Overview
Prominence Health was seeking a partner capable of reviewing, dissecting and actioning complex healthcare legislation in a short timeframe to ensure ACA/QHP compliance and mitigate financial risks.
Specific Challenges
- Insufficient internal resources to review and act upon state legislation changes
- Difficulty retaining and attracting talent to support their growing needs
- Potential financial impact due to new legislation
- Tight timeframe for compliance with new legislation
- High filing error rates in existing operations
Solutions
Our team reviewed and analyzed ten legislative bills, totaling 242 pages, leveraging ClearFile’s Knowledge Base feature. We identified key implications, created an abridged 6-page version with recommendations, and updated member contracts (EOCs) accordingly.
What We Uncovered
An error rate of 20% was identified, indicating that members were at risk of receiving health plans with administrative errors. A lack of standard operating procedures was contributing to these operational inefficiencies.
Client Success
In an extremely accelerated time frame of just four weeks—where typically several months would be needed—we guided our client to successfully comply with new legislation, executing Binder, Form and Rate Filings on time – for the first plan year. This included the creation of a standard operating procedure for legislative review and the reconciliation of the 20% error rate, correcting over 10,000 cost-sharing errors across three plan designs.
Looking Forward
We aim to support our client with further legislative reviews, continuing to break down barriers and ensure the successful delivery of compliant ACA health plans. Year-2 plans include a post-mortem analysis on their operational processes and continuous improvements based on our findings.
