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(00:15) Ramesh Padri

Hey. Good morning, everyone.

First of all, thanks for taking the time to join our session today. Welcome to this special session from Simplify Healthcare.

I’m Ramesh Padri, Vice President of Product Delivery, based out of Chicago. I was in Minneapolis before I thought I will move somewhere warmer down south, and this is where I landed, Chicago.

And I have the pleasure of moderating today’s discussion.

We are here to talk about what it takes to support seven-plus years of consistent CMS PBP submissions by Benefits1™—which is Simplify Healthcare’s flagship platform—making it possible to submit 30% of all Medicare Advantage Plans nationwide.

As many of you know firsthand, PBP submission is not just a regulatory requirement. So, it is a high-stakes, time-sensitive, and detail-intensive process. Year after year, payers go through this. Some of the daunting challenges—you can give a thumbs up if you agree to any of these challenges—as a payer who goes through it is data inconsistencies across teams. Each team has different data for the same benefit. And sometimes, the payers go through manual spreadsheets that are highly error-prone.

And CMS is not helping either. They keep on changing their rules and regulations year over year, and that requires constant adaptation. And, most of the payers are bogged down with tight timelines—and we have seen with our own eyes how payers struggle with the timelines—and there is zero error tolerance from CMS.

And if the PBP submissions go wrong, the impact really turns costly. It could be your rejected submissions, compliance risks that could ripple through to your materials team (like your ANOC and EOCs), and sometimes it impacts your Star Ratings and even member experience in some cases.

That’s why the conversation we are having today is so important to get the PBP submissions right. This is where the Benefits1™ platform from Simplify Healthcare plays a crucial part, designed specifically for end-to-end benefit configuration and CMS bid submission.

I know some of the people in the audience are new to Benefits1™. To give a gist of what Benefits1™ is, it streamlines the full cycle of benefit management, right from benefit design, configuration, validation, and all the way through your successful PBP submission.

Not only that, it also enables building materials like your typical ANOCs, EOCs, and SBs. And it also integrates with your upstream systems, right, like your actuaries or formularies, and also to your downstream systems with your marketing portals and materials production.

So it’s kind of an end-to-end platform streamlining the benefits. Over the past seven years, the Benefits1™ platform has supported over 30% of all PBP submissions nationally, helping health plans reduce rework, ensure compliance, and scale with confidence, based on their submissions.

Today, our panelists will share how this platform has delivered results year after year, the challenges they’ve overcome in their journey, and what innovations lie ahead. I’m joined by three such leaders who have spent over seven years at Simplify Healthcare helping payers with the PBP bid submissions.

We will start with Tasneem Chital, Vice President of Product. Maybe Tasneem, if you want to introduce yourself.

(04:03) Tasneem Chital

Yep. Thank you, Ramesh.

Hi, everyone. I’m Tasneem Chital, Vice President of Product, on the government markets and Simplify Docs™. And, I have been fortunate to be here for close to a decade now with Simplify Healthcare. So, seeing the journey of the product development, right from the time, back in the days of submitting PBPs to the desktop application, and more current now to submitting the same PBPs to the web application. I am very excited and feel privileged to be a part of this panel with some of my colleagues who have been on the same journey with me.

(04:38) Ramesh Padri

Yeah. Thanks, Tasneem.

We have Rose Rasegan, Director of Product Delivery. Rose, if you want to introduce yourself, please.

(04:45) Rose Rasegan

Yes. Thank you. Hello, everyone. Rose Rasegan here.

I’ve been with the organization here at Simplify Healthcare for over seven years, and I have worked with every single one of our Medicare clients at some point for their implementation and/or production support, as well as working with any new clients that may be coming aboard. So, I’ve seen the complete journey and I’ve supported our clients throughout the years.

Thank you.

(05:11) Ramesh Padri

We have Kaustub Borole, Senior Product Manager. Kaustub, do you want to introduce yourself, please? 

(05:18) Kaustubh Borole

Sure. Hi, everyone. This is Kaustub Borole. I’m a Senior Product Manager here at Simplify Healthcare. I’ve been here for six plus years. And all these years, mainly, I’ve worked on the Benefits1™ product, and with our customers to support in their bid submission process. 

