Eligibility Screening for Eligibility & Enrollment is a one-stop shop for individual users to determine their eligibility to Exchange plans, Medicaid, CHIP and Basic health plan. They can also determine their eligibility to premium and cost sharing subsidies.

Our solution supports real time eligibility determination and has a standard eligibility process that can be configured at the benefit level. Individual is taken through an intuitive and structured eligibility determination process.

Salient Features:

• Eligibility determination to Medicaid, CHIP, Basic Health Plan, Exchange plans and Federal subsidies (Premium and Cost sharing)
• Seamless integration with Enrollment process
• Internal and External verification of eligibility information
• MAGI calculation and interface with IRS for income information based on taxes filed
• Real time eligibility determination
• Consistent customer experience
• Transmission of eligibility information to and from State agencies through HIPAA 270
• Eligibility determination for exemption from individual mandate
• Navigator/Broker access to eligibility determination module
• Process appeals to eligibility decisions
• Eligibility determination for other public programs like food support, cash assistance, child care assistance and child support with minimal configuration/customization