Eligibility & Enrollment
According to the Patient Protection and Affordable Care Act (PPACA), eligibility and enrollment should be primarily achieved through a verification process in which an applicant or enrollee can declare, affirm, or document that eligibility requirements have been met so that enrollment in coverage occurs at the time of application or renewal.
Softheon Exchange Connector Eligibility & Enrollment can significantly reduce the administrative burden that the plan issuers will experience during enrollment, thus allowing the plans to focus on customer care. It streamlines the eligibility verification and enrollment processes, thus reducing the time and expense required to enroll each new participant. Plans can increase the number of enrollees while simultaneously increasing their perceived level of customer service. HIXs transmit enrollment and eligibility data extracted from multiple databases in real time to health plan issuers via the Softheon Exchange Connector. This extract provides all the eligibility information required to successfully enroll members. Softheon Eligibility & Enrollment makes the information available to health plan clients in a format that each plan can immediately use in its enrollment process.
Softheon Eligibility & Enrollment’s major features perform these tasks:
- Submits applications to initiate eligibility and enrollment processes
- Provides supporting documentation to HIXs as requested
- Interfaces with HIXs to receive entire enrollment, disenrollment, and termination, as well as update renewals
- Serves as an intermediary between health plans and HIXs to allow seamless initial enrollment processing as well as verifications against information for renewals
- Allows tracking of enrollments
- Provides reports and data with privacy protections as required
Opportunities and Benefits
Softheon Eligibility & Enrollment customized technology offers opportunities and benefits for health plans so that they may provide superior service to their consumers. Benefits include:
- Online, transparent, and easy to use
- Accommodates members with different online user capabilities and language preferences
- Seamlessly integrates with public and private plan options and enrollment process
- Verifies enrollment information both internally and externally
- Quickly responds to market demands
- Leverages existing investments in technology
- Lowers management costs associated with the acquisition and maintenance of technology
- Enhances reliability and extensibility
- Connects members with a range of human services programs, including health coverage
- Provides strong privacy and security protections
- Ensures the privacy of the data
- Controls function-by-function access by individual users with automatic error detection
- Identifies demographic discrepancies.
- Improves cycle time from application to enrollment
- No need to modify existing enrollment processes to interface with multiple exchanges
