Cognosante helps resolve application and eligibility issues to aid consumers in obtaining health insurance
Case Study

Cognosante helps resolve application and eligibility issues to aid consumers in obtaining health insurance

Challenge

To quickly and accurately review and process applications for health insurance received through Healthcare.gov in order to identify and resolve inconsistencies preventing consumers from obtaining coverage.

Challenge

To quickly and accurately review and process applications for health insurance received through Healthcare.gov in order to identify and resolve inconsistencies preventing consumers from obtaining coverage.

In October 2013, the Affordable Care Act (ACA) officially allowed consumers to enroll for health insurance. During open enrollment, millions of consumers attempted to obtain health insurance through the Federally Facilitated Marketplace (Healthcare.gov). Many consumers who applied for coverage had experienced a change in life circumstances—a new job, a new child, or loss of prior health insurance coverage, to name just a few—that impacted their qualifications for exemptions to health insurance coverage requirements or federal subsidies that might make insurance more affordable.

Solution: Cognosante proposed a solution through which applications could be reviewed and processed to identify and resolve inconsistencies between the information provided by applicants and what the Federal government had on file. Essentially, the project team combines high throughput document management with direct applicant collaboration, ensuring the timely and accurate resolution of inconsistencies.

Using systems integrated into the direct data interfaces of Healthcare.gov, Cognosante staff reviewed submitted applications, identified application inconsistencies, and reached out to impacted consumers to resolve inconsistencies and complete eligibility determinations.

Result: Millions of consumers who might not have otherwise qualified for insurance subsidies or exemptions from the requirement to have health insurance have now been accurately determined to be eligible.