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Streamline Medicare Advantage Plan Lifecycle with Intelligent Automation

Streamline Workflows. Reduce Risks. Deliver Smarter Medicare Plans. Comprehensive Platform for Plan Benefit Package (PBP), Bid, Formulary, ANOC/EOC/SB, and CMS Compliance
Simplify complex Medicare Advantage plan operations with AI-driven automation for plan design, bid preparation, document generation, and CMS submissions—on a single integrated platform.
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Simplify Healthcare’s Benefits1™.Medicare Drives Over 30% of Nationwide PBP Submissions to CMS, Marking Over 7 Years as a Trusted Industry Leader
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Innovate and Scale with a Modular Platform

Connecting PBP, Bids, Formularies, Documents, and Submissions
Compliance Confidence. Configurable Framework. Medicare Advantage Ready.

Enterprise Product Catalog

Purpose-Built for PBP and Bid Accuracy

Establish a single, AI-powered source of truth to configure plan benefits, formularies, and cost-sharing details—aligned with CMS guidelines that are submission-ready.

  • AI-Driven Plan Standardization and Validation
    Ensure compliant and audit-ready PBP and bid data using pre-validated templates and AI rules that flag discrepancies early—reducing rework and CMS submission errors.
  • Integrated Formulary and Plan Design
    Model formularies alongside plan benefits with automatic validation against CMS criteria—streamlining configuration and reducing time spent reconciling drug tiers and benefits.
  • Unified Product Repository
    Maintain a centralized catalog of Medicare Advantage, MAPD, D-SNP, and Part D plans across regions and segments—ready for reuse, adaptation, and submission.
  • Actuarial and Compliance Alignment
    Eliminate discrepancies by auto-syncing benefit configurations with actuarial grids and CMS requirements—ensuring real-time alignment and seamless validation.

Automate CMS Filings, Document Generation, and Translation

Accelerate AEP and Beyond

Support end-to-end automation for CMS filings—PBP, Bids, ANOC, EOC, LIS Match, and MTM—along with CMS-compliant document generation and multi-language translation.

  • PBP Bid Filings
    Auto-generate validated files for HPMS submissions with version control and tracking for plan iterations.
  • CMS-Compliant Document Generation
    Generate ANOC/EOC, Formularies, LIS Match letters, and MTM communications with built-in templates and regulatory formatting.
  • Translation and Accessibility
    Leverage built-in language translation to meet CMS guidelines and member accessibility requirements.
  • Submission-Ready Workflow
    Enable pre-submission checks and collaborate across teams to finalize files with confidence—on time, every time.

Real-Time Insights and AEP Readiness Tracking

Stay Ahead of Regulatory Timelines

Gain visibility into every stage of plan design, filing, and compliance to meet CMS deadlines confidently.

  • Compliance Dashboard
    Track plan configurations, filing status, and document readiness across regions and LOBs.
  • AEP and Filing Calendar
    Monitor deadlines, milestones, and submission windows with alerts and reminders.
  • Risk and Exception Flags
    Identify and act on outliers, validation errors, and version conflicts before they impact timelines.
  • Audit Trail and Readiness Logs
    Maintain a full history of changes, approvals, and team activities for internal and external audits.

End-to-End Integrations

Built to Work with Your Ecosystem

Connect seamlessly with CMS systems, internal systems, and external vendors to streamline Medicare Advantage operations.

  • CMS and HPMS Integration
    Automate submission of PBP, Bids, and documents directly into CMS systems with acknowledgment tracking.
  • Data Exchange with Core Systems
    Integrate with actuarial tools, pharmacy systems, and core admin platforms for real-time sync.
  • Downstream System Enablement
    Share validated plan data with member portals, provider directories, and sales platforms.
  • API and Event-Based Architecture
    Ensure flexible, low-friction integration with upstream and downstream systems.

AI-Powered Sales Enablement

Equip Teams with Compliant, Customized Content

Empower sales, brokers, and agents with accurate plan data, benefit comparisons, and enrollment materials tailored to member needs.

