AUTOMATED PREMIUM RATE PROCESS

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Engagement Summary

All new small business groups and small business groups changing plans will be required to purchase ACA compliant plans. A process exists that automated the rate load for ACA plans which doesn’t automate Non-ACA plans.

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Challenges

  • Health Plan have very specific Premium rates based on various factors which include age, gender, location, industry, health habits and other factors.
  • Due to which Premium rates that need to be loading into Membership & Billing application (Facets) can go up to million records for a large health plan.
  • Manually loading the Premium rates is very expensive, time consuming, error prone and insecure.
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Solution

  • Automated solution was developed with following features.
  • Business/Underwriting had the ability to load Premium rates directly without any manual intervention.
  • Business has the ability to view the validation failed records.
  • Thousands of records were loaded in seconds.
  • Reads the rates available for multiple plans on different tab of underwriting file at a time and loads after all the business validation.
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Results

  • 100% Premium rates were loaded without any errors.
  • Business was able to save months of manual entry time.
  • Health Plan saved millions on a yearly bases.
  • Application was developed for Affordable Care Act plans but the solution is now used for all lines of business.

Best Practices:

  • Designing dynamic tool enabling ability to handle upcoming or future products rates.
  • Usage of wraparound technologies that can complement the system and provide an alternative technology for business functionality.