Benefits Coverage Manager

Overview

Health plans often configure, review, and manage complex benefit plans in MS Excel and Word which introduces inefficiencies in the process of creating, reviewing, and approving these plans in a timely manner.

These inefficiencies can lead to delays in bringing plans to market, filing plans with the appropriate state and federal entities, and can impact sales and enrollment activities, all of which may require additional manual efforts to meet these time sensitive milestones in the plan's life-cycle.

Benefits Coverage Manager (BCM) streamlines and helps build efficiencies for administrators and consumers of individual and group plan data by providing a central source of truth for benefit managers to create, manage, and review plan designs.

BCM organizes the data into a centralized platform, making it consumable by other systems and enabling health plans to distribute coverage information quickly and effectively while supporting vital downstream activities such as:

• Plan sales and member enrollment
• Federally required document generation and distribution
• Financial forecasting and analysis
• Claim pricing and payment

Key Features & Functionality

• Create and edit Medical, Pharmacy, Dental, and Vision plan designs
• Create copies of plans Create Custom Plans from existing plans
• Associate multiple plans within a Bundle
• Create and manage list of Plan Services
• Create and manage Plan Cost Share min/max values
• Create up to 10 copies of a single plan
• Update Plan Details across multiple plan
• Track Versions of Plans and Restore Plan Details from previous versions
• Generate CMS Compliant Coverage Scenarios with Appian RPA

Benefits & Business Impact

• Mitigates manual maintenance and versioning of Insurance Plan Designs
• Enables the definition of organizational standards for plan design attributes to ensure compliance with State and Federal guidelines
• Expedites speed to market for health plans and enables customization of plans to differentiate coverage for health plan members