Client Results: Achieving Required Documents Compliance and Ensuring Ongoing Accuracy

Developing formal, repeatable processes and procedures led to compliance for a Required Documents Program.

Challenge

The client needed to achieve compliance in the delivery of their Centers for Medicare & Medicaid Services (CMS) required documents for the upcoming plan year. Without compliance, the organization faced financial penalties and member abrasion. They also needed to develop formal, repeatable processes and procedures to ensure ongoing accuracy and compliance.

Solution

During an eight-month engagement, ProspHire drove an organizational assessment and conducted stakeholder interviews to define current state processes and procedures, identify gaps and mitigate risks. They analyzed the existing enterprise and established a formal governance and operating model. ProspHire then developed a formal Required Documents Program and worked with the client to accurately produce and distribute all required documents to members for the upcoming plan year.

Result

With ProspHire’s help, the client achieved compliance in the delivery of all annual required documents, ultimately achieving cost savings and maintaining member satisfaction. The Required Documents Playbook and Program Toolkit that ProspHire created defined all processes and procedures for the program and outlined a foundational operating model to ensure continued accuracy and compliance.

Deliverables

CMS Required Documents compliance
Required Documents Playbook
Program Toolkit
Current state assessment
Foundational operating model

Client Overview

The client is a managed care organization (MCO) that provides health services to members within Pennsylvania. They are one of the largest Medicare programs and the largest D-SNP program in the state.