(05:36) Ramesh Padri

Thanks, Kaustubh.

Let’s dive right into our questions, but there is a Q&A session right at the end. You have the opportunity to ask any questions. And if you want to start typing your questions in the chat, you are welcome to do so.

Well, Tasneem, I’ll start with you.

The focus of the conversation with you is more around the strategic product foundation. Let’s start with you on the big picture. 30% of PBP submissions nationally is not an easy feat, and we all know that. What product features and capabilities in Benefits1™ is making this huge milestone possible? What did we do right, or what did we do differently?

(06:17) Tasneem Chital

So, you know, thank you, Ramesh.

Alright. So, if I trace back the journey, right, for the last seven, eight years, when we were kind of evaluating the pain points that healthcare payers are going through, what we found that typical workflow to be is they are working with their actuaries where they’re handed off Excel files embedded with macros and stuff like that. They’re using those to key in the benefits in the PBP software. Then some are working separately with their pharmacy teams for prescription-related data. They key that in separately in the PBP software. Some of them have these vendor files for supplemental information, largely dental, vision, hearing, and in some cases, some additional benefits.

So you can imagine there is this multiple Excel files. All of these changes are iteratively coming across to them in multiple versions. So, managing them, making sure that they are not making an error, was a manual, time-consuming, and error-prone approach.

We also found that it’s not just submitting to PBP is not the end. What they also had to do then with that data is they had to create Excel files from it in various formats, you know, that was suited to their downstream users. So, the mandated materials team got one format. The core admin team got another. The portals team got a third.

And see, some of them did have tech teams, but there were a lot of back-and-forth requirements, SQL procedures. Because, as we know, CMS makes considerable changes every year to their software, to the benefits and such. So keeping up with all of those changes was a pretty big task.

So when we were designing and thinking through Benefits1™, we wanted to make sure that it’s not just creating a digital source of truth and optimizing the way you’re managing your benefit information, but also typically addressing this whole end-to-end life cycle. All the way for upstream, all the way through downstream. Whether you have actual files or need all of these bulk update capabilities, advanced reporting capabilities, or integration to downstream systems, it was just making sure all of these capabilities were packaged in one.

Now, coming to your question, how do we keep up with CMS, managing such a large volume of data from the application? 

I would say that there are three large platform-related core capabilities.

I think number one is that the platform has a dynamic data structure. What we mean by that is that the design studio—product designing piece—is completely business user configurable. So, we have benefits business analysts who analyze all of HPMS changes, and they are the ones who are configuring these design changes directly in the application. So we have no tech intervention to create our design.

And what the system does is it automatically whips up the user interface, it creates the reporting database at the back end, and the API endpoints. Which is why we can turn around these changes and keep up with the CMS changes that quickly.

So, our reports are ready. Of course, our user interfaces is ready much in advance. If there are integrations—we support both upstream and downstream—all of that we are able to take care of pretty quickly.

Additionally, it’s a modular application. So, if your needs are genuinely creating a source of truth with all of these bulk update capabilities, you can go with that. If you want to plug and play with any of our other capabilities, you want to customize it to suit your workflows; all of that flexibility is within the platform itself.

And lastly, it’s a fully scalable product. There’s a large volume of data that is managed across our applications every single year, every single bid season. The number of syncs we do, cascades we run, and integrations that we facilitate. So, all of these features combined facilitate this large volume of data and keep up with CMS regulations every year.

(10:21) Ramesh Padri

Yeah. That’s quite impressive, Tasneem. This proves that a strong foundation leads to consistent results. No doubt about it, and thanks for that response.

My next question is around the regulatory cycles with CMS. We all agree that regulatory cycles are growing more complex year over year, and it is not easy to manage ever-changing regulations from CMS. How do you enable future proofing with the platform while still meeting the immediate needs of filing teams?

(10:55) Tasneem Chital

Right. So, from keeping up and meeting the needs of the filing team, I think one thing I will say is that, you know, we do have a team that is industry experts as well as product SMEs. And, you know, the team is very well versed with the way the PBP application is laid out. They are very quick to analyze and incorporate all of the changes in that.

