We Serve the Health Insurance Exchange
Purpose-built solutions for unique markets
Tackle the challenges of government-sponsored plans with Convey’s expertise and understanding of regulatory requirements.
With a focus on plans that include the Health Insurance Exchange, we help issuers like you manage the burdens created by the influx of files for analytical or data correction purposes, the high volume of discrepancies, and Exchange response reporting.
And for issuers with agents selling their Affordable Care Act (ACA) plans, we provide an agent management platform that ensures they are in compliance, ready to sell, and compensated accurately.
Designed to support government programs
Technology and support solutions designed specifically for government-sponsored plans rely on industry-leading processes to deliver results in this continually evolving market that ensure fraud, abuse, and headline risk are minimized.
Our dedicated compliance and quality teams partner with your team to guarantee:
- compliance with changing healthcare trends, guidelines, rules, and government regulations,
- understanding and interpretation of regulations,
- employees follow regulations and requirements,
Working with unique state-based marketplace models with varying levels of sophistication, we deliver multiple solutions for Marketplace issuers
We adhere to the Seven Elements of an Effective Compliance Program (OIG), and our robust security framework is HITRUST Certified and HIPAA & CMS compliant.
Tailored suite of solutions for complete agent management
Elevate and streamline the agent and broker sales cycle, from pre-enrollment to renewal. Our Miramar:Agent solution offers a better way to navigate your sales management process. Improve scalability with advanced agent onboarding, oversight, plan comparison and enrollment portals, telesales services, and commissions management.
Award-winning data environment for ACA risk adjustment
The Pareto Hub (data management platform) collects, processes, and stores risk adjustment data, giving users full access to analytics and strategic insights to make informed decisions and improve broader revenue goals.
Data lake, artificial intelligence, and open-source big data technologies allow us to ingest data in all formats and types at scale. We then organize them with appropriate data governance mechanisms within our data catalog and provide efficient configuration capabilities to democratize data access and analytics so that you benefit from:
- actionable insights into provider and point-of-care performance
- end-to-end data quality that improves EDGE submissions and PLRS accuracy
- generating response files to drive corrections with HHS
- correct orphans to ensure subscribers have access to care and the plan is receiving payment
- interim reconciliation to minimize timing issues
Annual ACA market analysis
We deploy an interactive analysis of the Department of Health and Human Services (HHS) Summary Report on Risk Adjustment Transfer Payments for the Affordable Care Act market each year. The analysis includes year-over-year (YOY) comparisons of state average metrics, issuer transfer payments, and high-cost risk pool payments.
Proven financial data reconciliation management
Miramar:Reveal has supported the reconciliation of payment data since 2007 with rigorous, compliant, and transparent workflow controls that ensure the accuracy of your operational process and resulting payments.
Convey reconciles approximately 12 million members regularly, including 48% of the ACA market to:
- create discrepancy cases when there are differences between Federally facilitated Marketplace (FFM) data and the issuer
- identify enrollment and payment disputes for submission to HHS
- import dispute response files (ERRD) for tracking and additional remediation
- generate response files to drive corrections with HHS
- correct orphans to ensure subscribers have access to care and the plan is receiving payment
- reconcile on an interim basis to minimize timing issues
Our solutions support Commercial and Medicare markets, too. Explore how.
