Enrollment is the starting point of your consumer relationships.

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

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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.

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Capabilities

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

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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

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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

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