As health insurers gear up to participate in the largest open enrollment period in history, a major concern is how to reconcile member records and premium payments across multiple organizations and information systems
Bellevue, Wash. (PRWEB) July 24, 2013
Next week at the Technology & Operations on the Health Insurance Exchanges Summit in Carlsbad, Calif., a healthcare IT expert from Edifecs, Inc. will lead a session discussing how health insurers can effectively manage the increased complexity and associated revenue risk of participating on health insurance exchanges (HIXs). Healthcare business advisor John Kelly will share strategies insurers can use to reconcile their internal member records with those maintained by the HIX. The Summit’s agenda centers on how health insurers can more easily navigate the operational complexities of an HIX and understand the subtle nuances that contribute to their success.
A key part of the Affordable Care Act (ACA), HIXs are online marketplaces where consumers can shop for, compare and purchase health insurance. The ACA mandates that all state and federally facilitated exchanges be up and running by October 1, 2013—less than three months from now. According to a recent survey of healthcare professionals at the 2013 Healthcare Mandate Summit, the number of health insurers planning to participate on one or more HIXs in 2014 will be very high, as will the number of consumers. In fact, the open enrollment period from October 1 through December 31, 2013 will be the largest such period in history.
While the revenue opportunity for health insurers is quite large, so is the risk, particularly in reconciling member enrollment, claim and premium payments across multiple organizations and information systems. HIXs represent a departure for health insurers because their internal systems are no longer the only system of record. Tracking the federal cost-sharing reduction subsidies provided to lower-income members also adds complexity.
WHEN: Monday, July 29, 2013 from 11:15 a.m. – 12:15 p.m. PDT
WHAT: Healthcare industry veteran John Kelly will lead the second installment of a two-part session focused on the enrollment process and ongoing claim and premium payment reconciliation. Kelly will outline the unique technical complexities and business challenges of participating on an exchange. He will also discuss how health plans can ensure their member records are completely in sync with the HIX records and that all premium payments—including subsidies by the federal government—are properly accounted for before claims are paid.
WHO: John Kelly, Principal Business Advisor at Edifecs, is a nationally recognized health information exchange expert. Mr. Kelly provides strategic consulting to Edifecs customers, specializing in information exchange and applying the principles of supply chain integration to the healthcare delivery lifecycle. His wide-ranging experience includes serving as CIO of healthcare network provider NaviNet, Director of eBusiness Architecture at Harvard Pilgrim Health Care, and Managing Director of his own health IT consulting firm. Kelly also served as the architect and technical lead for the Commonwealth of Massachusetts’ statewide HIE project, a forerunner to today’s HIX programs.
About Edifecs, Inc.
An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA, Operating Rules and ICD-10.
Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.
Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of Washington, 100 Best Places to Work in the state of Washington, an Inc. 5000 fastest-growing private company and one of the 500 Fastest Growing Companies in North America by Deloitte. Edifecs is headquartered in Bellevue, WA. For more information, please visit http://www.edifecs.com. Reported by PRWeb 50 minutes ago.
Bellevue, Wash. (PRWEB) July 24, 2013
Next week at the Technology & Operations on the Health Insurance Exchanges Summit in Carlsbad, Calif., a healthcare IT expert from Edifecs, Inc. will lead a session discussing how health insurers can effectively manage the increased complexity and associated revenue risk of participating on health insurance exchanges (HIXs). Healthcare business advisor John Kelly will share strategies insurers can use to reconcile their internal member records with those maintained by the HIX. The Summit’s agenda centers on how health insurers can more easily navigate the operational complexities of an HIX and understand the subtle nuances that contribute to their success.
A key part of the Affordable Care Act (ACA), HIXs are online marketplaces where consumers can shop for, compare and purchase health insurance. The ACA mandates that all state and federally facilitated exchanges be up and running by October 1, 2013—less than three months from now. According to a recent survey of healthcare professionals at the 2013 Healthcare Mandate Summit, the number of health insurers planning to participate on one or more HIXs in 2014 will be very high, as will the number of consumers. In fact, the open enrollment period from October 1 through December 31, 2013 will be the largest such period in history.
While the revenue opportunity for health insurers is quite large, so is the risk, particularly in reconciling member enrollment, claim and premium payments across multiple organizations and information systems. HIXs represent a departure for health insurers because their internal systems are no longer the only system of record. Tracking the federal cost-sharing reduction subsidies provided to lower-income members also adds complexity.
WHEN: Monday, July 29, 2013 from 11:15 a.m. – 12:15 p.m. PDT
WHAT: Healthcare industry veteran John Kelly will lead the second installment of a two-part session focused on the enrollment process and ongoing claim and premium payment reconciliation. Kelly will outline the unique technical complexities and business challenges of participating on an exchange. He will also discuss how health plans can ensure their member records are completely in sync with the HIX records and that all premium payments—including subsidies by the federal government—are properly accounted for before claims are paid.
WHO: John Kelly, Principal Business Advisor at Edifecs, is a nationally recognized health information exchange expert. Mr. Kelly provides strategic consulting to Edifecs customers, specializing in information exchange and applying the principles of supply chain integration to the healthcare delivery lifecycle. His wide-ranging experience includes serving as CIO of healthcare network provider NaviNet, Director of eBusiness Architecture at Harvard Pilgrim Health Care, and Managing Director of his own health IT consulting firm. Kelly also served as the architect and technical lead for the Commonwealth of Massachusetts’ statewide HIE project, a forerunner to today’s HIX programs.
About Edifecs, Inc.
An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA, Operating Rules and ICD-10.
Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.
Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of Washington, 100 Best Places to Work in the state of Washington, an Inc. 5000 fastest-growing private company and one of the 500 Fastest Growing Companies in North America by Deloitte. Edifecs is headquartered in Bellevue, WA. For more information, please visit http://www.edifecs.com. Reported by PRWeb 50 minutes ago.