Additionally, what we also do is we make sure that all of the communication that is there is very tightly managed. So, we are communicating very openly and transparently with all our clients—these are the changes and release schedules that are coming up.

And we have a very, very, close association with both CMS as well as with the clients. Because sometimes there are changes that CMS makes on the fly, so we’ve got to make sure that that partnership with them is also pretty much established.

And then we have a feedback loop from a product perspective that we have established with our clients. We have user groups where we sync up with them and we are closely listening to every feedback that they are giving to us. And we make sure that that feeds back into the product backlog, and they do have whatever capability they would need to be successful in the next filing season itself.

Of course, if there’s a CMS change that needs us to develop and design a capability, that is also pretty much done. And, of course, the dynamic modular nature of the platform enables us to turn this around pretty quickly as well.

(12:22) Ramesh Padri

Okay. That’s insightful. These regulations are not a constant pain and are not easy to handle. And turning around these changes pretty quickly, it’s amazing. Thanks for that.

My next question is around the future. Let’s discuss what lies ahead of us. Looking ahead into 2026 and beyond, what product innovations do you believe will reshape how payers approach bid filing over the next few years?

(12:52) Tasneem Chital

Yeah. There’s a lot of interest in AI and what use cases AI can solve in the payer world. Currently, our Benefits1™ platform is already having its own native intelligence assistance—its own AI assistant—which facilitates comparisons, smart querying, and everything across the platform. Now we want to leverage it further to build the plan and benefit designer, wherein we are leveraging AI as well as the CMS data that we already have access to for our insights capability. And to make plan and benefit recommendations in real time to the user as they’re building the plans within Benefits1™.

Then also, there are a number of agentic AI use cases to facilitate certain manual updates and processes that we are seeing that the business user may be doing in the application. You know, smart dashboarding and notifications, as they are kind of working in the application.

And then lastly, there’s also, you know, the use of AI in the integrations that we are kind of looking at. We already have an advanced capability from upstream and downstream integrations in the way our AIs are generating as well. But this is more of seeing how we can make our mappings faster as well, leveraging all of these AI capabilities.

(14:17) Ramesh Padri

Yeah. Lovely. That’s more futuristic. We all agree there is no future without AI. And, getting ready for the future, keeping peers in mind, it’s amazing. Thanks for that.

So, my last question to you is, what is your favorite capability in Benefits1™ for PBP submission? What do you like the most?

(14:37) Tasneem Chital

I know that’s a very difficult one to choose, Ramesh. But, if I do have to make a choice, I think I’ll say HPMS sync. I think for two reasons.

It’s a very appropriate reminder for some of us when the CMS made that big change—when they went from desktop to the web application—it took two to three years, I believe, to actually make that change. We had less than six months to turn that around. And the fact that our team worked hard and they turned that change around, and we actually had a large volume of PBPs and payers actually filing through our application that very year. It’s a very proud moment, honestly. So I feel that for that reason.

And the second is also it’s another reminder of the scale and the volume that our application can handle. As well as the dynamic nature. So, as you know, we are able to sync every year with CMS with all of the changes that they do. And in a couple of minutes, we are able to sync hundreds of plans to HPMS as well. So, because of that, I would say that the HPMS sync is one of my favorite capabilities.

(15:47) Ramesh Padri

Yeah. Nice. That’s very much needed, syncing of it with HPMS. Thanks, Tasneem.

Moving on, Rose, I want to discuss with you on delivery and operations. You have been at the forefront of executing PBP submissions across different years and filing seasons. What does it take operationally to deliver accurate on-time submissions at this scale year after year? What did we do right with the payers?

(16:18) Rose Rasegan

So, from a Simplify Healthcare standpoint, utilizing our Benefits1™ platform, we do a lot of pre-season planning. We look at the volume surges, any edge cases, and we also developed a playbook. And in that playbook, we have the preparation for the next bid cycle. And as Tasneem mentioned, as HPMS releases or CMS releases the changes, our team analyzes those changes. And we also communicate them. But we communicate them in the form of release notes. So our clients can see every single change that’s coming in year over year, and we communicate that out with the release notes, and the schedule in which it’ll be implemented. So when they release those changes, we have the ability to turn them around—say they release in January, usually, we have them incorporated into our tool by January.

