Discover how Healthcare Payers, TPAs, and ASOs can leverage leading-edge technology to streamline day-to-day business operations

Commercial Benefit Plan Management

A single source of truth to store and customize commercial benefit plans and auto-generate documents and processes right from quotes to claims processing.
Explore eBenefitSync™

Medicare Advantage Plan Management

Industry’s first CMS PBP integrated Medicare Advantage solution to auto-generate CMS PBP outputs, ANOC/EOC, and SB documents and simplify competitive analysis.
Explore eMedicareSync™

Medicaid Plan Management

End-to-end platform to manage plan data, documents, system integration, and data interoperability for Medicaid Managed Care and Medicaid Fee-for-Service plans.
Explore eMedicaidSync™

Individual and SHOP QHP Plan Management

Solution designed to automate varied needs of Individual and Small Group ACA compliant benefit plans from automating workflows to auto-generating documents.
Explore eACASync™

Group Lifecycle Management

Manage group information setup, including ASO setup, ASO fees, performance guarantees, group setup, membership, broker information, PBMs, and vendors using automated group lifecycle management solution.
Explore eGroupEnroll™

Benefits Content Streaming

Leverage a cutting-edge solution to accelerate benefits content generation and streaming across the enterprise.
Explore eContentStream™

Our Success Stories

Leading health plans rely on Simplify Healthcare to work smarter, faster, and optimize operational efficiency. Read our success stories and learn how we have enabled higher client satisfaction.

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A Large Health Payer in the Northeast Leveraged eMedicareSync™ Value Assurance Package to Timely and Cost-Effectively Create Compliant ANOCs/EOCs and SBs

Read this case study by Simplify Healthcare to learn how a large Health Payer in the Northeast leveraged eMedicareSync™ Value Assurance Package to timely and cost-effectively generate compliant ANOCs/EOCs and SBs.

Elbow-to-elbow support for end-to-end document generation

Zero Compliance Issues

Generated fully compliant ANOC/EOC and SB documents
Cost-Effective Solution

Budget-friendly solution for document generation
100% Accurate Documents

Built documents with zero errors
Peace of Mind

No last-minute rush or long and stressful working hours
 

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A Large Payer Improved SBC Generation Timelines by up to 50% with eBenefitSync™

A large Healthcare Payer on the East Coast with more than half a million members and a very high growth rate was challenged with an outdated tool and inefficient SBC generation process. The Payer creates more than 7,000 SBCs every year. It was looking for a solution that could accurately auto-generate SBCs and integrate SBCs to the central data repository.

Automate SBC Generation and Integration to Central Repository

Automated SBC Generation

Reduced the time required to generate SBCs by up to 50%.
Improved Compliance

Enabled the downstream of compliant documents to targeted systems
Streamlined Workflows

Created a robust and efficient workflow that boosted productivity and efficiency.
Automated Exporting of SBCs

Enabled transfer of SBCs to the client’s central data repository in a few clicks.

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A Large Health Plan Automated its State Filings and Benefit Plan Configuration With eBenefitSync™

A large health plan in the Northeast, providing small and large group coverage and serving more than a million members, needed a solution that could ensure all its benefit information from thousands of plans was up-to-date, reusable, and available enterprise-wide. It also needed to expedite the benefit plan development process and compliance by automating state submissions, a regulatory mandate.

Automate State Filings and Benefit Plan Configuration

Access to a Single Source of Truth

Eliminated 95% of data redundancy and minimized errors
Reduced Operational Costs

Achieved the ability to seamlessly suspend and reinstate products and plan packages in real-time
Automated State Filings

Automation of state filings process by generating necessary documents accurately in a few clicks
Improved Member Satisfaction

Improvement in member service through better manpower allocation resulting from efficient processes

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A large Payer became the first to publish plans on the MA marketplace using eMedicareSync™

A large Payer was struggling with their Medicare Advantage (MA) plan management. They were unable to integrate data from multiple sources into a single integrated system to get a 360-degree view of information and drive accurate and efficient data and processes. They were looking for ways to eliminate manual legacy processes, automate MA product/plan configuration and document generation processes, improve the quality of care and patient engagement, consolidate data, and accelerate speed to market.

Accelerate speed to market with a single source of truth for MA plan configuration

Faster speed to market

Improved speed to market to successfully become the first company to publish plans on the Medicare Advantage marketplace.
Improved quality of care

Enabled integrated data operability for data-driven and collaborative MA product management and care management.
Access to single source of truth

Leveraged a single source of truth to automate CMS PBP bid submissions, auto-generate documents, and elevate productivity.
Optimize Medicare Star ratings

Helped manage last-minute CMS changes, decrease submission errors, lower admin costs, and risk of penalties to optimize CMS Star ratings.

