Health Insurance Exchange Solutions

With coverage expansion provisions of ACA going into effect, it allows individuals to choose plans competitive both in price and in benefits, through the Health Insurance Exchanges established by the act. With the open enrolment in insurance products offered through the federal and state health marketplaces begins, individuals gain more control over how they spend their healthcare dollars. These new marketplaces will allow individuals with low to moderate income to purchase insurance eligible for government subsidies.

Though varying in numbers between agencies, according to estimates, it will attract 69 million new insurance customers in 10 years, thus opening an opportunities and challenges to health insurers. With the member-centric marketplaces, it will require major makeover on how the Insurance Payers are setup.

Business Challenges

  • Building a seamless system that generates health coverage options and enrolment in real time.
  • IT Systems should have the capability to generate transparent Data on program evaluation and performance management.
  • Requiring a massive simplification of eligibility and enrolment systems to accommodate the approximately 36 million citizens entering the HIX market.
  • Automation of medical eligibility determination to make the state exchange functional and usable.
  • Setting up of system for a seamless one-stop shop that must assure to serve individuals and families.
  • Documentation, proper flow of information between Medicaid, CHIP and the exchange and co-ordination with Centres for Customer Information and Insurance Oversight (CCIIO) who are overseeing the federal funding for the exchanges.

Our Services

Nous has domain knowledge of the different integration and interoperable systems to meet the ACA expectations. Nous understands the HIX well and can offer solutions in any of it's components, either through pointed solutions and whole-part solutions involving all major elements. Having Centers of excellence in each of the competence area helps Nous in providing the best solutions.

  • health insurance exchange services
    Development of HIX Web portal and Mobile portal.
  • Healthcare Payer Insurance Exchange
    Master Data management and maintain information flow between all stakeholders (Medicaid, CHIP and the Exchange).
  • healthcare insurance services
    Dedicated team (named TAC) having expertize in Technical assistance and customer support.
  • health exchange marketplace services
    Expertize team (named iDash) experienced in maintenance of the web servers in the state.
  • HIX Services
    Have an independent verification and validation team (named TesTree) capable in Auditing of Exchange system for Compliance (HIPAA, PHI, NIEM).
  • Performance testing for Healthcare portals Performance Testing of HIX Web portals and Mobile Portal.

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