decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Managed Care Model Compliance Plan / Marketing-Enrollment-Disenrollment
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Article Overview
This premium article explains how managed care organizations can structure a compliance plan for marketing, enrollment, and disenrollment activities. It covers broad approaches to monitoring performance, gathering feedback, assessing staff knowledge, and reviewing materials for consistency with plan policies and applicable oversight expectations. The content is aimed at compliance professionals, managed care administrators, and others responsible for plan operations and oversight.
Why This Topic Matters
Marketing and enrollment practices in managed care can affect beneficiary understanding, plan integrity, and regulatory compliance. A practical compliance framework helps organizations monitor activity, identify problems, and maintain consistent internal review processes.
What You Will Learn
- How a managed care plan can approach compliance monitoring for marketing, enrollment, and disenrollment activities.
- What kinds of internal feedback and survey methods may be used to evaluate member experience.
- How staff knowledge and agent performance can be assessed within a compliance program.
- Why independent review of marketing materials is part of a compliance process.
Who Should Read This
- Managed care compliance professionals
- Plan administrators
- Health plan operations staff
- Quality assurance teams
- Utilization management staff
- Legal and regulatory review personnel
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