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Health Insurance Marketplace

HC3 Advisors supports Qualified Health Plan Issuers in offering programs on the FFM, SBM and Partnership Exchange Marketplaces. Our clients leverage HC3's industry experience in plan operations, business process and regulatory compliance for their Exchange based programs. We provide guidance to health insurance Issuers regarding the certification standards for individual and/or Small Business Health Options Program (SHOP) Qualified Health Plans (QHPs) offered through the federal Health Insurance Marketplace

Filing Process

Guidance to health insurance issuers regarding the certification standards for Individual and/or Small Business Health Options Program (SHOP) Qualified Health Plans (QHPs) offered through the federal Health Insurance Marketplace “Exchange”.

 

HC3 Advisors will assist in developing the timeline and actions that your business needs in order to:

  • Developing the Filing Strategy

  • Preparing QHP Templates

  • Managing the Objection process

Electron File Management

Organizing and sending data between health care exchange parties has always been a complicated process. With new government mandates just around the corner, EDI requirements will continue to be an important part of healthcare business practices moving forward.

 

  • Enrollment and Disenrollment in a Health Plan (834) transaction

  • Health Plan Premium Payments (820)

  • Health Claim (837) transaction

  • Eligibility Inquiry/Response for a Health Plan (270/271)

  • Health Claim Status (276/277)

  • Healthcare Remittance Advice (ERA) (835)

 

Compliance

HC3 Advisors' Consultants are here to assist you in navigating the ever-changing regulatory and compliance environment. Working with issuers and CMS to ensure their organizations are in compliance with The Affordable Care Act (ACA).  The compliance challenge requires an organization to change behavior by providing.

 

  • CMS Monthly Baseline and Reconciliation process

  • Machine Readable Provider Directory

  • Are your members getting an accurate view of your network

  • Learn what you can do to ensure your network information is correct

 

 

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