So from a client’s perspective, operationally, it always starts out with a simple plan renewal in our tool. Basically, taking all the plan data from the previous year, renewing it to the next. So their focus then is really the changes that are coming in from the HPMS changes as well as any business decisions that are made, if they have growth or that type of, different changes. So, our clients can then begin updating Benefits1™.Medicare as early as they like—meaning we don’t have to wait.

Clients are utilizing Benefits1™.Medicare have access to it at all times, whereas with HPMS, that production window kicks off in April. So, it first starts out with competitive analysis, right, determining what they want to do in the next plain year. Then if they’re going through their bid pricing rounds, they can make those updates within Benefits1™.Medicare as early as possible and utilizing our version management, they can version out each one of those pricing rounds in preparation for the bid submission.

And lastly, they can submit in or they can sync their information from Benefits1™ as many times as they’d like to prior to that first Monday in June bid submission deadline.

(18:26) Ramesh Padri

Yeah. So thanks, Rose. That’s excellent and quite insightful, clearly explaining how the filing works in line with HPMS. Lot of preparation and planning goes behind the scenes to manage payers at different scale.

Thank you so much, Rose.

My next question is around the headwinds we all face with CMS. You constantly face headwinds during the filing seasons, working with many payers. I would like to cover some of the challenges that the Medicare Advantage Plans face during the PBP submission. If you can quote some examples that would be really helpful, what those challenges are, and how Benefits1™ is positioned to solve those challenges.

(19:21) Rose Rasegan

Absolutely. So, when I look at examples from previous years, I have two examples to share.

I’ve had one large client that had basically doubled the number of PBPs they’re going to offer the next plan year. And with our tool, the scalability is easily managed. So, we have not only our bulk update capabilities that help us copy plans over. So, they were easily able to manage that growth within our tool.

Another example would be a client—a large client—that was expanding their membership into different regions, so that growth alone really increased their volume.

Now, in both examples, utilizing our tool made it easy to manage. What I mean by that is they didn’t have to hire additional resources to pick up those additional PBPs and volume of work. It was easily managed within our tool directly, by utilizing our bulk update capabilities, being able to copy the plans over, and starting the work early in our tool in preparation for the bid submission.

(20:35) Ramesh Padri

Yeah. Thanks, Rose. These are good examples, and we can take a deep dive if there are any additional questions from the participants.

And we are able to solve it with no additional resources considering the amount of changes. That looks magical to me, and thanks a lot for that.

My next question is around the PBP submission. Let’s demystify the engine behind the scenes. Can you walk us through a typical PBP submission timeline using Benefits1™ right from kickoff to CMS upload?

This would be helpful for payers who are new to Benefits1™.

So, what are the steps involved?

(21:15) Rose Rasegan

Okay. So let’s talk about it from an implementation standpoint.

So when we engage with a new client, the first thing we want to do is develop the source of truth. So we request the previous year’s JSON files. We have a data migration capability to load all of that information directly into Benefits1™, and we can validate the information by generating a JSON out of our tool and comparing it with the client’s JSON file from HPMS. That’s the validation on all of the plan data is in our tool successfully.

Obviously, with training for client, after that happens, it’s a simple, again, renewal to the next plan year, and then the normal course of business begins. Our clients would be trained on all features within our tool, meaning the things that I’ve already referenced. Version management, our bulk update capabilities, and basically, they can begin work. So, if they have growth, they can copy plans, they can manage their changes year over year, all in preparation for that initial bid.

Then, again, coming back to our tool, they can version out the plans. So when the benchmark changes come in, they simply make those updates in Benefits1™ and again sync them back up into HPMS.

And then lastly, for the final bid, when those final changes are decided, the changes can be done in Benefits1™. And when HPMS opens up that window, they can sync those changes back up to HPMS.

