Qualified Health Plans and Health Exchanges

Data management for health insurance exchange (HIX) enrollment, eligibility, governance, and financial reconciliation

Actively selling products and services on a public health insurance exchange? As an early exchange you are likely providing a basic marketplace for qualified health plans to interact with and attract new customers. 

As insurance exchanges evolve, your customers will expect predictive service and a wider breath of product offerings. Your business will need to evolve—and the technology you deploy needs to keep up with it.

This is a marathon, not a sprint. To prepare, you need more than applications, you need a flexible data management infrastructure. This flexibility will both benefit you now and position you to rapidly adapt to future data exchange, eligibility testing, and financial reconciliation requirements. 

Backed by this solution, you are ready to engage members in new ways, to compete with other plans and to suggest the right product to consumers. Our scalable data management capabilities empower you with data that is ready for you to use for a broad range of situations—and in ways you can’t yet imagine. Today, you can:

  • Immediately connect, integrate, and transform data with health exchanges to support the enrollment, eligibility, governance, and financial reconciliation of electronic data exchanges
  • Validate data is clean, safe, and connected
  • Build a single 360-degree member record to ensure eligibility status is accurately maintained

The solution is based upon Informatica Data Exchange, which manages electronic data exchanges and provides visibility and auditability of enrollment, eligibility, and financial reconciliation processes with:

  • Connectivity to health exchange gateways via virtually any communication protocol
  • Pre-built and maintained libraries for HIX and HIPAA
  • Unique support for any-to-any data transformation with unique support of parsing of unstructured data such as PDF, Excel or Word documents
  • Data transformation of HIX or HIPAA messages with automatic creation of TA1 error reports
  • End-to-end visibility of all data exchange to ensure data delivery and auditability
  • Master data management—strengthened with a robust healthcare data model—that delivers trustworthy provider, patient, member and location data as well as the tools you need to manage data quality

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