Syntel’s Health Insurance Exchange Enablement Solution


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Syntel’s Health Insurance Exchange Enablement Solution enable Payers to build interfaces for various state exchanges and customize their existing systems to support HIX interfacing and business processes.

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Syntel’s Health Insurance Exchange Enablement Solution

  1. 1. 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% faster time- to-market, leveraging Syntel’s understanding of leading core administration products such as such as TriZetto Facets, IKA, Metavance and HealthEdge • 15% lower Total Cost of Operations (TCO) with easy set up and maintenance of state or exchange-specific rules, • EDI/HIPAA compliant for 820 payment and 834 enrollment transactions • Reusable testing repository to manage recurring system changes • Enabled HIX enrolments for a leading Payer to integrate three state exchanges with more than five SHOP and seven federally- facilitated exchanges (FFEs) into the legacy core system • Integrated a regional east coast Payer with the state exchange and built custom interfaced to enable member enrollment for a leading core operations product Healthcare Payers are redirecting their strategic focus to assessing the new membership and increasing their market share along with shifting their operational focus to improving their IT capabilities. This is necessary to support post-reform plan design and management, automating manual processes used to quickly achieve exchange compliance. With the shift in the strategic and operational focus, Payers face challenges associated with integration of their existing systems with the exchanges, and combine different approaches and processes across states. Some of these challenges include: • Handling large- scale reconciliation of enrollment, member and payment data • Tracking separate payments from different sources for a single premium amount for members • Coding and maintaining state-specific rules related to eligibility, enrollment and payments • Identifying and resolving gaps in federal payments due to variations in subsidy calculations Payers need to partner with an experienced IT solutions provider in the healthcare industry, to seamlessly migrate to an advanced IT platform and transform their business towards capturing and retaining HIX members. Syntel’s Solution Syntel’s Health Insurance Exchange Enablement Solution enables Payers to align their existing business processes and IT infrastructure with State or Private HIX. We enable Payers to build interfaces for various state exchanges and customize their existing systems to support HIX interfacing and business processes. Our solution enables the core functionalities involved in HIX enablement, including: Syntel Exchange Enablement Solution Financial Management HIX Enablement Solution Plan Management Enrollment Services Portals Agent, SHOP, Member Syntel
  2. 2. For more information, visit Syntel online at or call us at US/+1 (248) 619-3503, UK/+44 (0) 207-636-3587 HIX Enablement: Seamlessly Connect Core Platform to Health Insurance Exchanges © 2014, SYNTEL INC. 052014 WHY SYNTEL ? Syntel’s HIX Enablement solution offers comprehensive Service Oriented Architecture (SOA) based integration, remediation and testing framework to build interfaces for various state exchanges. Key Features of our solution includes: • Multi-state exchange integrated with backend tables through a single SOA hub • Business Rules Management Solution (BRMS) to capture and maintain exchange rules • Interface design build-up backed by a rich trading partner integration experience • Ensure quality certification of transactions and speed up testing phase with reusable Business Process Test Repository (BPTR) • BPM dashboards to monitor, track and plan compliance levels, and ensure timely 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