ACA Marketplace

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The Federally Facilitated Marketplace (FFM) and State-Based Exchanges (SBEs) can be difficult to navigate. Health plans participating on public exchanges need to be agile and adaptable in order to manage policy changes and reconcile financial data—and that’s hard to do with outdated legacy systems.

In this complex environment, the quality of your technology solution can make a significant difference in customer retention, revenues, and compliance. With the Edifecs Enrollment Hub, health plans can mitigate these risks while modernizing their enrollment management and strengthening their market share.

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assimilate

  • Pre-configure state-specific guidelines, maps, and validation rules
  • Seamlessly and compliantly transition from the FFM to any SBE
  • Gain support for managing, delivering, and reconciling data against CMS records

Streamline integration & scaling

Facilitating compliance with out-of-the-box integration and file processing for federal and state-based exchanges.

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reconcile

  • Automate reconciliation against monthly enrollment audit files
  • Leverage intelligent workflows to identify, assign, and resolve complex discrepancies
  • Merge multiple updates and changes into a single transaction

Reduce discrepancies

Minimize processing errors to improve customer retention and assist with decreasing potential compliance and financial risks.

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act

  • Identify and address discrepancies in premiums or subsidy payments
  • Boost operational awareness with data element and transaction-level insights
  • Track and compare forecasts against actual payments

Increase visibility

Reduce costs and support member satisfaction with a holistic view of enrollment processing

Find out how we can support your health plan's performance.