subject: Enabling Health Insurance Exchange Payer Integration [print this page] One of most challenging and time-consuming endeavor that States may need to undertake while setting up online health insurance exchanges is building a secure IT infrastructure for exchanging sensitive health and payment data with various state and federal agencies. To ensure that the health insurance consumers have a trouble free insurance shopping experience and do not get weighed down with excessive information submission and data verifications, a system needs to be set up that enables auto-population of all income, citizenship and other consumer specific data to reduce burdens on consumers and insurers.
In the present healthcare model, health Insurance exchange payers integration can only be made possible through the use of information technology and utilizing the internet as a medium to transmit data. Payers aiming to market their products through the Exchanges to exchanges projected million strong consumer pool, would need to have an IT system in place that integrates with HIXs internal networks to allow for seamless interchange of data.
Health exchange implementation administrators too need to work cohesively with the payers to draw out and shape a common strategy and vision to set up a robust IT infrastructure. At their end, states would also need to utilize federal resources and establish seamless connections with federal agencies and units such as the IRS, Treasury Department to verify health, income, citizenship and other demographical data to ensure that the data provided by consumers is true and accurate.
To help insurers easily integrate with the health insurance exchanges, some IT firms have designed scalable and affordable exchange connectivity solutions that can be integrated with insurers internal IT network to facilitate secure and easy data interchange with multiple healthcare participants. A few of these available solutions boast of useful functionalities such as automated plan management that allows insurers to update their plans and benefits simultaneously across different public health insurance exchanges. Some software packages come loaded with automated modules that allow insurers to automatically share and mail SLA agreements to recipients. Insurers may also feel the requirements to regularly update or upgrade their health plans and benefits. Some of these software modules, facilitating health insurance exchange payer integration, significantly simplify the management of plan benefits and rates through automated applications.
Under the PPACA, October 2013 until January 2014, has been defined as open enrollment period for individuals and small businesses to enroll in health insurance exchanges. The insurance exchange business model depends on the effectiveness and smart management of the health insurance exchanges payers integration, for it to be viable and successful. Insurers looking to market their health products through the public state exchanges or federal exchanges would need to quickly establish a smart IT structure that enables easy data interchange among various healthcare participants, to benefit from PPACAs health insurance exchange model.
by: Shaun Mike
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