The Medicare Open Enrollment Period, sometimes called the Annual Election Period (AEP), runs each year from October 15 to December 7. During this time, Medicare health and drug plans can make changes in cost, coverage, and the providers and pharmacies in their networks. Also, during this period, beneficiaries with Medicare Parts A & B can switch to a Part C plan.
Before Medicare AEP begins, Heath plans prepare their systems, processes and people to ensure high-quality customer experience and meet Centers for Medicare & Medicaid Services (CMS) compliance. However, despite all the preparation and hard work, there are instances which impacts AEP significantly. Here are some of the examples:
This is not an exhaustive list, the severity and impact depend on various criteria such as membership count, number of plans, size of the plan, service area, etc.
The question is, why such unaddressed scenarios pop up despite all the preparation and is there a way to get to know such issues before they even occur in production?
Let’s try to go through the answer in steps:
I am not talking about using Sci-fi time machines to address this problem. There are time simulation solutions which can be used to mimic AEP scenarios before AEP begins. This will empower testing team to address above mentioned issues.
For one of our M360 clients Wipro has deployed time simulation module which enabled the client to perform end-to-end testing way before AEP. This resulted into a successful AEP.
Most of the health plans would start the AEP preparation in terms of completing the change requests, closing on all defects and consolidating any pending activities in the month of July. Generally, July’s software release would be a major one. Post this release internal AEP testing activities and AEP preparation would kick-in.
Health plans that have witnessed resource constraints, application error backlogs, error prone manual activities and increased member grievances during AEP must start evaluating an end-to-end pre-enrollment and membership management system.
Sooner the better!
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Santosh Gundurao Gurlahosur
With the expertise in Healthcare Information Technology, Santosh brings in a blend of domain, technology, delivery & program management experience. He has managed and grown large customers and is focused on building products, end-to-end customer management and nurturing robust & efficient teams to manage complex Healthcare & Medicare advantage products & services. Santosh is also AHIP certified