CMS announcement regarding 820 payment files and the interim process poses a new challenge for Issuers in the Health Insurance Marketplace
It’s a rough road ahead for Issuers trying to get paid in the Health Insurance Marketplaces.
The latest announcement from CMS on Monday, December 2, 2013 related to payment process changes for the Health Insurance Marketplace present yet one more challenge for Issuers. As GHG predicted several weeks ago, each new phase of the rollout is going to have bumps in the road or road closures in some cases.
The announcement that 820 Payment Files will not be issued in January to track detailed subscriber payments for Advance Premium Tax Credit (APTC) and Cost Sharing Reduction (CSR) subsidies is a total road closure. Please follow the Detour signs if you want to get paid.
The detour, in this case, is an interim process designed to allow the Issuers to get paid the subsidies they need in order to operate this line of business. But it will not come easily. The burden has been shifted from the government back to the Issuers to produce a monthly file requesting payment for the subsidies.
While this seems simple on the surface, the last minute changes present several challenges that must be solved:
- Ability to develop new systems and processes to accurately calculate data fields needed for payment
- Transition from interim process to 820 files once they become operational
- Effective 820 and total premium reconciliation following interim process
For GHG’s take on each of these critical areas, listen to our podcast where I dive into particular details regarding each one. Access the podcast now >>
Resources
Every health care organization is looking for improved outcomes, better compliance and enhanced process efficiency when it comes to managing membership and premium payments. GHG’s Valencia was designed specifically to meet those needs.
GHG announced its partnership with TriZetto to offer an end-to-end reconciliation solution that will enable health care payers to successfully participate in the Health Insurance Marketplaces. Together, Valencia™ and TriZetto will provide health plans the necessary reconciliation capabilities needed to analyze data quickly and efficiently. Learn more about the service >>
Join us December 11 from 2:00 — 3:30 pm ET for a lively session with Gorman Health Group strategy and data analysis experts who will discuss actual case studies that show how plans can mine data for precious insight that can help improve performance. Register now >>