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Blue Cross and Blue Shield of Vermont Selects Edifecs to Integrate its IT Systems with Vermont’s Health Insurance Exchange (HIX)

Off-the-Shelf Integration Solution will Help Insurer  Maximize Opportunity, Minimize  Disruption and Deliver a Smooth Experience to Individuals and Small Business Participating on the Exchange

BELLEVUE, Wash.—May 22, 2013— Today, Edifecs, Inc., a leading healthcare solutions provider specializing in healthcare information management and compliance technology, announced that Blue Cross and Blue Shield of Vermont (BCBS of VT) has chosen the company as its technology integration partner in anticipation for preparing to  integrate with Vermont Health Connect, the state’s health insurance exchange (HIX). Beginning in October of this year, more than 100,000 Vermont residents, individuals and small groups with 50 or fewer employees, will be required to transition to Vermont Health Connect for their health care coverage as part of what may be the largest open enrollment period in history nationwide. Health insurance exchanges are mandated as part of the Affordable Care Act.

BCBS of VT is deploying the Edifecs HIX Integration Solution, a hosted solution that integrates member enrollment and billing transactions among insurers, state health insurance exchanges and the federal government to reduce the implementation and operational risk of participating on an HIX. Of key concern for health plans during the first year or two of operating on an HIX are the expected changes and disruptions that will occur as state exchanges, the federal government and the healthcare industry work toward stable and predictable processes and system integration.

The Edifecs HIX Integration Solution serves as a “guardian” for a health plan’s HIX business—shielding and monitoring interactions with HIXs, financial institutions and the federal government. It ensures that only accurate and timely information is sent to core membership systems or reported to the federal government.

“As is the case with most of the health plan industry, we continue to be concerned about the operational readiness of the State and the Federal Governments HIX technical integration with us and we are doing everything we can to not let that impact the consumer experience and to ensure our members and all eligible Vermonters are able to enroll on day one,” said Dan Galdenzi, CIO of BCBS of VT.

“To feel more comfortable implementing a project as large as the State’s exchange in such an abbreviated time period we chose Edifecs for its ability to help reduce the impact on our existing IT infrastructure and streamline our integration timeline. Edifecs is a proven partner of ours and their experience with enrollment and claims management made this solution the right technology fit for BCBS of VT.”

Healthcare industry experts view HIXs as central to the effectiveness of the Affordable Care Act because they provide an online marketplace where consumers can shop for, compare and purchase health insurance. According to a recent survey of healthcare professionals at the 2013 Healthcare Mandate Summit, HIX participation in 2014 will be high. The survey also revealed the country’s health insurers are confident they will be ready by the October 1, 2013 launch deadline, but have reservations about how HIXs will be implemented and run.

“While most of the country is focused on the scheduled open enrollment date, the real challenge comes with the operational changes to the business and the long term sustainability of participation in the exchanges,” said Sunny Singh, CEO of Edifecs. “Edifecs is committed to supporting Blue Cross and Blue Shield of Vermont through the process of readying its IT systems for the state exchange, maintaining an outstanding member experience, and ensuring the long term success of its participation.”

BCBS of VT has taken a leading role in helping Vermont residents understand their health insurance options on the new HIX. It recently launched a new phone line staffed by trained representatives who can answer questions and provide detailed information about Vermont Connect. BCBS of VT has also held more than 35 community meetings all across the state with more than 1,600 small businesses and has many more planned in the weeks and months ahead.

In addition to the new phone line and trained staff, the company will also host webinars, enrollment meetings and provide one-on-one support at a new retail location in South Burlington, which opens in early May to help Vermonters find the coverage that is right for them.

On January 1, 2014, enrolled members will start using their health benefits, which means all qualified health plans, benefit tiers and payment contracts must be loaded and integrated with insurer IT systems to ensure members receive appropriate benefits and providers are paid promptly.

About BCBS of VT

Blue Cross and Blue Shield of Vermont is the state’s oldest and largest health insurer, providing coverage for about 180,000 Vermonters. It employs about 340 Vermonters at its headquarters in Berlin and branch office in South Burlington, and offers group and individual health plans. More information about Blue Cross and Blue Shield of Vermont is available on the Internet the Internet at www.bcbsvt.com. Blue Cross and Blue Shield of Vermont is an independent corporation operating under a license with the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

About Edifecs, Inc.

An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA, Operating Rules and ICD-10.

Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.

Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of Washington, 100 Best Places to Work in the state of Washington, an Inc. 5000 fastest-growing private company and one of the 500 Fastest Growing Companies in North America by Deloitte. Edifecs is headquartered in Bellevue, WA. For more information, please visit http://www.edifecs.com.

June 7, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.

Study: Health Insurance Exchanges Represent Immense Opportunity and Potential Risk for Health Insurers

Survey of 2013 Healthcare Mandate Summit Attendees Reveals Major Concerns, Though the Vast Majority Still Plan to Participate as Early as 2014

Bellevue, WA (PRWEB) February 20, 2013

Coming on the heels of last week’s deadline for states to inform the federal government of whether they intend to leverage a partnership health insurance exchange (HIX) or participate on the federally facilitated exchange, a study released today by Edifecs, Inc., shows that health insurers recognize both the promise and peril of HIXs. At the recent 2013 Healthcare Mandate Summit, more than 95 percent of senior healthcare professionals surveyed said they plan to participate in at least one HIX. Of those, a surprisingly large majority—80 percent—will do so in 2014. However, the study also reveals skepticism among respondents that state or federal exchanges will be ready to launch by the October 1, 2013 deadline. And once HIXs are up and running, respondents fear potential disruption to existing IT infrastructure and the difficulties in reconciling premium, enrollment and payment records from the HIXs.