(22:49) Ramesh Padri

Yeah, lovely. And I appreciate the way you explained it in simple terms.

Thanks for the detailed explanation of the process in simple terms, which has worked out consistently for many years. And for some of the payers, who are new to this, if you have more questions, we can definitely use the Q&A session towards the end.

So, Rose, my final question to you, what is your favorite capability and Benefits1™ for PBP submission? What do you like the most?

(23:19) Rose Rasegan

So, one of the features that I think that clients resonate with as well that I like to highlight is version management. So again, it really helps control that bid prep process. So, as you’re coming into the tool, you’re renewing for the next plan year, you start on a version, you can renew the version, baseline it if you will, for say your first pricing round, make your changes. And then when the next pricing round comes, you can version out again. Now the version management allows you capabilities, such as if there are changes that you made in the previous round that maybe leadership has decided we’re no longer going to go forward with, you can roll back to the previous version.

So it reduces the number of, you know, clicks and that type of thing or edits that you have to make to your plans. So the version management really controls those rounds. And then again, as I mentioned, once you submit your initial bid, you version out the plans, and we have our versioning, which allows for a minor version or a major version. So the major version really locks it down.

So the benefit there is that once you do your initial bid, you’ve versioned out to a major version. It is locked down until you create the next minor version, say, for your benchmark changes, and then the process repeats. So it really allows you to control the data within the tool as well.

(24:37) Ramesh Padri

Okay. Yeah.

Thanks, Rose. For all the amazing responses

Kaustub, you have played a key role in defining platform capabilities based on user feedback and real-world complexity. So, my next question to you, Kaustubh, is that most of the peers have a background working with HPMS. For the bid submission, they come with the background of HPMS. If a payer is already working with HPMS, how do they adapt to Benefits1™? What are the advantages of working in Benefits1™? Why should the payer shift to Benefits1™?

(25:10) Kaustubh Borole

Yeah. Sure. And this definitely comes a lot from new users, especially since the past few years, since the new HPMS web version has been launched. Users had to learn that it was a complete restructure of the PBP data as well. So one key thing about benefits one is that it mirrors the HPMS setup. So if any user has seen HPMS or has worked in HPMS, they would have the exact same experience working in Benefits1™ for the data entry. So the transition is extremely smooth.

So with minimum training or, actually, no training, user can directly view their plans and start their updates. In addition to that, the tool also has a lot of tool tips and guided workflows while they are working in the system. So, it’s pretty self-guided and easy to use. So that has made it easier for users to switch between HPMS and Benefits1™.

Mainly, users do like to work in Benefits1™ because of all of the bulk capabilities; it does save a lot of time working in Benefits1™. And, the platform also has customizable workflows, which can be tailored to the internal business processes of each business payer. So the workflow, overall working in the tool makes it more relatable and manageable to individual payers working in the system.

(26:41) Ramesh Padri

Yeah. Thanks, Kaustubh. I think that’s quite a lot of advantages to leverage Benefits1™.

My next question is around the scale of payers. We have payers at different scale. I’ve seen payers with thousand-plus plans using Benefits1™, and I’ve also seen payers who have less than five plans. So what features make Benefits1™uniquely suited to handle a CMS filing of various scales?

(27:09) Kaustubh Borole

Yeah. So as you mentioned, we have a wide range, from five to thousands of PBPs, and the same Benefits1™ platform handles all of them. I think the key here is what Tasneem mentioned earlier, the dynamic structure. So every year when CMS publishes the guidelines, we validate the entire PBP structure. And, for any updates, if payers want to add new plans, they want to add new services based on the changes to their plans. All of that is supported by default. So there is no additional work in that area.

Overall, we manage 2,000 plus PBPs in the system across our client base. So scalability is definitely there in terms of quite variable whether you’re working for, on five products or a thousand products at a time. The amount of work doesn’t increase in terms of managing that many products.

So, it’s mainly the way the product features are designed. Few features, like there are cascades, what we call it, it’s a way of bulk updating several sections of the product. So, there are repetitive benefits like dental, vision, and hearing, which are offered in almost all of the plans. So instead of going through each and every plan, opening it, going data entry screen by screen, these cascade functionalities help to manage all of that data in one table in one Excel file. The user can upload it, and all their plans get updated, with these dental, vision, hearing benefits.

