A Qualified Health Plan (QHP) is an insurance plan certified by the Health Insurance Marketplace that provides essential health benefits and follows cost sharing limits. QHPs are categorized into platinum, gold, silver, and bronze tiers based on the percentage of expected health care costs covered. The document discusses the benefits and costs associated with each metal tier and concludes that Nalashaa can assist payers in smoothly implementing QHP certification requirements and processes.
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Qualified Health Plans
1. Payer
Guidelines
for a Qualified
Health Plan
Payer
Guidelines
for a Qualified
Health Plan
Thejesh Kumar C. is a Solutions Consultant with 13 years of experience in US
Healthcare across different functional areas. Apart from being a certified RCM,
AHM, PAHM, CMS and AHIP professional, he also has vast experience in Claim
benefit management, ANSI X12 transactions, HL7, Medicare & Medicaid solutions,
Enrolment and other key areas.
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3. Conclusion
The process of certification of a QHP plan will have a huge impact on payer business. The
processes involved like monitoring the quality and defining quality metrics, defining rates,
designing plans, SHOPs and Exchange need a comprehensive strategy of solution. Business
process, policy, and system change impacts need to be identified, assessed, planned, and ana-
lyzed before going live. Nalashaa has great exposure in Health Insurance Exchange and creating
benefits for health plans, which will help assist in smooth delivery of QHP related services.
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At Nalashaa, we partner with healthcare organizations of all stages, from startups to established firms, and work with them to build
engaging user experiences that reduce organziational cost and risk. Our healthcare and technology expertise, along with our flexible
engagement models, make us a great fit for developing the quality technology while reducing time to market and engineering costs.
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