Healthcare industry experts view HIXs as central to the effectiveness of the Affordable Care Act (ACA) because they provide an online marketplace where consumers can shop for, compare and purchase health insurance. The Congressional Budget Office projects that nearly 12 million Americans will buy health insurance via an HIX in 2014(1).

The potential upside for a health insurer participating in an HIX is significant. According to a November 2011 PwC Health Research Institute report, the 12 million people who buy insurance through an HIX in 2014 will together pay approximately $60 billion in premiums. By 2019, those figures will grow to 28 million consumers paying nearly $200 billion in premiums(2).

The special report, “HIX Insights from the 2013 Healthcare Mandate Summit,” includes survey results from more than 125 senior healthcare professionals attending the 2013 Healthcare Mandate Summit that took place February 4-6 in Austin, Texas. The report reveals that while HIX participation will be high and the country’s health insurers are confident they will be ready by the launch deadline, they also have reservations about how HIXs will be implemented and run.

Key findings from the 2013 Healthcare Mandate Summit special report on HIX include:

    • Health insurers recognize the HIX opportunity and are taking preparations very seriously. When asked about their plans for participating in an HIX, 80 percent reported they plan to participate on an exchange in 2014—the first year HIXs will offer coverage and expected to be one of the largest open enrollments in history. When asked about meeting the October 2013 deadline, 70 percent of respondents said they were “very confident” or “somewhat confident” that their organization would be ready.

 

 

    • There is an urgent, immediate need for more information sharing and collaboration among health insurers and the HIXs they plan to join. Like any major business or technology project, transparency with stakeholders is imperative. However, most of the survey respondents reported a lack of good information coming from the state exchanges they are targeting for participation. Sixty-nine percent rate the quality of information as “poor” or “very poor.” In addition, an overwhelming 93 percent expressed a strong desire for exchanges to solicit input from them on how to define and operate their enrollment processes.

 

 

  • Health insurers are far more concerned about the ongoing challenges of operating on an exchange than the process of actually joining one. Each state has considerable leeway in determining how it will run its exchange, which means health insurers operating on multiple state exchanges face the daunting task of supporting multiple exchange formats and added levels of complexity. Just over 31 percent of those surveyed indicated they plan to participate on three to five exchanges, with another 15 percent planning to participate on more than eight.

 

“The message we heard from Summit attendees is that while compliance with mandates such as Health Insurance Exchanges is no easy feat, there are considerable benefits to be gained, including increasing member enrollment,” said Jamie Gier, vice president of Corporate Marketing for Edifecs. “The value of the Healthcare Mandate Summit was in helping healthcare organizations confirm whether they are on the right path toward compliance and where they can improve. And as the results of the survey demonstrate, many health insurers are embracing the opportunities that exchanges can provide.”

To download the report, visit http://www.edifecs.com/downloads/2013SummitSpecialReport_HIXs.pdf .

About the Report: “HIX Insights from the 2013 Healthcare Mandate Summit”
The survey was conducted among health insurers and healthcare provider attendees of the 2013 Healthcare Mandate Summit, an industry conference hosted by Edifecs that took place February 4-6, 2013 in Austin, Texas. The results are from a survey of more than 125 senior healthcare professionals—each of whom self-selected which questions they chose to answer, and this accounts for the variation in sample size by question. All respondents are actively involved in their organization’s compliance initiatives and carry significant responsibility for ensuring compliance with government mandates. Attendees represented a wide range of healthcare organizations, including commercial health insurers (68%), healthcare providers (11%), government entities and agencies (9%), and other healthcare industry organizations (12%).

The survey is not based on a probability sample, and therefore, no estimate of theoretical sampling error can be calculated. All decimals in this report are rounded to the nearest percentage point. This may result in certain numerical totals adding up to slightly more or slightly less than 100 percent.

The estimates and opinions expressed in this report are based on the survey results only, and the results do not purport to represent all entities or professionals in the healthcare industry.

About Edifecs, Inc.
An industry leader since 1996, Edifecs provides healthcare software solutions that improve operational performance by streamlining the exchange of information among health plans, hospitals, and other healthcare organizations, while enabling compliance with current mandates such as HIPAA, Operating Rules and ICD-10.

Today, more than 250 healthcare customers use Edifecs technology to unify transactions from any information channel source and input mechanism, while automating manual business processes such as enrollment, claims and payments management.

Edifecs is currently recognized as one of the 100 Fastest Growing Private Companies in the state of Washington, 100 Best Places to Work in the state of Washington, an Inc. 5000 fastest-growing private company and one of the 500 Fastest Growing Companies in North America by Deloitte. Edifecs is headquartered in Bellevue, WA. For more information, please visit http://www.edifecs.com.

February 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 6000 articles with John having written over 3000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 13 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit.