Cost Sharing Reduction Solution

Reduce Compliance Risk & Improve Reporting Accuracy With a Cost Sharing Reduction Solution

Simplified or Standard?

As part of the original regulations brought forth by the Affordable Care Act (ACA), health plans scrambled to lock down a methodology (either simplified or standard) for estimating individual member subsidies based on actuarial calculations of members’ out-of-pockets costs. The accurate reporting of this critical Per Member Per Month (PMPM) value to the government is key, as reimbursement funds and fines all rely upon its integrity.

New CMS Guidelines for Reconciliation Now, payers have the opportunity to switch from simplified to standard reconciliation reporting and have until April 2016 to prepare. For payers looking for a cost-effective way to meet the annual reporting requirement, or with limited resources, Infogix provides the simplified or standard Cost Sharing Reduction report required by CMS and the claims calculation and reconciliation logic to calculate the results. For payers looking for a more robust and scalable solution, our platform is flexible and grows with your business processes and data management needs. Infogix provides pre-configured reconciliations and business rules logic to support a wide range of claims systems and plan designs which run automatically on an ongoing basis. And to assist in the operational aspects of managing this data, the solution provides an additional layer of business reporting and exception management workflow capabilities at a competitive price.

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Benefits of the Infogix Cost Sharing Reduction Solution

  • Independence and Assurance: Runs independent of existing claims administration systems. Should a change in a claims systems vendor or Third Party Administrator occur, the Cost Sharing Reduction Reconciliation solution will continue to operate accurately with the relevant benefits administration and adjudication logic. In addition, the Infogix solution provides an added layer of assurance that your existing claims are being adjudicated accurately.
  • Real-Time Visibility: Runs automatically or on-demand as often as needed, enabling you to understand and track the current status of Cost Sharing Reduction receivables at any moment.
  • Customizable: Changes to any benefits or adjudication logic is quick, easy, and cost effective.
  • Cost and Operational Efficiencies: Supports diverse needs such as Advanced Premium Tax Credit and Membership Reconciliation, EDGE Server Data Management and Claims/Member Analytics offering you more value.
  • Best Practices and Knowledge Sharing: Provides best practices on leveraging ACA requirements to improve business operations, including but not limited to process efficiencies, regulatory compliance, and member population insights.
  • Cloud or On-Premises Offering: Flexible options to choose from based on IT priorities, budget, and deployment time frame.

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Proven Technology

  • Infogix has 30+ year proven technology that provides health plans a complete solution to meet their Cost Sharing Reduction needs
  • Pre-built validations, re-calculation of claims, real-time reports, and dashboards, coupled with the ability to cater each to the personalized needs of your organization result in a solution that can accurately provide your PMPM amount for CMS reporting
  • Infogix also provides up-to-date tracking of CMS requirement changes, which equate to timely updates provided to your implemented CSR solution

“In this new world of health care reform, there are myriad of complexities to the legislation and the processes, and if you’re not on top of all of it, it can make a huge financial impact. We ultimately made the decision that investing in the quality of the Infogix Cost Sharing Reduction Solution just made the best business sense and will, at the end of the day, protect our members, for whom the legislation was intended to help.” Robert Ruocco, VP, Information Systems, Leading Healthcare Insurer