WebInsure Exchange ManagerState-of-the-art technology allows health plans to seamlessly integrate with state and federal health insurance exchanges
Health and dental plans need a solution that will allow them to sell and manage their products on the Federally Facilitated Marketplace and State-based Exchanges. They need the ability to manage the plan, enrollment, group, claims, billing and payment data and, most importantly, comply with state guidelines. WebInsure Exchange Manager is a cloud-based application that provides this essential integration between the plans and state & federal health insurance marketplaces.
Plans can easily showcase products, process applications, track payments & subsidies and update plan rates online – all at the state or federal marketplace level. WebInsure Exchange Manager is highly scalable, flexible and continuously updated to ensure ACA/HIPAA & exchange compliance. This product helps plans avoid an otherwise cumbersome state-by-state integration process, saving time, money and effort. The system can accept and relay data from and to external sources, such as public and private exchanges, brokers and others; as well as, synchronize with the plans internal systems.
WebInsure Exchange Manager consists of several components listed below.
Enrollment Manager: Enables the ability to send and receive all enrollment related information to and from the exchange—new enrollments, disenrollments, terminations, cancellations and renewals.
- Send carrier acknowledgements to enrollment changes to exchange
- Allow verifications against existing enrollment information
- Allow tracking of enrollments and receiving fulfillment material from insurer online
- Facilitate group set up and enrollment for SHOP
- Manage enrollment and payment linkage
- Reconcile member and enrollment data; communicate discrepancies
Payment Manager: Enables insurers to send and receive all payment related information. It allows for the management and aggregation of premium, APTC and subsidy payments, late payments, broker commissions and more.
- Multiple payment processing options: EFT, credit card, check, payroll deduction, HRA, HSA, etc.
- Receive, process and send payment and APTC data
- Receive, process and send subsidy payments from federal agency
- Aggregate premium, APTC and subsidy payments
- Reconcile against premium and payment receivable for approved enrollments
- Manage late payments
- Manage broker commissions
- Receive and process remittance information for all payments
Benefit & Rate Manager: Allows insurers to manage certifications of marketplace plans and maintain up-to-date benefit, network and rate information with appropriate approvals.
- Manage plan benefits, network, rates and additional information documents for marketplace
- Manage initial plan certification and submission
- Manage compliance to plan certification
- Manage renewals/re-certifications and submission
- Update benefits and rates with necessary approvals
- Facilitate periodic maintenance and update of network data on exchanges
Risk Manager: Enables integration with claims to understand the risk profiles and facilitate risk assessment. It also allows insurers to conduct and manage risk adjustment in accordance with state and federal exchange compliance.
- Integrate with insurers and marketplace for claims data
- Conduct Risk profiling and manage profiles
- Facilitate 3R risk assessments and adjustments
- Perform CSR and Subsidy reconciliation
- Perform 3R reconciliation
- Java/J2EE & AJAX based application
- Enterprise Service Bus (ESB)/Service Oriented Architecture
- Cloud-hosted application
Implementation & Customization
- Change the look and feel of the application based on your needs
- Integrate with multiple 3rd party systems for analytics/reports/billing needs
Frequently Asked Questions
- How does your system conform to the changing federal rules and remains compliant with the PPACA?
- Do you utilize cloud-based environments for your solutions?
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Data sheetHealth Exchange Integration
State of the art technology allows health plans to seamlessly integrate with state and federal health insurance exchanges
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