BROOKFIELD, Wis., Nov. 27, 2012 /PRNewswire/ -- Connecture, Inc., the leading provider of Web-based information systems used to create health insurance marketplaces and exchanges, today announced the immediate availability of a new Health Plan Management module of StateAdvantage, the company's commercial off-the-shelf product suite that enables states to efficiently create and operate consumer-friendly health insurance exchanges. The new module includes all of the capabilities states need to quickly qualify licensed health plans, offer them in public exchanges, and manage their use. Now, states can attain everything needed for effective health plan management from a single, consolidated solution.
As defined by the Patient Protection and Affordable Care Act, health insurance exchanges (HIX) address five functions: consumer assistance, financial management, enrollment, eligibility and plan management. At the most basic level, states have three choices: They can create a state-run HIX in which the state controls all exchange functions, participate in the federally-facilitated exchange in which that authority falls to the federal government, or take part in a federal partnership exchange. States were to inform the U.S. Department of Health & Human Services (HHS) of their intended plans on November 16, 2012; however, they now have additional time (until December 14) to file their final HIX blueprint with HHS.
The federal partnership exchange, in which the state controls the plan management and/or consumer assistance functions, is attractive to many states because it enables them to maintain control over the state's health insurance market and reserves the flexibility to move forward with a state-run exchange in the future. Effective plan management is also absolutely crucial to ensure that qualified plans remain in compliance with all agreed upon terms, including rates, benefits, participating doctors, etc. For these reasons, effective plan management is critical for successful state or partnership exchanges, and therefore, healthcare reform.
The health plan management module of StateAdvantage encompasses technologies perfected over 15 years providing the health insurance industry with Web-based solutions currently used by more than 25 million Americans to shop for and enroll in health plans online. Connecture's commercial clients include more than half of the nation's 20 largest carriers and more than half of all Blue Cross and Blue Shield plans. More than one million businesses rely on systems from the company. To date, Connecture is supplying the shopping and enrollment functions of the American Health Benefit Exchanges (AHBE) and Small Business Health Options Programs (SHOP) exchanges in Maryland and Minnesota.
- Issuer account management: StateAdvantage includes workflow processes consistent with best practices and the accepted protocol of the health insurance industry to make it as easy as possible for carriers to offer licensed plans for qualification, and ultimately, use in public exchanges.
- QHP certification and agreement: With the new module, workflows associated with the qualification of health plans and the resulting agreements are streamlined, tracked and managed with utmost precision and reliability, ensuring that certification is thorough and fast.
- Monitoring of all participating health plans: State regulators can easily monitor participating health plans for compliance with all agreed terms commensurate with their qualification in adherence with the requirements of the ACA, including rates, coverage levels, procedures covered, participating physicians and networks, and the myriad variables that address individual taxpayer's needs.
- Plan renewal and certification: Connecture automates the renewal process to ensure that carriers and states alike are always informed of contract status and pertinent renewal deadlines, a capability of singular importance for its legal and compliance implications.
- Rate and benefit collection: The newest module of StateAdvantage makes rate and benefit collection faster and easier than ever before – easily processing numerous file formats in real-time to deliver exceptional, up-to-the-minute accuracy.
- Easy integration with the federal exchange and the National Association of Insurance Commissioner's (NAIC) System for Electronic Rate and Form Filing (SERFF): Using accepted standards and platform and system-agnostic, all modules of StateAdvantage can be easily integrated with federal and industry systems – negating the need for costly and complex integration projects.
- Turn-key use with additional StateAdvantage modules: The plan management module is designed for turn-key use with Connecture's shopping and enrollment modules (optimized to ensure that the process is as intuitive as possible for consumers) and tools that make getting assistance from navigators and brokers easy. StateAdvantage offers workflows, tools, and time-tested expertise that enables navigators to effectively offer assistance in-person and remotely.
"Many states have a proud track record of determining which plans best serve their citizens," said Dan Maynard, president of Connecture. "Our Health Plan Management module for StateAdvantage combines the proven technologies required for effective plan management with capabilities that deliver the transparency and efficiencies states need to keep costs down. Departments of Insurance can now move forward with confidence that their plan management efforts will result in more choices for taxpayers, a streamlined process for carriers and compliance with federal law – all while avoiding ambitious custom software development schemes and the costly delays that go with them."
For more information on Connecture's Health Plan Management offerings or to speak with the company's leaders at the MTG-Health Insurance Exchange Plan Management Forum VI or at the NAIC Fall 2012 National Meeting in Washington, D.C., call (866) 274-6759 or email [email protected].
Connecture is the leading provider of Web-based information systems used to create health insurance marketplaces and exchanges. Its industry-proven solutions enable consumers, employers and brokers to more easily shop for, purchase and renew health insurance while minimizing back-office administrative expenses for health plans. Connecture's solutions are provided to health plans, state insurance exchanges, private exchanges and insurance brokers. More than 25 million Americans shop for their health insurance through systems built by Connecture, and more than half of the nation's 20 largest plans rely on them to sell, administer and manage their plans and products effectively. For more information, visit www.connecture.com.
Davies Murphy Group