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A leading Payer reduced quotes to claims configuration processing timelines by 50% with eBenefitSync™

A leading health plan on the East Coast was challenged due to disparate legacy systems and manual processes across the account operations unit. Their complicated quotes to claims configuration processes were slow and prone to errors and took an average of 23-37 calendar days for varying complexity plans. They were looking for an end-to-end benefit plan management solution to redesign and streamline the operational processes, reduce the number of manual steps, save time from quotes to claims processing, and get groups into production.

Reduce quotes to claims configuration processing timelines by 50%

Shorter processing time

Helped in achieving zero claims processing errors with shorter processing time and fast turnaround of the products.
Performance Optimization

Helped in reducing the quotes to claims configuration processing time to 10 calendar days from an average 23-37 days.
Improved product setup time

57% reduction in the average product setup and 64% time saved in the end-to-end group setup time.
Savings in non-claims activities

57% savings in non-claims activities which helped in reducing time and cost and achieve operational excellence.

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A large Payer reduced its benefit product build timelines by 80% using eBenefitSync™

A large health plan on the East Coast with more than half a million members and a very high growth rate was challenged with manual, outdated, and error-prone benefit product configuration processes. It was an ongoing challenge for the health plan to streamline enrollment period activities and other benefit plan management processes without any last minute back and forth. To improve the benefit plan management processes, they set a goal of reducing their product build timelines to 7 calendar days.

Reduce benefit product build timelines by 80%

Faster product build timelines

80% reduction in the benefit product build timelines using a single source of truth.
Faster optimized processes

The benefit plan management processes reduced from an average of 18 calendar days to 3.5 calendar days.
Reduced claims recoveries

Reduction in the errors impacting the claims management processes with faster turnaround time.
Simplify plan management

Faster optimization and automated processes to deal with high volumes of new groups and renewals.

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A consortium of large Payers improved speed to market by 70% and reduces data redundancy by 90%

A consortium of large health plans was challenged by benefit plan data proliferation across their IT ecosystem. Their end-to-end benefit plan lifecycle was error-prone with disconnected manual processes involving a series of bandaid solutions. Additionally, the consortium had large health plans with conflicting priorities, which prevented a “one size fits all solution.”

Create a single source of truth for benefit plans and improve speed to market by 70%

Faster speed to market

Improved speed to market by up to 70% by reducing the renewal process time from 28 hours to 4 hours.
Improved data quality and consistency

Reduced data redundancy by up to 90% and improved data accuracy and consistency by up to 80%.
Improved processes and efficiency

Reduced benefit errors by up to 70% and improved process efficiency by up to 67%.
Improved member satisfaction

Significant improvement in member Provider satisfaction.

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A large TPA consolidated over 250 pages of Group and plan data and automated documents

A large TPA was struggling with a tedious manual process for onboarding new groups and renewing them. Their process involved capturing benefit plan and new group onboarding data across 20+ disjoint documents with 250+ pages each. In addition to this, the SBC, Benefit Matrix, Faxback, and SPDs were generated manually.

Automate onboarding and renewals and improve customer service quality by 70%

Faster speed to market

80% improvement in speed to market with data consolidated in a single source of truth.
Faster turnaround time

Automated document generation provided a fast turnaround time to TPA client change requests.
Robust workflow process

A robust workflow process ensured all the stakeholders were informed and data was well organized and loaded by TPA.
Simplify document management

Auto-generation of key collateral materials and accurate management of benefit plan and new group onboarding data.

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A midsize Payer integrates Core-Admin systems with a single source of truth to reduce data redundancy by 98%

A mid-size health plan wanted to optimize the benefit plan implementation on the Core-Admin platforms. The following were their key pain points:

  • Significant data redundancy which prevented them from effectively testing and troubleshooting
  • Integration with Salesforce – a lot of the front-end information was captured in the CRM tool that had to be re-keyed
  • SBCs, QHPs, and other document generation – the manual processes were time-consuming and error-prone

Integrate with Core-Admin systems and improve data reusability by 98%

Faster Core-Admin integration

Faster Core-Admin platform benefit product build in less than 4.5 calendar days using a single source of truth.
Improved quality scores

Improved quality scores by up to 95.7% across all touchpoints using automated benefit plan management solution.
Faster Implementation

Reduction in average renewal time per product to 13 mins and new group implementation time to 3 hours.
Increase in data reusability

Improved data consistency within the Core-Admin system and data reusability by up to 98%.

Listen to Our Customers

''Working on a few benefits product development and enhancement projects, I had the opportunity and pleasure of working with Simplify Healthcare. I found the team very enterprising, innovative, and committed, with the way they executed their responsibilities, overcame challenges, explored solutions, and solved problems.''
— Benefits Implementation Manager
''What I appreciate about Simplify Healthcare is that they anticipate what will be needed to complete the entire project end-to-end, which minimizes late project life cycle budget increases.''
— Benefits Testing Manager
''They help teams to do their jobs better and faster by dummy-proofing various aspects of the product build. eBenefitSync™ enables and encourages consistent product builds, but allows for group-specific benefit requests.''
— Former Health Plan CIO