Explanation of Benefits Toolkit

Save time, empower your teams and effectively upgrade your processes with access to this practical Explanation of Benefits Toolkit and guide. Address common challenges with best-practice templates, step-by-step work plans and maturity diagnostics for any Explanation of Benefits related project.

Download the Toolkit and in Three Steps you will be guided from idea to implementation results.

The Toolkit contains the following practical and powerful enablers with new and updated Explanation of Benefits specific requirements:

STEP 1: Get your bearings

Start with...


• The latest quick edition of the Explanation of Benefits Self Assessment book in PDF containing 49 requirements to perform a quickscan, get an overview and share with stakeholders.


Organized in a data driven improvement cycle RDMAICS (Recognize, Define, Measure, Analyze, Improve, Control and Sustain), check the…


• Example pre-filled Self-Assessment Excel Dashboard to get familiar with results generation


Then find your goals...

STEP 2: Set concrete goals, tasks, dates and numbers you can track

Featuring 999 new and updated case-based questions, organized into seven core areas of process design, this Self-Assessment will help you identify areas in which Explanation of Benefits improvements can be made.

Examples; 10 of the 999 standard requirements:


1. Does the plan limit the compensation that may be taken into account in determining benefits or contributions on behalf of any employee to no more than the annual compensation limit?
   
   

2. Can other individuals, as family members, including the subscriber of your plan, obtain information on your Health Insurance account?
   
   

3. What peer review literature sources are utilized by your organization to maintain current industry standards in the review process?
   
   

4. Is the role of any entity in the arrangement explicable solely or principally by tax reasons or for obtaining the relevant benefit?
   
   

5. What should you do if your EOB show is that your insurance claim was denied or that there is a request for additional information?
   
   

6. Is there any limit on the total amount of cost sharing charges that an enrollee in a marketplace health insurance plan has to pay?
   
   

7. Do patients need to sign anything to transmit claims electronically and how do you change patient address information?
   
   

8. Will your organization provide the forms to the employees upon termination for Portability and Conversion?
   
   

9. How do you know if you qualify for financial assistance with private medicare prescription drug coverage?
   
   

10. What are the barriers that may prevent your organization from participating in the procurement process?
    
    


Complete the self assessment, on your own or with a team in a workshop setting. Use the workbook together with the self assessment requirements spreadsheet:


• The workbook is the latest in-depth complete edition of the Explanation of Benefits book in PDF containing 999 requirements, which criteria correspond to the criteria in...


Your Explanation of Benefits self-assessment dashboard which gives you your dynamically prioritized projects-ready tool and shows your organization exactly what to do next:


• The Self-Assessment Excel Dashboard; with the Explanation of Benefits Self-Assessment and Scorecard you will develop a clear picture of which Explanation of Benefits areas need attention, which requirements you should focus on and who will be responsible for them:
  
  


• Shows your organization instant insight in areas for improvement: Auto generates reports, radar chart for maturity assessment, insights per process and participant and bespoke, ready to use, RACI Matrix

• Gives you a professional Dashboard to guide and perform a thorough Explanation of Benefits Self-Assessment

• Is secure: Ensures offline data protection of your Self-Assessment results

• Dynamically prioritized projects-ready RACI Matrix shows your organization exactly what to do next:



STEP 3: Implement, Track, follow up and revise strategy

The outcomes of STEP 2, the self assessment, are the inputs for STEP 3; Start and manage Explanation of Benefits projects with the 62 implementation resources:


• 62 step-by-step Explanation of Benefits Project Management Form Templates covering over 1500 Explanation of Benefits project requirements and success criteria:


Examples; 10 of the check box criteria:


1. Cost Management Plan: Are changes in scope (deliverable commitments) agreed to by all affected groups & individuals?
   
   

2. Procurement Audit: Are there systems for recording and managing stocks (where part of contract)?
   
   

3. Procurement Audit: Did your organization identify the full contract value and include options and provisions for renewals?
   
   

4. Human Resource Management Plan: How do you determine what key skills and talents are needed to meet the objectives. Is your organization primarily focused on a specific industry?
   
   

5. Schedule Management Plan: Is the steering committee active in Explanation of Benefits project oversight?
   
   

6. Schedule Management Plan: Have Explanation of Benefits project management standards and procedures been identified / established and documented?
   
   

7. Lessons Learned: How well were expectations met regarding the frequency and content of information that was conveyed to by the Explanation of Benefits project Manager?
   
