Optimize ACA Plan Enrollment Operations
Participating on the public exchanges with legacy technology can leave plans scrambling to reconcile enrollment and financial discrepancies. Subsequent processing delays and errors can lead to low customer retention rates, heightened compliance risks and threatened revenue streams. Mitigating these risks and strengthening market share is achievable with a modern, enrollment management strategy.
Marketplace Regulatory Compliance
- Out of the box integration and file processing for the FFM
- Pre-configure state-specific guidelines, maps and validations rules
- Enable support for baseline RCNI and RCNO, and pre-audit file formats
- Transition smoothly from the FFM to any SBE
Ensure compliance with a best-in-class member enrollment solution.
Improve Financial Reconciliation
- Process payment remittances in any format
- Reconcile to current and historical enrollment records and periods
- Quickly identify missing payments or discrepancies in premiums or subsidy payments
- Track expected, projected, and actual payments
- Export and import financial details for offline review
Safeguard revenue with discrepancy identification and complete reconciliation.
Automate Coverage Updates
- Automate the processing of multiple transactions received for the same member and void canceled initial enrollments, up front
- Merge multiple updates/changes into a single transaction
- Convert CIC Term/CIC Adds into change transactions
Identify and resolve enrollment file issues on arrival, in real-time.
Streamline Discrepancy Resolution
- Automate reconciliation against monthly enrollment audit files
- Employ intelligent workflows to identify, assign and resolve complex discrepancies
- Reconcile paid subsidies against expected amounts and generate dispute reports
More efficient exception handling for full-file transmissions. Avoid processing delays and customer dissatisfaction.
Enable Lifecycle Visibility
- Deliver out-of-the box business-level view of processing and operational performance
- Enable data element and transaction-level visibility
- Ensure greater operational awareness through alerts and notification, across all lines of business
Deliver end-to-end enrollment processing visibility to enhance member satisfaction while reducing costs.