Member Premium APTC Reconciliation

As member premium and Advanced Premium Tax Credit (APTC) reconciliation payments are paid, and claims are processed, reconciliation challenges continue to be a focus due to the complexity and volume of information being processed.

Potential challenges with this end-to-end process include:

• Duplicate, missing and inaccurate member information on incoming 834s
• Membership information is out of sync, impacting monthly tracking
• An 820 process is not in place, thus not providing full member-level visibility and reconciliation in the interim
• Missing, duplicate, or inaccurate member invoices being sent
• Inaccurate or delayed member and subsidy payments
• Received payment versus expected payment discrepancies
• Monthly adjustments may not reconcile with outstanding balances

The issues noted, if not reconciled and tracked, put payers at risk of being out of compliance, in addition to incurring financial loss and leading to customer dissatisfaction. Considering the number of systems involved with processing enrollment data, achieving data quality with the information on the exchanges will be crucial for ensuring customer satisfaction. The ability to monitor and report on this data will allow payers to set rates and apply for risk mitigation funding from the federal government. Healthcare payers need to consider how they will ensure this data remains accurate and reliable so company revenue is enhanced.

Enterprise solutions approach

Since Precisely provides a common controls and visibility solution 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 how Precisely helps with APTC reconciliation to ensure you are capturing all the revenue from the new members and subsides available from the government.