Healthcare Reform for Health Plans

Regulatory Compliance 

Meet the most complex Affordable Care Act (ACA) regulations with confidence:

• EDGE Server Solution: Reduce your administrative burden and complete the EDGE server requirements on time and with confidence in the integrity of your data. 
• EDGE Initial Validation Audit (IVA): Tap into our expertise in EDGE server data, claims auditing, and clinical coding to help you meet the Initial Validation Audit requirements.
• Cost Sharing Reconciliation: Capitalize on the value of the Standard reconciliation method without burdening your technology, finance, and actuarial staff by tapping into our comprehensive services and analytic expertise.
• T-MSIS Data Extracts: Has your state passed responsibility for this Medicaid and CHIP reporting requirement to your plan? Our experienced data analysts can devise a plan to get you on the path to compliance.

Risk Management

Help reduce members' health risks while holding down your costs: 

• Risk Score Optimization: Actively mitigate and proactively monitor your financial risk so you can control loss ratios and move forward with programs for managing illness and educating members.
• EDGE Compliance Validation: Ensure that you’re ready to meet the HHS data and technical requirements, and have accurate data to begin your risk optimization efforts with our Compliance Validation services.
• RAPID Discrepancy Reporting: Reconcile your EDGE data and discrepancies that are impacting your risk adjustment and reinsurance payments.

Ongoing Performance Improvement 

Continue to improve your performance with data and customized reports: 

• ACA Advantage Suite Module: Using our best-in-class Advantage Suite database, you can integrate various data sources and robust analytics to answer your Exchange-related business questions.