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Streamline Medicaid Plan Operations with Smart Automation

Purpose-built for Medicaid Product Configuration, code set management, and document generation
Accelerate Medicaid plan setup with AI-powered configuration, real-time validation, and automated document generation—on a unified platform.
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Innovate and Scale with a Modular Platform

Connecting State-Specific Requirements, Product Configuration, and Document Generation
Built for Agility. Designed for Compliance. Scaled for Medicaid.

Enterprise Product Catalog

A Centralized, State-Specific Foundation

Configure and manage Medicaid Fee-for-Service (MFFS) and Medicaid Managed Care (MMC) plans across states with a modular, AI-powered product catalog—built for compliance, reuse, and rapid deployment.

  • State-Specific Plan Standardization
    Standardize and validate Medicaid plan structures across different states using configurable templates aligning with state specific requirements.
  • Unified Repository for MFFS and MMC Plans
    Consolidate all plan data into a governed catalog—eliminating fragmented spreadsheets and ensuring consistency across updates and filings.
  • Automate Actuarial File Uploads and Report Generation
    Sync actuarial changes with product data to avoid duplicate data entry. Generate reports near real-time with updated product data and send to downstream systems and users.

Automate Document Generation and Translation

Meet State Regulations with Speed and Accuracy
  • State-Compliant Medicaid Document Generation
    Auto-create member handbooks, benefit booklets, provider directories, welcome packets, and rights notices—ready for delivery in state-approved formats.
  • Built-In Language Translation
    Comply with state-mandated language access requirements through integrated translation workflows for threshold and alternate languages.
  • Version Control and Audit Trails
    Maintain a complete, traceable history of document versions, approvals, and submissions to ensure compliance and audit readiness.

Real-Time Insights and Readiness Tracking

Stay on Top of State-Specific Medicaid Deadlines and Plan Milestones
  • Compliance Dashboard
    Monitor plan configuration progress, document generation, and filing readiness across MFFS and MMC programs—at both state and plan levels.
  • Medicaid Calendar Tracking
    Visualize state-specific timelines, submission windows, and required milestones—customized per state contracts and renewals.
  • Exception Management
    Identify gaps, missing validations, or conflicts early—reducing rework and ensuring timely response to state feedback.
  • Audit Logs and Version History
    Maintain a full trail of approvals, configuration changes, and document iterations to simplify audit preparation and internal reviews.

End-to-End Integrations

Built to Work with Medicaid Ecosystems Across States
  • State Medicaid System Integration
    Seamlessly exchange plan and document data with state portals and Medicaid Management Information Systems (MMIS) via secure formats and protocols.
  • Upstream and Downstream System Connectivity
    Integrate with actuarial tools, provider systems, and internal operations platforms to eliminate duplicate data entry and manual coordination.
  • Member Communication Channels
    Push approved content—such as handbooks, notices, and directories—into member portals, contact centers, and mailing vendors.
  • Flexible Data Exchange
    Support batch uploads, secure FTP, APIs, and event-based messaging to adapt to the varying tech maturity of state systems and partners.

AI-Powered Sales Enablement

Equip Teams with Accurate, State-Compliant Materials for Enrollment and Education
  • Tailored Plan Collateral
    Auto-generate Medicaid-compliant handbooks, benefit booklets, provider directories, and enrollment kits aligned to MFFS and MMC program requirements.
  • Support for Member Outreach and Broker Tools
    Deliver accurate plan content through broker portals, outreach campaigns, and state-specific communication workflows.
  • CRM and Eligibility System Integration
    Sync plan configurations and approved content with sales, CRM, and eligibility systems to reduce manual data handling and ensure consistency.
  • Usage Analytics and Optimization
    Track material usage, member engagement, and outreach effectiveness to improve campaign performance and compliance tracking.

Compelling Business Case. Proven Value.
ROI in Year One. Platform Advantage.

Benefits1™ is purpose-built to simplify multi-state Medicaid plan operations, improve accuracy, and deliver measurable outcomes across stakeholders.

Product Teams

  • Standardize plan design across states with flexible templates
  • Reduce duplication and manual errors in configuration
  • Improve plan turnaround with centralized updates
  • 40% reduction  in configuration and validation efforts

Compliance and Regulatory Teams

  • Ensure audit-ready documentation with version tracking
  • Eliminate last-minute rework during state submission windows
  • Reduce risk of non-compliance and state penalties
  • 70% reduction  in document-related errors and rejections

Member Communications and Outreach

  • Deliver accurate, translated member materials on time
  • Support multiple state-specific formats from a unified system
  • Improve member engagement and satisfaction
  • 50% faster delivery  of handbooks, directories, and notices

Operations

  • Streamline handoffs between actuarial, compliance, and product teams
  • Gain visibility across plan setup, document generation, and submissions
  • Reduce silos and unnecessary back-and-forth
  • 5x faster  time-to-launch for new plan versions

IT and Integration

  • Scale across states with a low-code, integration-ready platform
  • Minimize dependency on legacy systems and manual scripts
  • Support real-time data exchange with MMIS and eligibility systems
  • Millions of transactions processed securely and efficiently

Empower Benefits1™ with BNi (Ben-ny)
– Your AI Assistant for Smarter Plan Management

