An industry leading PBP filing and compliance solution for Medicare Advantage Health Plans

One solution to help you design smart benefits, automate PBP filings, generate 508-compliant ANOCs, EOCs, and SBs, personalize competitive analysis, and automate actuarial product comparison

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2024 Medicare Advantage PBP Filing Season Recap

Simplify Healthcare is positioned in the Leaders Category in the 2023 IDC MarketScape for U.S. health plan product/plan benefit configuration solutions.

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Enable a connected benefits journey for the Medicare Advantage market

Infuse efficiency in every process of the Medicare Advantage plan build and improve speed to market

One-Stop Solution for All Products

Manage a single source of truth platform to improve data accuracy and reusability across all products

Automate Bid Submissions

Future proof managing 13,000+ fields of CMS bid package with robust versioning and validation capabilities

Seamless Integration Capabilities

Leverage out-of-the-box APIs to readily connect with common third-party applications powering claims, underwriting, customer service, self-service, and more

Errata-Free Compliance

End-to-End compliance with ANOC, EOC, and SB documents by leveraging a 508-compliant automation engine

Power your connected benefits journey with integrations

Extend the capabilities of Benefits1™.Medicare with a host of integrations to achieve end-to-end lifecycle management of your Medicare Health Plans

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.Actuary

Accelerate actuarial inputs to design changes and portfolio ideation

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.Insights

Enable market comparisons for portfolio design or validation

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.IntegrationHub

Use API and events to communicate data in a model that is easily consumable by target systems

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.Sales

Enable sales and sales ops to customize benefits for EGWP via seamless integration with a sales CRM system

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.SuperUser.Studios

Empower superusers to maintain design, rules, and workflow configurations while also establishing governance

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.DataServices

Use a relational database to drive reports and analytics on the source of truth data or communicate it in a model that is easily consumable by target systems

.AI

Leverage the power of Generative AI to incorporate periodic code set changes published by the CMS into Benefits1™, ensure compliance with CMS ANOC and EOC templates, and provide context-aware help from the product assistant

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Service1™

Deliver accurate and complete answers to members, providers, employer groups, and brokers/agents for benefit inquiries

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Claims1™

Enable automated claims configuration, code set level configuration of benefits, and testing to support claims adjudication

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Experience1™

Automate dynamic content generation and stream accurate, compliant, and consistent benefits data across the enterprise

Simplify Healthcare is positioned in the Leaders Category in the 2023 IDC MarketScape for U.S. health plan product/plan benefit configuration solutions.

What Our Customers Say

Director

Marketing Communications

Benefits1™.Medicare infused efficiency in every process of Medicare Advantage plan management. It gave us a significant competitive advantage as we were able to build product and communication documents accurately and fast. We became the first company to publish plans on the Medicare Advantage marketplace
Vice President

Marketing Communications

Simplify Healthcare is a long-term strategy partner and a key part of our ecosystem. In the past 3 years, Benefits1™.Medicare has consistently helped us manage our Medicare Advantage products with ease. However, the new VAP service takes the whole experience up a notch. We want to continue using VAP year-on-year
Senior Product Manager

Large Health Plan

We were incredibly happy with the Simplify Healthcare team and their ability to think outside the box. They were super-responsive, working with us to get accurate outputs, in a timely manner. We also appreciate the full transparency on open issues. Benefits1™.Medicare has been a game-changer for us!

Frequently Asked Questions (FAQs)

Here is what our customers usually ask us

What is Medicare Advantage (MA) plan management?

Most Medicare plans run their product configuration process from spreadsheets, but that burdens the users with duplicate data entries into the CMS PBP system, increasing the risk of errors and last-minute fire drills that require manual data manipulation. Medicare Advantage plan management is the process of managing end-to-end Medicare Advantage product/plan configuration, enabling Health Plans to automate their PBP processes, streamline operations, and auto-generate documents while complying with all State/Federal policies, rules, and regulations

What is CMS PBP integration and Medicare Advantage product configuration?

Plan Benefit Package (PBP) is a well-defined system enabling Health Plans to submit their Medicare Advantage plans for CMS approval. Our solution, Benefits1™.Medicare, can be easily integrated with CMS to automate PBP submissions and efficiently configure customized Medicare Advantage products with just a few clicks

What are the challenges with traditional Medicare Advantage plan management processes?

Traditional processes often create challenges like maintaining benefits data in Excel grids, inconsistencies between the grids, last-minute CMS changes, manual generation of documents, proofing, and re-proofing with every update. Similarly, loading your plan data into the CMS PBP system can be problematic since it is typically a manual data entry process that is slow, tedious, and error-prone. Finally, keeping up-to-date with CMS changes can be very difficult for Health Plans while ensuring the new requirements are fully understood, and the needed changes are made to the Medicare Advantage plans

Why use the Medicare Advantage product configuration solution?

Benefits1™.Medicare is the industry’s first CMS PBP integrated turnkey MA product configuration solution, enabling Health Plans to automate end-to-end Medicare Advantage plan management and document generation processes. It helps improve accuracy, timeliness, and cut efforts/costs by up to 75%. The solution can help eliminate last-minute CMS changes and generate CMS PBP output and documents with the push of a button

What kind of documents can be generated with a MA plan management solution?

With the MA plan management solution, Health Plans can auto-generate all MA compliant documents like ANOC, EOC, and SB with just a few clicks. The solution enables consistent and accurate document generation for reduced risk of penalties and timely and accurate filings

How can you automate Medicare Advantage product management, PBP loading, and document generation?

Put the innovation at the core of your Medicare Advantage processes with Benefits1™.Medicare, one-of-its-kind game-changing Medicare Advantage product management, PBP loading, and document generation solution. It helps automate plan development, ANOC, EOC document generation, auto compare products to ensure effective and efficient audit/QA, create a single source of truth for all Medicare Advantage product information, and comes pre-configured to load PBP to automatically update CMS rules

Case Studies

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Independent Health's Digital Transformation Powered by Benefits1™.Medicare Automation Suite for End-to-End PBP Management and Document Generation

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A Large Health Payer Leveraged Benefits1™.Medicare VAP to Timely and Cost-Effectively Create Compliant ANOCs/EOCs and SBs

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A large Payer became the first to publish plans on the MA marketplace using Benefits1™.Medicare

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