Enrollment is the starting point of your consumer relationships.

Stand apart with the industry’s easiest, most transparent enrollment experience

Read More

Health Insurance Exchange

How can you participate in multiple exchanges to scale your business while avoiding the exponential cost of point-to-point integrations?

The Edifecs Health Insurance Exchange Solution is your single gateway to the Federal Marketplace, state-based marketplaces and private exchanges.

Solution Spotlight

  • Health Insurance Exchange

    The Edifecs Health Insurance Solution serves as a “guardian” for a health plan’s exchange business, shielding and monitoring interactions with exchanges, financial institutions and the federal government. This front-end gateway ensures that only accurate and approved enrollments are sent to core membership systems and the government.

    Learn more


TThe Edifecs Health Insurance Exchange Solution makes managing both Individual and SHOP enrollment simple and trouble-free.

Minimize business risk of exchange and marketplace integration

Expedite exchange readiness and ongoing compliance with government mandates by mitigating the expense of point-to-point integration with the Federal Marketplace and each state exchange.

  • Create business agility in navigating last minute changes to state exchange and Federal Marketplace trading mandates
  • Identify and resolve discrepancies between exchange updates and your enrollment system of record
  • Mitigate revenue risk while supporting regulatory reporting by reconciling premiums and subsidies for each customer
  • Reconcile and audit exchange enrollments, producing discrepancy detail reports for a current view of enrollment status

Read More

Put your members first with a great marketplace experience

Achieve a positive brand experience with your customers with timely and accurate service. Resolve inquiries efficiently because your exchange enrollment status is visible wherever it is in the enrollment lifecycle.

  • Standardized, automated workflow prioritizes resolving enrollment exceptions and items requiring intervention
  • Audit your exchange enrollments by generating discrepancy detail reports with each processing update
  • Identify errors in the dashboard, select and drill down to repair exceptions with dynamic updates to the dashboard

Read More

Protect your revenue

The Health Insurance Exchange Solution receives and reconciles all sources of premium payments including subsidies.

  • Holds and reconciles binder payments for enrollments
  • Manages remittance advice for EFT notification, for subscriber policies and small group coverage
  • Reduces revenue leakage by identifying potential discrepancies in subsidy amounts against expected amounts based on payer membership records

Read More

Get in touch.
And tell us how we can support you.