research showed Medicare Advantage enrollees who voluntarily switched plans were disproportionately in plans with lower quality ratings. Between 2013 and 2014, 14 percent of enrollees in plans with 2 or 2.5 star quality ratings switched plans, while only 3 percent of enrollees in 5 star plans switched. The article states, “These findings suggest that factors related to the star ratings may cause some beneficiaries to switch plans.”
Posts Tagged: health plans3 Predictions in the Wake of Recent Health Plan Mergers
In case you missed it, Aetna and Anthem recently signed deals to merge with health insurance giants Humana and CIGNA, respectively. These mergers have created quite a stir in the insurance market, with many experts left questioning what this will mean for the managed care and commercial market in the years to come.
Posts Tagged: health plansMA and Part D Plans: Jumpstart Your CY2016 ANOC and EOC Documents Creation
In late January, CMS released the “CY 2016 PBP/SB Software List of Changes and Known Issues,” which includes a summary of the changes to the Plan Benefit Package (PBP) software that Medicare Advantage and Part D plans will use to upload their 2016 AEP materials bid submissions to CMS later this year.