Tango

QuickTourSBC Building

Application:Tango+ Business Rules & SBC Updates

Tango+& SBCs

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The Setting

Elixir designed certain Tango+ applications especially for health plan organizations.

How did Elixir learn about what it is like to work inside health plan document workflows?

The Elixir Professional Service team has been analyzing document workflows inside some of the largest health plan organizations in North America for several years.

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The Setting

The Crisis

Every year, during theMedicare, Medicaid, and Commercial enrollment periods, plan renewals and updates wereincreasing exponentially. These new documents had to be deliveredquickly, and free from mistakes.

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The Crisis The Elixir team recognized common regulatory and compliance document production challenges for health plan carriers.

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Struggle & Stress

24/7

The Elixir Team witnessed the struggle and stress of health plan payer employees, as they worked through continuousand growing renewal cyclesand heavy enrollment periods.

stressed out employees

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The Challenge

The first Culprit

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Summary of Benefits Coverage template.

Elixir HeathcareWelcome to

Elixir created real-time solutions fordocument workflows by identifying the issues behind the documents. Our number one goal was clear: automating SBC workflows.

The Size of the ProblemThe passage of the Affordable Care Act brought with it the dawn of the SBC.

SBCs are complex documents regulated to communicate variable combinations of plan benefit information to consumers.

Health plan carriers are required to update SBCs for every plan variation they offer. They must have current SBCs for all their plans.

Plan carriers are also responsible for delivering any SBC within seven days of its being requested.

SBC updates must be done fast for any and all changes in membership status, including annual and periodic renewals, and new enrollments.

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The Cost of Compliance Health plan carriers are responsible for implementing all regulatory and compliance changes for their SBCs (as de-creed by overseeing authorities) with little notice.

Plan carriers must also deliver updated SBCs to any member who is affected by an update or change to one of their plan benefits.

The cost of compliance can be staggering, especially for large organizations with tens of millions of members.

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The cost of compliance is a burden, but the cost of non-compliance can quickly become untenable.

The Cost of FailureThe Affordable Care Act clearly placed compliance responsibility on health plan carriers.

Failure to comply with SBC regulations can result in monetary fines, and other penalties.

The amount of a compliance viola-tion fine varies is usually multiplied by a factor of the total number of members and/or plan versions that include, or do not include, the con-tent in question.

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The cost of compliance is a burden.

The cost of non-compliance can quickly become untenable.

Existing MethodologyMany SBC workflows depend on third-party vendors, especially during enrollment and renewal periods.

This approach put health plans at the mercy of vendors to prioritize SBC work and deliver SBCs in compliance with regulating authority deadlines.

Some health plan carriers opted to produce their own SBCs. They placed the SBC burden onto established workflows and, in turn, onto the heads of existing employees, who had to deliver the documents fast and error-free.

These organizations were quickly overburdened during enrollment and plan renewal periods.

The manual processes health plan provider workflows depend on for SBC production involve tedious updates to individual xml spreadsheets, for each plan they offer.

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Elixir knew there was a better way to do SBCs. We knew that workflow automation was the answer.

The automation of SBC processes had to be easy for business users to learn and do.

SBC updates and plan changes meant that Elixir’s solution had to be dextrous enough to apply one just one change to a single field, one time; and also capable of sweeping changes across the board.

Tango+ applications had to provide both surgical functionality, for mi-cro-granular results, and the capaci-ty to change course in real-time. Tango+ had to be plastic, never rigid, easy to use, and highly adapt-able.

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Want to experience the power of Tango+?Click here to see more and get in touch.

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Problem SolvedTango+ is agile and scalable. Tango+ customapplications are keys that unlock and focus the raw power of its core.

SBC ApplicationsElixir development teams exploited the SaaS architecture of Tango+ to design integrated, configurable applications for building custom-ized templates. Tango+ applications embrace singularly complex challenges, like automating SBC templates and updates.

The complexity users encounter applying updates and changes with variable data and content is a challenge that Tango+ applications are designed to meet head-on.

Meanwhile, business users experi-ence simple, intuitive interactions with Tango+, like clicking, and dragging & dropping content or business rules into preconfigured hotspots.

Tango+ ease of use and powerful core services facilitate workflow automation. Users can quickly apply changes to a single field, or even create rules to effect changes across multiple outputs.

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