Healthcare Reform | Health Plans | Analytics image

Healthcare Reform for Health Plans

Robust analytics and decision support tools to help health plans face the challenge of healthcare reform with confidence

For health plans participating in the health insurance marketplace, staying on top of the regulations is particularly challenging. We’re currently hosting more than 24 EDGE servers, processing records for more than one million members, and partnering with more than 35 plans to provide additional compliance services. 

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.