The Patient Protection and Affordable Care Act (ACA) empower consumers to choose health plans that suit their individual needs. Healthcare Payers need to realign their strategies to stay competitive in the changing marketplace.

HIX Enablement: Seamlessly Connect Core Platform to Health Insurance Exchanges

BUSINESS BENEFITS

DELIVERING EXCELLENCE

• 25-30%fastertime-to-market,leveragingSyntel’sunderstandingofleadingcoreadministrationproductssuchassuchasTriZettoFacets,IKA,MetavanceandHealthEdge

• 15%lowerTotalCostofOperations(TCO)witheasysetupandmaintenanceofstateorexchange-specificrules,

• EDI/HIPAAcompliantfor820paymentand834enrollmenttransactions

• Reusabletestingrepositorytomanagerecurringsystemchanges

• EnabledHIXenrolmentsforaleadingPayertointegratethreestateexchangeswithmorethanfiveSHOPandsevenfederally-facilitatedexchanges(FFEs)intothelegacycoresystem

• IntegratedaregionaleastcoastPayerwiththestateexchangeandbuiltcustominterfacedtoenablememberenrollmentforaleadingcoreoperationsproduct

HealthcarePayersareredirectingtheirstrategicfocustoassessingthenewmembershipandincreasingtheirmarketsharealongwithshiftingtheiroperationalfocustoimprovingtheirITcapabilities.Thisisnecessarytosupportpost-reformplandesignandmanagement,automatingmanualprocessesusedtoquicklyachieveexchangecompliance.

Withtheshiftinthestrategicandoperationalfocus,Payersfacechallengesassociatedwithintegrationoftheirexistingsystemswiththeexchanges,andcombinedifferentapproachesandprocessesacrossstates.Someofthesechallengesinclude:

• Handlinglarge-scalereconciliationofenrollment,memberandpaymentdata• Trackingseparatepaymentsfromdifferentsourcesforasinglepremiumamountfor

members• Codingandmaintainingstate-specificrulesrelatedtoeligibility,enrollmentand

payments• Identifyingandresolvinggapsinfederalpaymentsduetovariationsinsubsidy

calculations

PayersneedtopartnerwithanexperiencedITsolutionsproviderinthehealthcareindustry,toseamlesslymigratetoanadvancedITplatformandtransformtheirbusinesstowardscapturingandretainingHIXmembers.

Syntel’s Solution

Syntel’s Health Insurance Exchange Enablement SolutionenablesPayerstoaligntheirexistingbusinessprocessesandITinfrastructurewithStateorPrivateHIX.WeenablePayerstobuildinterfacesforvariousstateexchangesandcustomizetheirexistingsystemstosupportHIXinterfacingandbusinessprocesses.

OursolutionenablesthecorefunctionalitiesinvolvedinHIXenablement,including:

Syntel Exchange Enablement Solution

Financial Management

HIX Enablement Solution Plan Management

Enrollment Services

Portals Agent, SHOP, Member

Syntel

Formoreinformation,visitSyntelonlineatwww.syntelinc.com orcallusatUS/+1 (248) 619-3503, UK/+44 (0) 207-636-3587

HIX Enablement: Seamlessly Connect Core Platform to Health Insurance Exchanges

©2014,SYNTELINC. 052014

WHY SYNTEL ? Syntel’sHIX EnablementsolutionofferscomprehensiveServiceOrientedArchitecture(SOA)basedintegration,remediationandtestingframeworktobuildinterfacesforvariousstateexchanges.

Key Features of our solution includes:• Multi-stateexchangeintegratedwithbackendtablesthroughasingleSOAhub• BusinessRulesManagementSolution(BRMS)tocaptureandmaintainexchangerules• Interfacedesignbuild-upbackedbyarichtradingpartnerintegrationexperience• Ensurequalitycertificationoftransactionsandspeeduptestingphasewithreusable

BusinessProcessTestRepository(BPTR)• BPMdashboardstomonitor,trackandplancompliancelevels,andensuretimely

processes

Health Insurance Exchanges

Syntel HIX Enablement Services

- EDI transaction Interfacing (834 and 820)- Validation of Enrollment & Disenrollment- Pre-enrollment business validations - On boarding with private exchanges or in-house e-stores - Member and Group Portal Enhancement- Remediation of Agents and facilitator/navigator management

- Payment and Tax/premium credit reconciliation- Premium Processing and system updates- Remediation of claims and accumulators systems- Business Rules configuration Benefit, Plan, Product Configuration

- New Plan Performance Analytics and Monitoring- Data Analytics and competitive Analysis- Cross sell and Up sell- HIX and CMS Regulatory Reports including edge server reporting for risk adjustments and reinsurance- Tracking plan compliance levels and discrepancies- Member Retention and Recapture

Enrollment Enablement Core Administration Analytics and Reporting

Payer Membership ,Financial and Adjudication Systems

Payer Systems

Enabled 3 state exchanges , more than 7 federally-facilitated exchanges (FFEs) and 4 SHOPs

End to End Testing Reusable Test Repository Domain-based Business Process Testing Repository (BPTR) framework

Individual Employer Employee

Testing

Edge Server