   

8. Team Member Performance Assessment: What is used as a basis for instructional decisions?
   
   

9. Requirements Traceability Matrix: Describe the process for approving requirements so they can be added to the traceability matrix and Explanation of Benefits project work can be performed. Will the Explanation of Benefits project requirements become approved in writing?
   
   

10. Quality Audit: Are there appropriate means for intervening if necessary?


 
Step-by-step and complete Explanation of Benefits Project Management Forms and Templates including check box criteria and templates.

1.0 Initiating Process Group:


• 1.1 Explanation of Benefits project Charter

• 1.2 Stakeholder Register

• 1.3 Stakeholder Analysis Matrix


2.0 Planning Process Group:


• 2.1 Explanation of Benefits project Management Plan

• 2.2 Scope Management Plan

• 2.3 Requirements Management Plan

• 2.4 Requirements Documentation

• 2.5 Requirements Traceability Matrix

• 2.6 Explanation of Benefits project Scope Statement

• 2.7 Assumption and Constraint Log

• 2.8 Work Breakdown Structure

• 2.9 WBS Dictionary

• 2.10 Schedule Management Plan

• 2.11 Activity List

• 2.12 Activity Attributes

• 2.13 Milestone List

• 2.14 Network Diagram

• 2.15 Activity Resource Requirements

• 2.16 Resource Breakdown Structure

• 2.17 Activity Duration Estimates

• 2.18 Duration Estimating Worksheet

• 2.19 Explanation of Benefits project Schedule

• 2.20 Cost Management Plan

• 2.21 Activity Cost Estimates

• 2.22 Cost Estimating Worksheet

• 2.23 Cost Baseline

• 2.24 Quality Management Plan

• 2.25 Quality Metrics

• 2.26 Process Improvement Plan

• 2.27 Responsibility Assignment Matrix

• 2.28 Roles and Responsibilities

• 2.29 Human Resource Management Plan

• 2.30 Communications Management Plan

• 2.31 Risk Management Plan

• 2.32 Risk Register

• 2.33 Probability and Impact Assessment

• 2.34 Probability and Impact Matrix

• 2.35 Risk Data Sheet

• 2.36 Procurement Management Plan

• 2.37 Source Selection Criteria

• 2.38 Stakeholder Management Plan

• 2.39 Change Management Plan


3.0 Executing Process Group:


• 3.1 Team Member Status Report

• 3.2 Change Request

• 3.3 Change Log

• 3.4 Decision Log

• 3.5 Quality Audit

• 3.6 Team Directory

• 3.7 Team Operating Agreement

• 3.8 Team Performance Assessment

• 3.9 Team Member Performance Assessment

• 3.10 Issue Log


4.0 Monitoring and Controlling Process Group:


• 4.1 Explanation of Benefits project Performance Report

• 4.2 Variance Analysis

• 4.3 Earned Value Status

• 4.4 Risk Audit

• 4.5 Contractor Status Report

• 4.6 Formal Acceptance


5.0 Closing Process Group:


• 5.1 Procurement Audit

• 5.2 Contract Close-Out

• 5.3 Explanation of Benefits project or Phase Close-Out

• 5.4 Lessons Learned


Results

With this Three Step process you will have all the tools you need for any Explanation of Benefits project with this in-depth Explanation of Benefits Toolkit.

In using the Toolkit you will be better able to:


• Diagnose Explanation of Benefits projects, initiatives, organizations, businesses and processes using accepted diagnostic standards and practices

• Implement evidence-based best practice strategies aligned with overall goals

• Integrate recent advances in Explanation of Benefits and put process design strategies into practice according to best practice guidelines


Defining, designing, creating, and implementing a process to solve a business challenge or meet a business objective is the most valuable role; In EVERY company, organization and department.

Unless you are talking a one-time, single-use project within a business, there should be a process. Whether that process is managed and implemented by humans, AI, or a combination of the two, it needs to be designed by someone with a complex enough perspective to ask the right questions. Someone capable of asking the right questions and step back and say, 'What are we really trying to accomplish here? And is there a different way to look at it?'

This Toolkit empowers people to do just that - whether their title is entrepreneur, manager, consultant, (Vice-)President, CxO etc... - they are the people who rule the future. They are the person who asks the right questions to make Explanation of Benefits investments work better.

This Explanation of Benefits All-Inclusive Toolkit enables You to be that person.

Includes lifetime updates

Every self assessment comes with Lifetime Updates and Lifetime Free Updated Books. Lifetime Updates is an industry-first feature which allows you to receive verified self assessment updates, ensuring you always have the most accurate information at your fingertips.