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Health plans participating in the ACA Marketplace should make it a top priority to effectuate coverage immediately after enrolling through Pay Now by automating binder payments. Providing enrollees the option to pay immediately after enrolling during Open Enrollment increases effectuation and retention but requires planning and connectivity.

Health plans have added challenges with converting an enrollee to a member due to the utilization of multiple distribution channels including:

  • Brokers
  • Self-Enrollment
  • State-Based Marketplaces (SBMs)
  • Enhanced Direct Enrollment Platform (EDE)

Converting Enrollee to Members

Investing in a Pay Now option allows enrolls to submit the binder payment immediately after enrolling regardless of what distribution channel they utilize. Granting the member the option to pay upon enrollment reduces membership drop-off between enrollment and the due date of the first payment, a period that many health plans struggle with.

Connecting with Outside Parties to Automate Binder Payments

Health plans can facilitate the Pay Now options by working with a trusted technology partner that connects internal payment platforms to CMS or SBMs. Upon submitting plan fillings to the Centers for Medicare & Medicaid Services (CMS) or SBMs, health plans receive a specific payment URL that redirects the enrollee to the payment platform.

Through Pay Now, member payment information will be available to health plans before their enrollment information, typically featured on nightly 834 files, arrives. Health plans will need to integrate with CMS or SBMs to link payment and enrollment information when the standard 834 file becomes available. SAML connectivity allows Exchanges to convey needed member information and provides a specific number linking the payment to the 834 enrollment transaction.

Robust communication between health plans and Exchanges allows for the enrollees to become members before the enrollment information becomes available, sharply reducing the number of enrollees lost before submitting their first payment.