Member Premium Reconciliations

Automate the financial reconciliation related to your exchange-driven membership.

Infogix provides two offerings tailored for both state and federal marketplace requirements to fully automate the complex reconciliation process to ensure compliance, maximize revenue and provide flexible reporting and dashboards.

Marketplace 820 Policy-Based Payment Reconciliation

The solution reconciles 820 files (and optionally PPR files) with member payment data, on a schedule you define, and generates exception reports of items requiring research and ultimately generates the 820 dispute form for CMS.

Member Premium & APTC Reconciliation

The solution reconciles APTC payments with member payment data to ensure that each invoice is completely paid. It will generate exception reports of items requiring research. The Infogix solution monitors payment details, so potential issues can be quickly identified at the source.

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Member Premium & Policy-Based Reconciliations

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Marketplace Membership Reconciliation

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The Affordable Care Act (ACA) provides new coverage options to millions of new members. These new options create several challenges yet offer opportunities to integrate new channels into a payer’s existing business. As member premium and APTC payments are paid, and claims are processed, reconciliation challenges continue to be a focus due to the complexity and volume of information being processed.

Payers turn to Infogix to solve the many challenges that accompany constant reform and looming deadlines such as these:

  • Fully automating the monthly reconciliation of the Preliminary Payment Report (PPR) and 820 with the payer’s membership and billing system and generating the 820 dispute form.
  • Preventing missing, duplicate, or inaccurate member invoices from being sent
  • Determining inaccurate or delayed member and subsidy payments
  • Analyzing received payment versus expected payment discrepancies
  • Identifying monthly adjustments that may not reconcile with outstanding balances

Specific analysis provided around payments reconciliation includes:

  • Tracking estimated APTC and premium payments at the member level
  • Reconciling incoming estimated payment details with actual payments from billing systems
  • Providing real-time visibility into expected versus actual payment collections
  • Reconciling APTC and CSR payment submissions with 834 membership data and 820 payments.

View our data sheets for Marketplace Membership Reconciliation as well as Member Premium and Policy-Based Payment Reconciliations.

How We Can Help

The Affordable Care Act offers health plans a variety of new revenue opportunities. By doing the financial reconciliation related to your exchange driven membership, you can ensure that you are capturing all the revenue from the new members and subsidies available from the government. You’ll also maintain the necessary compliance, avoiding misreported enrollment information and associated fines and customer service issues.