Resolution of more than a million health insurance marketplace consumer inquiries
Case Study

Cognosante data reconciliation and standards expertise drives resolution of more than a million health insurance marketplace consumer inquiries

Challenge

To establish a process, build out an IT system, and onboard and train an analyst staff to respond to and resolve consumer inquiries about perceived errors on their healthcare tax forms.

Challenge

To establish a process, build out an IT system, and onboard and train an analyst staff to respond to and resolve consumer inquiries about perceived errors on their healthcare tax forms.

In the fall of 2013, the Affordable Care Act (ACA) entered its first open enrollment period. The following tax season, millions of consumers were exposed to the Health Insurance Marketplace tax form for the first time. This potentially confusing form, used for reconciliation at tax time, explains coverage obtained through HealthCare.gov and provides details on received premium tax credits (based on projected annual income as estimated at enrollment).

Solution: With more than 25 years’ experience supporting the implementation of large public health insurance systems and programs, Cognosante anticipated the risk associated with the distribution of these new tax forms and worked collaboratively with Centers for Medicare & Medicaid (CMS) to plan a response strategy for consumer inquiries, as well as the case analysis support services this new process would require.

In just four weeks, Cognosante mobilized a large team of data reconciliation specialists. Over a six-month period, this team managed issues ranging in complexity from simply mailing out another tax form to highly complex cases requiring updates to coverage dates, premiums, and tax credit information. The work encompassed consumer and health plan customer support, expert analysis of EDI transactions, secure data exchange, case management, data reconciliation, and detailed reporting on case type and workflow analytics.

Cognosante’s data standards experts include former state, provider, and insurer employees with extensive experience navigating Marketplace and Medicaid data. A deep understanding of data and transaction standards used in health IT systems ensured accurate and timely issue resolution despite the large volume and complexity of inquiries received.

Result: Through the first tax season, Cognosante has resolved more than a million cases for consumers who reported issues with their tax forms.