Case Study: Large Plan Sponsor Wins Award for Medicare Part D Compliance Solution

The largest non-investor-owned health insurer in the United States and the fourth largest health insurer in the country overall, won an industry award for a compliance solution built on FormRouter.

Challenge:

In April of 2006, sponsors of the Medicare Drug Benefit Program became liable for the fraud, waste and abusive activities of their downstream subcontractors. This forced a FormRouter customer to build a system to meet the regulatory and contractual requirements to protect the Medicare Trust Fund and reduce the risk to Plan Sponsors.

• Build an online risk assessment tool

  - Long PDF assessment surveys needed to be collect.
  - Surveys needed to be filled out over time and shared by their
    subcontractors in the free Adobe Reader or Adobe Acrobat.
  - Surveys needed to have supporting documents attached.
  - Surveys needed to be securely transmitted to a database.
  - Compliance staff needed to be notified when assessment surveys
    were submitted.

• Create a paperless monitoring program

  Once the PDF assessment surveys, data and attachments were collected into a database, compliance staff needed to open the original PDF documents for review and analysis in an electronic format.

• Build a solution rapidly with non-technical staff

  FormRouter's customer needed to rapidly build a solution without programming. In addition, the solution needed to be added to or modified over time.
  

Solution:

• FormRouter.NET Account
  
  - A FormRouter.NET account was used to securely capture PDF
    assessment forms into a Microsoft Access database in their offices.
  - Email alerts were sent to internal compliance staff for each PDF that was
    submitted.
  
  
• FormRouter’s File Extraction Tool
  
  Once the PDF assessment surveys, data and attachments were collected into a database, FormRouter’s file extraction tool allowed entire PDF forms and file attachments to be opened and used electronically.
  

Benefits:

• A user-friendly PDF interface to their subcontractors.
• Subcontractors were able to save, share and work on PDF forms
  over time before submission.
• Compliance staff was empowered to build their own forms and securely
  capture responses to a database without programming.
• The solution was set up rapidly and cost effectively.
• The technology can be used concurrently for other projects without
  additional cost.

Summary:

Compliance staff, with off-the-shelf tools, developed an industry award winning compliance solution on time and under budget.