  • CMS-Validated Benefit Comparison Tools
    Deliver human-friendly, regulation-ready plan comparisons to members and brokers.
  • Tailored Collateral Generation
    Auto-generate Summary of Benefits (SBs), enrollment kits, and other sales documents for each plan.
  • CRM and Broker Integration
    Push plan details and updates to sales platforms and broker tools to reduce errors and rework.
  • Track Usage and Effectiveness
    Measure content utilization across sales channels and refine based on performance insights.

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

Benefits1™ is purpose-built to streamline plan operations, eliminate rework, and deliver measurable outcomes across teams.

Product

  • Prioritize competitive plan innovation—not manual CMS mapping
  • Eliminate redundant bid versions, handoffs, and spreadsheet rework
  • Improve transparency, collaboration, and compliance
  • 35% reduction  in plan design and validation efforts

Sales and Brokers

  • Enable self-serve comparison tools and customized sales kits
  • Drive faster onboarding of new brokers and improve CMS readiness
  • Boost broker/member experience with accurate and timely materials
  • 10–15 point lift  in sales and engagement satisfaction

Marketing and Compliance

  • Generate compliant ANOC/EOC and LIS Match documents
  • Eliminate delays and reduce dependency on manual formatting
  • 70% cost savings  on translation and document versioning

Finance

  • Lower admin overhead and achieve ROI in the first year
  • $1 on Simplify = $6–$8  in internal or third-party rework costs
  • Reduce CMS filing penalties and resubmission risk

Operations

  • Automate bid workflows and submission validations
  • Increase speed and quality of AEP readiness
  • 75% faster time   to finalize plan documents and filings

IT

  • Scalable platform designed for CMS timelines and integration
  • Centralized Medicare plan repository reduces silos
  • Self-serve APIs for seamless connectivity with upstream and downstream systems

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 Medicare Plan Operations

Across the industry, Medicare Advantage plans are streamlining operations, accelerating filings, and scaling with confidence—powered by automation, AI, and a modern approach to Medicare benefit plan management.

Leading Health Plans Are Already Transforming Medicare Plan Operations

Across the industry, Medicare Advantage plans are streamlining operations, accelerating filings, and scaling with confidence—powered by automation, AI, and a modern approach to Medicare benefit plan management.

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.

Get the IDC Spotlight
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Change What’s Possible in Medicare Advantage Benefits

65+ health plans didn’t wait for the future—they built it. With Simplify Healthcare, they accelerated filings, ensured compliance, and delivered 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™.Medicare

How does Benefits1™.Medicare support product standardization?

Our AI-powered platform helps standardize Medicare Advantage benefit designs and reduce retesting. It enables a unified product catalog that aligns with CMS guidelines—supporting accurate, scalable, and compliant PBP and Bid configurations.

Can it centralize all Medicare plans in one place?

Yes. It brings together MAPD, D-SNP, Part D, and supplemental benefits into a single catalog—eliminating the need to manage multiple systems or manual spreadsheets.

How does BNi help with compliance and visibility?

BNi provides real-time insights into AEP readiness, PBP/Bid validation status, and document generation progress. It includes AI-powered dashboards and proactive alerts to ensure CMS compliance and avoid missed deadlines.

Does it automate filings and document generation?

Yes. Benefits1™.Medicare automates key CMS filings—including PBP, Bids, Formulary, and MTM—while also generating ANOC/EOC and LIS Match documents in CMS-compliant formats with translation and 508 accessibility.

How does it improve coordination across departments?

It replaces manual handoffs and fragmented workflows with intelligent dashboards—enabling real-time collaboration across actuarial, compliance, product, and operations teams.

Is the platform integration-ready?

Yes. It supports batch, API, and streaming integrations with CMS systems, actuarial tools, sales platforms, and document repositories—ensuring seamless data exchange across the Medicare ecosystem.

What sales enablement capabilities are included?

Benefits1™.Medicare includes AI-powered tools to support brokers and internal teams—offering plan comparison generation, Summary of Benefits creation, LIS/MTM kits, and CRM integration for real-time data sync.

Can we track quoting and sales performance?

Yes. The platform includes analytics to track bid submission timelines, plan uptake, broker usage, and enrollment trends—helping you refine product strategy and improve sales outcomes.