Data Interoperability Solutions


Cost Share Integration

  1. Manage out-of-pocket costs and coordinate them between external vendors;
  2. Provide routine synchronization files and exception reports for members exceeding maximums, deductibles or other cost constraints;
  3. Frequency is real-time, several times per day, daily or weekly (non-medical and non-Rx only);
  4. Mitigates member cost-share exceeds situations, manages synchronization and reports on correction events.

Eligibility Discrepancy Reporting

  1. Review eligibility timeframes, dependent information and plan coverage;
  2. Provide exception reports to identify discrepancies between vendors;
  3. Data frequency: daily; Report frequency: weekly or monthly;
  4. Mitigates coverage errors amongst vendors which causes a non-uniform member experience;

Address Review and Discrepancy Reporting

  1. Review individual addresses from different vendor feeds to identify the discrepancies;
  2. Provide exception reports so discrepancies can be corrected;
  3. Frequency is daily, weekly or monthly;
  4. Reduces or eliminates incorrect member mailings, HIPAA violations and member disruption;

Telemedicine Coordination

  1. Coordinate eligibility coverage and member cost share data;
  2. Provide ongoing synchronization to monitor feed health and improve coverage coordination;
  3. Frequency is available for daily, several times daily or up to real-time;
  4. Reduces member cost-share exceeds situations, coordinates coverage to match BCBSM eligibility coverage periods and identifies discrepancies for corrective actions;

Deductible/Out-of-Pocket Credits on Takeover Cases

  1. Integrate deductible and cost-share data from previous vendors and coordinate them to BCBSM and all coordinating vendors;
  2. Provide ongoing synchronization to monitor feed health and improve coverage coordination;
  3. Frequency is a one-time load plus potential runout;
  4. Reduces member cost-share exceeds and member calls;

HSA Coordination

  1. Submit member data and cost information to HSA vendors;
  2. Include exception reports, member coverage periods and OOP incident information;
  3. Send data at a desired frequency for the HSA vendor, up to real-time;
  4. Allows members to see information through their HSA portals and coordinates coverage between the health plan and the HSA offering;

Pediatric Dental

  1. Submit member coverage data to dental providers for pediatric coverage under essential health benefit requirements;
  2. Include data quality management and all exception reports;
  3. Send data at a desired frequency, up to daily;
  4. Synchronizes the membership coverage periods to provide accurate timeframes and a uniform experience for all members;

ACA Communications

  1. Prepare health plan eligibility so that it can be combined with payroll & plan data to send annual 1095 forms to employees and electronic reporting to the IRS;
  2. Provide regular reports to show enrollment changes so plan sponsors can send communications to members with changes;
  3. Change reports monthly and IRS data annually;
  4. Simplifies the member communication requirements and annual reporting requirements;

Internal Analytics

  1. Submit essential data to internal business analytics team;
  2. Manage data quality issues, make data correction and determine department data needs to reduce internal time spent managing and correcting data;
  3. Send data on an engagement basis as needs are determined;
  4. Reduces the time spent internally cleaning data, increases data quality and allows analytics teams to focus on general analytics;

Edge Reporting

  1. Review claim submittals to the data collection and make error corrections to improve accuracy;
  2. Provide regular support for filings made with Edge server reporting;
  3. Data to be reviewed on a monthly basis in preparation for each submittal;
  4. Reduce the internal review process, number of rejected claims and increase accuracy;

Payroll Coordination and Comprehensive Eligibility Discrepancy Review

  1. Coordinate payroll data for plan sponsors and identify discrepancies with the enrollment feeds;
  2. Manage quality issues in the data feed, identify changes to the files and monitor all discrepancy resolution;
  3. Data to be reviewed on a daily or weekly basis, based upon plan sponsor request;
  4. Reduces discrepancies between plan sponsor enrollment and BCBSM coverage;

Leasing Networks

  1. Coordinate claim and membership information from administrators utilizing the network;
  2. Manage data quality issues, synchronization and reformat to meet BCBSM data requirements;
  3. Send and receive data in a desired frequency, up to real-time;
  4. Manages coverage periods for members and claim information for administrators using the network;

Enhanced Data Services

  1. Coordinate custom data requests with plan sponsors by receiving plan sponsor requirements, reformatting data and managing quality issues;
  2. Change data formatting, include required elements and run quality checks;
  3. Send data as individual engagements;
  4. Review data with plan sponsors to ensure requirements are met and provide basic support;

HIPAA Compliance

Accumulation Technologies

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17199 N. Laurel Park Drive | Suite 400 | Livonia, MI 48152 | 1.734.237.5100