Additionally, similarly, there is Rx Cascade or prescription. Rx especially is a very heavy data entry section, and it’s quite time-consuming to update that. So, this functionality helps to manage all of that Rx data in one central location. And in one go, without having the need to open all the products, it updates all of the Rx plans in one go. So this, overall, drastically reduces the time in data entry. And irrespective of the number of products, whether it’s 10 or a few hundred, the amount of work doesn’t change. Same users can easily manage the scale.

As Rose mentioned earlier, we have seen customers doubling their PBPs in the same year. So there was no need for additional people. The same people were able to manage that large scale, with this product functionality.

(29:49) Ramesh Padri

Okay. Thanks, Kaustub. And I appreciate these bulk and mass updates making payers’ lives much easier to manage PBP submissions.  

My next question is more of an extension to the previous question. During the PBP submission cycle, speed, accuracy, and flexibility are important to all the payers, especially for enabling yearly benefit updates, automation, and audit tracking. Can you share how Benefits1™ can support payers during filing? 

(30:17) Kaustubh Borole

Sure. So I’ll talk about the product features which have been very helpful for the customers, from start to end, for their bid.

To start with, there is insights. So what the insight module gives is access to all of the competitor data, which has the previous bids which are submitted to CMS. So users are able to see the Star Rating spread, the enrollment spread, the benefit data across the entire nation, and they’re able to compare their benefits data with competitor plans. So that becomes a very good starting point in deciding or analyzing the year-over-year changes.

For data entry, as I mentioned, all of these bulk capabilities just make the data updates very easier and simpler, and it reduces a lot of time, and mainly it reduces a lot of manual errors as well.

Along with that, we have global updates. What global update allows is to if there is any repetitive update which needs to be done, if you want to add a service or update a service based on the new changes across multiple plans, we can do it once and apply to all plans using global updates. So these mainly help to avoid any kind of repetitive work in the tool. Comparatively, in HPMS, we would have to open each and every plan and do it manually one by one. But Benefits1™ makes it very flexible to manage them in parallel.

In addition to that, one of the most used features is in our reporting. The reports are very advanced, and there are various kinds of reports, out of the box from the system. One is I would like to mention the activity log report. So all the activity which is done by all users, whether it’s updating the plans or any kind of other activity, when and where and why that change was made, everything is logged in the system. So that gives a good audit trail over all the activities which have been done over the past week, past month or, in this cycle. So it helps users to track all of their changes.

And, last but not least, the one which Tasneem mentioned, the system is integrated with HPMS. So with one click, the user can select all of these plans, and the plans get synced to HPMS. So, all the plans get validated in one go and get pushed to HPMS.

So, overall, I think, these features help the users from start to end, in the entire bid process.

(33:06) Ramesh Padri

Okay. Yeah.

Thanks, Kaustub.

I think we are slightly delayed.

Well, what is your favorite capability in Benefits1™ for PBP submission? Maybe if you can keep your answer to fifteen seconds, that’ll help.

(33:20) Kaustubh Borole

Yeah. Sure. 

So, my personal favorite is the newest feature we have launched, which is the Benny. It’s an AI assistant, and I feel it’s pretty cool to just talk or chat with the assistant. And it has access to all of the PBP data and your documents data. And it’s just very easy to get and interact with all of that information, compare plans. So, yeah, I think that’s a very powerful tool we launched this year. 

(33:48) Ramesh Padri

Okay. Thanks, Kaustub. Thanks a lot to all of you for answering all the questions.

The participants, audience, any questions you have, please feel free to ask right now.

(34:11) Tasneem Chital

So, I believe the questions will have to be typed in the chat, since all the participants are muted. So, if you guys can please type your questions in the chat, we will answer them. 

(34:30) Tasneem Chital

First question, can we ask about material development in Benefits1™? 

(34:33) Ramesh Padri

Yeah. You can ask any question. Go ahead. 

