Innovative Solutions

AccumTech’s mission is to power connectivity for health insurance carriers so they can focus on delivering modern solutions to their customers. Today’s members, employers, trust funds and group customers all demand interconnected health plans with a full complement of offerings. These interconnected plans need coordination among all of the service providers filling the major health components like medical and pharmacy or ancillary benefits like dental, behavioral health and a variety of other plan features.

AccumTech’s solutions allow these solution providers to connect their data and communicate member systems. The systems are data agnostic and allow for a low barrier to entry. The streamline integration to the AccumTech network allows these services to focus on their patient delivery as the data is seamlessly moved between all of the other product providers. The net result: smooth product integration for the customers without the hassle of custom data connections for every product partner.

Problem

Group health plan customers and insured plans offering essential benefits need to have deductible and other out-of-pocket accumulators coordinated under High-Deductible Health Plan and Affordable Care Act requirements. To ensure a smooth and consistent member experience, claims must be coordinated constantly between all essential health components: medical, pharmacy, pediatric dental, pediatric vision, behavioral health, durable medical equipment, physical therapy, telemedicine and any other health segments. Increasingly, carriers and third party administrators may need to coordinate with dozens of different parties to satisfy their entire client portfolio.

Solution

The ClaimGen system smoothly connects all of these systems together by creating a central hub for managing the data. Each organization becomes its node and connects to the hub using native formats & data rules. ClaimGen builds special connections so that a carrier can submit data into the ClaimGen hub and receive data from the hub using the same stream – even though the data comes from a variety of other payers and products. The experience for the carrier: data for all customers and all product lines flowing through one connection, powered by the ClaimGen hub.

AccumTech’s unique member mastering process ensures accurate coordination of member data. All records are trafficked between all necessary parties and creating workflows for any erroneous data. The close monitoring of these data discrepancies help to flag potential setup issues like incongruent plans or member enrollment errors that can result in a poor member experience or inappropriate spend of plan funds.

Problem

Third party administrators, enrollment agents and human resources systems offer employers an excellent tool for tracking worker status, plan enrollment and other employee needs. However, they can be put to the test when they need to integrate with a large variety of carriers using custom 834 implementations that are unique to each product type or carrier. Connecting customer enrollments to their carriers rapidly and accurately is essential to reduce waste and maximize employee satisfaction. Paper processes, fax and custom website enrollments are too slow and costly to run effectively.

Solution

AccumTech’s Enrollment Engine allows employers to connect their human resources systems directly using the native formats and layouts of the system. AccumTech will create custom couplings for those systems and draw it into the Enrollment Hub. From there, the data can be directed to all product providers. From there, the Enrollment Hub will compare the employer rosters against the carriers to find discrepancies – before it results in waste or member abrasion.

The Enrollment Hub priorities: