HHS wants to improve its technical communications with federal marketplace plans next year, Kevin Counihan, CEO of Healthcare.gov, at AHIP's Exchange Forum, said Thursday.
Counihan also reminded payers about an upcoming deadline to submit their risk adjustment claims data, which has been coming in slower than the department had anticipated it would.
“For 2015, we prioritized the customer experience and in 2016 we're focusing on improving and enhancing issuer-facing infrastructure,” Counihan said.
Improvements are expected to include increased automation of back-end payments to insurance companies, and a smoother process related to 834 forms. These files contain an individual's demographic information and plan selection.
The changes are needed, said officials from three major plans who spoke on a later panel on future priorities for HealthCare.gov.
“We still face a number of challenges on the operational side,” said Don Petrym, program manager, healthcare reform, at BlueCross BlueShield of Tennessee.
One is a phenomena known as “orphaned enrollment” in which a person will reach out to a plan and say he or she is covered, but the company will have no record of such coverage.
Counihan also raised concerns about some payers potentially losing out on payments they may be owed by HHS.
The Affordable Care Act created the risk adjustment program to protect against adverse selection. This provision was included to compensate insurance companies, which are now prohibited from charging a premium based on health status.
Plans that feel they should receive a payment need to submit 2014 claims data by April 30, so HHS can notify issuers of payments owed no later than June 30. More response were expected at this point and HHS is concerned because it hasn't heard from many insurers yet.
“Clearly, we have got some issuers further ahead than others, and we have some issuers, to be quite frank, that haven't submitted anything at all,” Counihan said. “One of things I would like to underscore is the critical importance that all issuers get their data in ... in order to make our payment timeline.”
Follow Virgil Dickson on Twitter: @MHVDickson
