Insurers Doubt Feds HIX Readiness

Jacqueline Fellows, for HealthLeaders Media , February 27, 2013

The building blocks of the plans, prices, and infrastructure depends on data, and that, says Gier, is something insurers are worried about, specifically, reconciling records.

"Historically, insurers have maintained a single system of record for member enrollment, claim and payment information," says Gier. "Now, however, insurers will need to reconcile their detailed member records with those maintained by the HIX on at least a monthly basis. They also have to verify that the information contained in both systems is accurate to confirm eligibility, credit premiums, ensure correct payments and provide good customer service."

Digging into the daily details of how these exchanges will work illustrates the complexity of the systems needed to keep the numerous networks of information running smoothly. The collaborations required also illustrate the delicate balance states have to maintain with insurers and providers.

"Another concern is the potential for ongoing change to HIX formats and standards. As each HIX gets up and running, there will be fixes and changes to make things run more smoothly," says Gier.

"All of those will require adjustments by the insurers to maintain interoperability with the HIX systems and business processes. Insurers will need to make sure whatever system they use is flexible enough to accommodate all of the inevitable changes coming down the road after implementation."

The survey also reports that most health insurers (55%) plan on being part of more than one HIX. That means an even heavier reliance on IT systems that can maintain interacting with multiple sets of requirements, based on the HIX model. However, most insurers saying they'll participate in more than one exchange is a key take away, and perhaps an indication of the confidence healthcare organizations have in finding more opportunities than challenges in the new health insurance exchanges.

Jacqueline Fellows is an editor for HealthLeaders Media.
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