Marketplace Membership Reconciliation

The accuracy of membership information is critical to minimize impact on downstream processes. Identifying issues early in the process when they are less expensive to remediate is crucial to streamline operations and improve the member experience. Assuming data is good is a formula fraught with uncertainties which can lead to higher costs when bad data is uncovered by either you or your member.

In these situations, member ID cards may be delayed or issued in error resulting in member dissatisfaction. By doing reconciliation related to your exchange–driven membership, you can ensure that you are capturing all the revenue from the new members and subsidies available from the government. You will also maintain the necessary compliance, avoiding misreported enrollment information and associated fines and customer services issues.

Precisely monitors Marketplace Membership transactions from the time the data is introduced into the health plan, whether it comes in through a Federal/State Marketplace or through direct channels. Precisely provides health plans with a data quality controls and visibility platform that not only ensures data quality and automated reconciliation controls, but provides transparency into marketplace membership reconciliation to ensure the accuracy of member data that enters your systems for processing. These steps are vital to implement along with Precisely’s Cost Sharing Reduction (CSR) and Member Premium & APTC Solutions.

Enterprise solutions approach

Since Precisely provides a common Controls and Visibility platform that provides flexibility to reconcile data across multiple business processes and data structures, the same control concepts are standardized to reconcile in a holistic approach. The solution automatically routes exceptions to different business units to research and resolve quickly based on customer-defined business rules. This is accomplished while maintaining an audit trail for compliance purposes which allows critical resources to focus on what matters to ensure customer success.

Read more about The Marketplace Membership Reconciliation solution and how it combines the best technology and industry expertise that ensure that financial, operation, and compliance risk is minimized.