Meet BNi (Benefits1™ Native Intelligence)—an embedded AI assistant that enhances plan management through automation, insights, and context-aware guidance.
Tick Conversational AI Interface
Navigate plan configurations using intuitive, natural language commands.
Tick Document Intelligence
Search, compare, and summarize ANOCs, EOCs, SBCs, and other plan materials.
Tick Annual Readiness Monitoring
Track AEP milestones with real-time alerts to avoid delays and missed deadlines.
Tick Context-Aware Guidance
Surface plan-specific recommendations grounded in live configuration data.
Tick Proactive Design and Filing Insights
Receive strategic input on benefits design, actuarial data imports, and filing accuracy.
Tick Adoption Intelligence
Track feature usage, optimize workflows, and drive long-term platform value.
Experience a smarter way to manage benefits with BNi (Ben-ny). Read the Press Release

Leading Health Plans Are Already Transforming Medicaid Plan Operations with the Platform Advantage

Across the country, Medicaid health plans are accelerating filings, improving compliance, and scaling with confidence—powered by automation, AI, and a smarter approach to managing Medicaid Fee-for-Service (MFFS) and Medicaid Managed Care (MMC) programs.
See What’s Possible

Leading Health Plans Are Already Transforming Medicaid Plan Operations with the Platform Advantage

Across the country, Medicaid health plans are accelerating filings, improving compliance, and scaling with confidence—powered by automation, AI, and a smarter approach to managing Medicaid Fee-for-Service (MFFS) and Medicaid Managed Care (MMC) programs.
See What’s Possible

Trusted at Scale

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Recognized for Market Leadership

Simplify Healthcare is positioned in the Leaders Category of the 2023 IDC MarketScape for U.S. Health Plan Product/Plan Benefit Configuration Solutions.

Read the full IDC report
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Ready to Modernize Your Group Benefits Strategy?

Learn how leading payers are gaining a competitive edge by automating group benefits at scale—powered by AI, clean data, and modular workflows.

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Change What’s Possible in Medicaid Plan Management

65+ health plans didn’t wait for the future—they built it. With Simplify Healthcare, they moved faster, stayed compliant, and scaled their Medicaid operations with confidence.
Now it’s your move.
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Experience the Power of a Connected Ecosystem

Benefits1™ is just the beginning. Seamlessly integrate with Simplify Healthcare’s full suite of intelligent solutions—spanning product, provider, claims, benefits inquiry, and custom app development—to ensure accuracy, efficiency, and compliance at every stage of the
benefits lifecycle.

Simplify Provider Lifecycle

Streamline network adequacy, contracting, credentialing, roster files, data management, and claims config with an advanced, modular solution that delivers efficiency and effectiveness.

Explore Provider1™ →

Simplify Claims Configuration

Configure benefits and provider data directly into claims systems like TriZetto® Facets® and QNXT™ using intelligent automation.

Explore Claims1™ →

Simplify Benefits Inquiry Experience

Deliver accurate, consistent benefits information across all channels—powered by AI-enhanced guidance that improves member experience and boosts NPS.

Explore Xperience1™→

Simplify Document Management

Auto-generate 150+ mandated and marketing documents with built-in 508-compliance, translations, and integrated print fulfillment.

Explore Simplify Docs™ →

Simplify Custom App Development

Design and deploy custom apps faster with embedded AI and low-code development—tailored to your organization’s unique needs.

Explore SimplifyX™ →

We don’t just deliver software—we work alongside your teams to guide implementations, simplify adoption, and ensure sustained success.

Explore HealthConsult

Frequently Asked Questions (FAQs)

What our customers ask most about Benefits1™.Group

How does Benefits1™.Medicaid support plan standardization?

Our AI-powered platform helps standardize MFFS and MMC plan designs across states, reducing retesting and manual variations. It creates a centralized product catalog with validated structures aligned to each state’s requirements.

Can it centralize all Medicaid plans in one place?

Yes. It consolidates MFFS and MMC benefit packages into a single governed catalog—eliminating the need for spreadsheets and reducing duplication across regions.

Does it automate document generation?

Yes. Benefits1™.Medicaid generates compliant handbooks, provider directories, welcome packets, and other member communications. Built-in workflows enforce document versioning and approval processes.

Is the platform integration-ready?

Absolutely. It supports ETL, APIs, and event-based integration with MMIS, state portals, eligibility platforms, and internal systems like CRM and provider management.

Can it generate documents before plans are finalized?

Yes. The platform supports early-stage document generation using pre-approved content, enabling timely delivery of welcome packets and member handbooks—even while final validation is in progress.

How does BNi help with compliance and visibility?

BNi (Benefits Native Intelligence) provides real-time tracking of milestones, alerts for readiness gaps, and AI-powered dashboards to ensure Medicaid compliance and reduce QA effort.

How does it improve coordination across teams?

It eliminates dependency on email chains and spreadsheets by using centralized workflows and dashboards—enhancing collaboration across product, compliance, actuarial, and operations teams.

What outreach and enrollment support features are included?

The platform enables personalized member communications and generates accurate enrollment collateral for MFFS and MMC programs. It integrates with broker and outreach systems for seamless distribution.

Can we track outreach and document delivery performance?

Yes. Built-in analytics let you monitor member engagement, outreach effectiveness, and document access to continuously optimize Medicaid communications.