Healthfirst, a New York-based not-for-profit managed care organization offering health insurance to individuals and families living in the New York metro area, has selected the Infogix Cost Sharing Reduction Solution to accurately forecast financial formulas under the Patient Protection and Affordable Care Act (ACA) healthcare reform legislation, while also ensuring the integrity of associated data, according to the vendor. Infogix, based in Naperville, Ill., specializes in software that automates the monitoring and analysis of operational data.
The ACA requires that insurers/payers reconcile relevant Cost Sharing Reduction (CSR) data with the government on an annual basis in order to calculate CSR reimbursements. Infogix’s Cost Sharing Reduction Solution allows companies to conduct the required reconciliation while providing data integrity and visibility into overall management of cash flow, the vendor says.
“In this new world of health care reform, there are myriad complexities to the legislation and the processes, and if you’re not on top of all of it, it can make a huge financial impact,” comments Robert Ruocco, VP, Information Systems, Healthfirst. “We ultimately made the decision that investing in the quality of the Infogix Cost Sharing Reduction Solution just made the best business sense and will, at the end of the day, protect our members, for whom the legislation was intended to help.”
The Infogix Cost Sharing Reduction Solution for Healthfirst will include automated and customized controls, government advanced payment monitoring, detection of missing or out-of-balance payment, monthly forecast on expected vs. actual reconciliation reports and charts, and centralize dashboards of all CSR-related metrics, according to Infogix. The vendor reports that the following capabilities influenced Healthfirst’s selection of the Infogix Cost Sharing Reduction Solution:
- Forecast and determine the difference between actual cost sharing for the member and the cost sharing under the hypothetical applicable plan;
- Capture source data from various sources requires to calculate the difference;
- Map claims and claim lines to plan information and benefits information;
- Calculate CSR amount
- Manage discrepancies identified during reconciliation