(34:38) Rose Rasegan

So, I think that is her question. Right?

So, just to kind of start answering that question, our tool integrates the plan data directly into materials such as the annual notice of change, evidence of coverage, and the SB. So, we manage those year-over-year with clients. We can also develop other materials within our tool beyond just the mandated materials.

(35:05) Rose Rasegan

Great. That’s a great question.

How are the annual notice of change year-over-year changes developed?

So I’ll take this one, if everyone’s alright with that. Yeah.

As I mentioned, you know, we from an implementation standpoint, we load in the previous year’s JSON files. So, just looking at it from an implementation standpoint, we always have the two years of data. So, from an annual notice of change, our tool systematically compares the plans year over year. By a simple ANOC chart processing that we have in our tool, we can do it in a bulk manner or plan by plan. It systematically compares and populates those benefit changes in an ANOC chart view so that you see what benefits have changed year over year and you have the ability to, manage the language that will appear around those cost share differences in our tool, and you can standardize that so it’s consistent across your plans.

So it is systematic. We have a master list that sits behind that can help standardize the language for it. And basically, that’s very quick and easy to manage year over year.

(36:32) Tasneem Chital

We still have five minutes. Are there any other questions that we can answer for you today?

(36:41) Ramesh Padri

Yeah.We need some tough questions for this panel. Not easy ones.

(37:12) Tasneem Chital

So, the next question is, does the system create a PBP report like HPMS does?

Kaustubh, do you want to take this one?

(37:20) Kaustubh Borole

Yeah. Sure.

So, the system actually has multiple reports. So to answer your question, yes. The system does create a PBP report, like HPMS. In addition to that, basically, the multiple reports we have is, you can have a single report for multiple products or all your products, in one Excel file. There can be a year-over-year report where the PBP information of the same products from last year to this year are shown side by side, and the differences are highlighted. So, yes, the reports are there from the system with year-over-year, selected year, and differences.

All these capabilities are there.

(38:06) Tasneem Chital

Right. And then, do you want to highlight the report builder capability as well?

(38:11) Kaustubh Borole

Yeah. Sure.

So yeah. Thank you for that.

So the standard reports we have basically will have all the information in the system. But as we know, the PBP structure is quite huge. So the report builder capability we have, what it does is, whenever there is a need to create those ad hoc reports, we have seen several of our customers generate ad hoc reports for out-of-network benefits, out-of-network nodes to validate all of this information. There’s a quick way in the tool to select what benefits you would like and generate a report specific to that for any number of PBPs. So the report builder gives that flexibility to extract any information across all your products.

I think there’s a follow-up. Can we do a straight compare between HPMS and Benefits1™ PBP? Does the data vary between two?

We can do a straight comparison. We have multiple ways of doing a compare actually. So the reports can be compared as we have kept the structure same as the PBP, as that’s needed for our API submissions as well. So, yes, the reports can be compared. Along with that, the JSONs which export from HPMS in our system, we have JSON compare tool as well, which compares the entire data. These are just additional ways to make sure the data in the Benefits1™ and HPMS are completely in sync. So, yeah, users don’t even have to compare each report manually. There are ways to generate JSONs for all plans from HPMS and benefits one, and it gives a complete compare report.

(40:10) Tasneem Chital

We do appreciate the questions.

(40:14) Ramesh Padri

Yeah. These are good questions. Thanks, Amanda.

So anybody has any other questions?

I think, there are no other questions, I believe.

You can still reach out to us. And thank you to all our panelists for sharing some valuable insights into the engine behind the 30% of Medicare PBP submissions for the past seven years.

To our audience, thank you for your time and engagement. I know you’re all busy in your day-to-day work, and I appreciate you taking time today. We hope you are walking away with some clear picture of what it takes to deliver a successful PBP submission and why a strategic platform partnership like Benefits1™ matters more than ever.

If you have any further questions, feel free to reach out to us, the Simplify Healthcare team, or to our panelists. And thanks once again, and we look forward to seeing you at future discussions.

Thanks, everyone, for your time. Appreciate it.

(41:26) Rose Rasegan

Thank you.

Thanks, everyone.