Heartland Advantage
First D-SNP build. Passed model of care review first try.
Executive Summary
Heartland Advantage was launching its first Dual Eligible Special Needs Plan in Ohio — a LOB with distinct NCD-aligned specialty requirements and CMS model of care documentation that their Medicare Advantage team had never navigated before. Blueprint's D-SNP-specific configuration loaded Ohio's dual-eligible provider type requirements automatically, flagged the NCD specialty gaps the team hadn't anticipated, and generated the documentation structure needed for the CMS model of care review. Heartland passed on the first submission.
The Challenge
- 1
First D-SNP build — the team had MA experience but had never navigated NCD-aligned specialty requirements or dual-eligible network standards.
- 2
NCD specialty categories were poorly mapped in their existing provider data, making it impossible to know which providers met D-SNP requirements.
- 3
CMS model of care review requires documentation of care coordination network standards that the team had no prior process for producing.
The Solution
Blueprint's D-SNP configuration auto-applied NCD specialty categories and dual-eligible provider type requirements specific to Ohio.
Provider records were remapped against NCD specialty definitions — the team discovered that 12 contracted providers they thought counted didn't.
Blueprint's adequacy scoring surfaced exactly which NCD categories had gaps, giving the team a prioritized recruitment list 10 weeks before submission.
Key Results
1st
D-SNP model of care review — passed
12
Providers remapped to correct NCD categories
10 wks
Gap visibility before deadline
“We had no idea which providers actually counted toward D-SNP adequacy until Blueprint mapped them. That 12-provider gap could have been a deficiency notice.”
Build Timeline
How the build unfolded
D-SNP workspace configured; Ohio NCD requirements loaded automatically
70 contracted providers remapped against NCD categories — 12 gaps identified
Targeted outreach to NCD-eligible behavioral health and LTSS providers
All NCD category gaps filled; care coordination documentation started
Submitted to CMS — model of care review passed on first review
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