Context: The Federally Facilitated Marketplace (FFM) established by CMS provides individuals and small businesses a “one-stop shop” for private health insurance options. Throughout the FFM enrollment process, discrepancies arise that need to be investigated and reconciled in a timely manner so that customers receive the correct coverage, and plan issuers receive the correct payments.
Challenge: Each year, taxpayers who obtain insurance through the Federally Facilitated Marketplace receive a 1095a tax form, which explains their coverage and any premium tax credit they have received. If the form contains errors, customers may not be able to successfully file their tax returns. A case must be opened to resolve any discrepancies between the customer’s tax form, the Internal Revenue Service, and the FFM. Once resolved, a corrected tax form is issued to the citizen.
To help the customer resolve disputes, identify trends, and improve the customer experience in the Federally Facilitated Marketplace, we applied data science principles, including predictive and prescriptive analytics.
Innovative Solution: Cognosante has a deep understanding of the core data sources that underlie these transactions, which means we’re able to analyze data and adjudicate disputes across multiple workstreams. For this challenge, we leveraged data on 1095a form disputes from two separate but related workstreams—customer and plan issuer—to identify and mitigate the scenarios that cause disputes in the first place. By applying predictive and prescriptive analytics techniques to this data, we analyze and document the customer journey through the FFM, identify opportunities for issuer outreach and education strategies, and predict discrepancies that may arise in the future.
Our cloud-based Business Intelligence approach promotes self-service analysis and supports a sustainable, data-driven decision program, built on MS Dynamics CRM and Microsoft Azure. Based on user roles, proper data governance and security protocols, business owners and stakeholders across platforms can access, examine, and visualize data in a more timely and efficient manner.
Tangible Result: Our client, CMS, can now mitigate a customer issue before it comes a dispute, shorten the amount of time a dispute remains open, and provide a more positive experience for healthcare marketplace participants.