Blue Cross Blue Shield Automates Medicare Communications to Drive Compliance

Challenge

Managing highly regulated member correspondence using email and spreadsheets created a time consuming, labor-intensive processes which was prone to errors and compliance risk.

Solution

A system to track and process client communication changes to ensure adherence to guidelines, while providing full visibility into what changed, who made the change and who approved the communications.

Outcome

Fully compliant and documented process to properly assign, process, review, approve and produce timely customer communications.

Reducing Errors in Regulated Communications

Each year the Centers for Medicare & Medicaid Services (CMS) releases a vast number of regulatory updates to Medicare programs that health plans must abide by. Once CMS releases their regulatory guidelines, there is a short period of time to review, interpret, organize and execute changes in many of their operational processes such as PBP submissions and the updates to member marketing materials.

Preparing highly regulated member and marketing materials, such as ANOCs, EOCs, SBCs, EOBs, and member correspondence are timeconsuming, labor-intensive and prone to compliance risk. The short time-frame to properly execute puts health plans at risk of not meeting requirements correctly or on-time and that risk comes with a hefty price tag. The cost of non-compliance can be millions of dollars in financial penalties and market restrictions. Health payers must rethink how they execute these updates to achieve compliance and goodwill.

Blue Cross Blue Shield

This Blue Cross Blue Shield (BCBS) company is one of the leading health payers in North America serving over 5.5 million members with over 8,000 employees. The company manages more than 40,000 files year-round and is a front-runner in Medicare Advantage products.

The Challenge

Compliance adherence is a top priority for BCBS’s Medicare Advantage teams. The company manages large scale document reviews - documents that they have no real visibility into - for member materials that are evaluated against strict guidelines. Often managed through manual processes like email and spreadsheets, this BCBS company was at risk of missing compliance requirements and deadlines which can put them at risk for penalties.

The company’s main challenges were

“Blue Relay software allowed for us to easily replace our manual and time consuming document management process with an automated and more efficient technical solution.” - Director of Medicare Operations, Blue Cross Blue Shield

01

Lack of Effective Tools

With disparate tools like email and spreadsheets, there was poor cross-team collaboration and project tracking which resulted in errors, rework and extra costs.

02

No Real-Time Visibility Of Progress, Status and Deadlines

At any moment, it was difficult to get a pulse on what was happening – what tasks were done, what was left to do and where the bottlenecks were. This limited their ability to progress and improve.

03

Unable To Reallocate Resources

In Real-Time To Meet Deadlines Aligning resources to support upcoming work/load balance was hard to manage. Without real-time insights, they could not proactively manage the teams to avoid problems.

04

No Audit Controls For Compliance

Due to the previous issues along with the growth in Medicare Advantage products, the team had little confidence that proper steps and requirements were followed properly, putting them at compliance risk.

The Solution

Indellient created the Blue Relay platform for one purpose; to give organizations with complex business processes, like this BCBS company, the confidence they need to ensure that every Medicare operational process has been properly assigned, processed, reviewed, approved and produced on-time, with regulatory compliance and the ability to prove it.

“In just seconds we could pull a review of what happened and prove everything was okay and up to spec.”

Manager, Program Oversight and Communications, Blue Cross Blue Shield

Blue Relay was used to track all documents, processes and people for some of their programs and it soon became apparent that they were managing more documents than originally thought. The team soon realized what they thought were a couple hundred documents was actually about 2000. Along with providing full visibility into their documents, Blue Relay was deployed across several operational processes including development and member material management teams.

01

Tracks all activities in real-time

02

Tracks who is doing what and when

03

Effectively handles change management between systems and stakeholders

04

Provides quality assurance tools while providing a full audit trail

Results

Blue Relay streamlined the communication review processes for the 330 users that are signed up to date, resulting in significant improvements in efficiency and risk management during review and approval cycles. The company can now respond quicker to new CMS guidelines and tight timelines for critical member communications.

The solution successfully provided:

One Source of Truth
In an instant, the team knows all job statuses, resource availability, bottlenecks and deadlines for all operations.

Work Management
Simplified the daily routine of employees by giving them easy scheduling features, and notifications/alerts that made it easy to accomplish tasks, avoid rework and focus on priorities.

Proactive Resourcing
Ensured team leads could proactively manage employee workloads to meet targets, particularly in peak periods.

Compliance Adherence
Minimized the number of errors made in content development. With the right tools and processes, staff were able to finish tasks correctly the first time.

Quicker Collaboration & Output
Increased efficiency as the platform fostered quicker collaboration and greater information sharing across multiple departments.

Audit Trail
Provided a full audit trail that the team can access at any point to show compliance adherence.

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