Comprehensive Healthcare Enrollment and Subsidy Management Program
This program focuses on Affordable Care Act Marketplace Enrollment and Subsidizing, post-enrollment subsidy processes, and financial management. It includes identifying eligible patients, coordinating enrollment, managing subsidies, and ensuring proper documentation. The program aims to provide support to patients and streamline the subsidy process for efficient healthcare coverage. Detailed calendars and budget projections for 2017, 2018, and 2019 are also outlined in the content.
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Presentation Transcript
Affordable Care Act Marketplace Enrollment and Subsidizing Identification of all potentially eligible patients based on existing financial assistance information. Criteria for Marketplace eligibility is included in Verity Source programming and Marketplace eligible identifiers are placed to facilitate reporting . Advance Planning Communication with eligible households starts early and continues up to open enrollment. Harris Health multi disciplinary planning committee developed to plan all aspects of the project. Identification of the third party coverage/plan that will be subsidized. Contracted with multiple third party enrollment agencies to perform telephonic and face to face enrollment. Involved in the training of the agents Alpha split of referrals amongst agencies Automated referral processes Tracking of all referrals occurs
Post-open Enrollment Subsidy Process Specific support team developed to handle day to day issues, invoice reconciliation and coordination of various documentation requirements that may impact coverage. Special phone line established for the subsidized patients . Reconciliation of monthly invoice to ensure valid payments are being made. Registration system is updated with Marketplace coverage information . Special Enrollment Period throughout the year for newly eligible patients.
Calendar 2017 Calendar 2018 Calendar 2019 Projected Average Monthly Membership Projected Approximate Reimbursement Budgeted Average Monthly Membership Approximate Subsididies Paid Average Monthly Membership Approximate Subsididies Paid Projected Approximate Subsididies Approximate Reimbursement Approximate Reimbursement 3,699 $1.2m $6.9m 9,675 $13m $20.7m 14,363 $23.8m $42.7m
