When it comes to Affordable Care Act health insurance plans and Medicaid, accurate and timely eligibility results are critical. With over a decade of experience providing state-based exchange (SBE) solutions, including Medicaid eligibility assessment and determinations, GetInsured is the leading marketplace vendor. Our impeccable record of eligibility processing has resulted in integration with seven different state Medicaid agencies, 23 million consumer enrollments, more than 26 million Electronic Data Interchange transactions, supporting over 100 carriers, 12,000 brokers, and coordinating with 3,500 navigators/assisters.
Experienced Project Team and Proven Process
At GetInsured, we are united by our dedication to our mission. Our staff includes experienced project managers, specialized technical experts, testing staff, experts with Federal Data Services Hub integration, and expertise in navigating CMS regulations and relationships. Their knowledge and dedication not only facilitate smooth implementations but also guarantee ongoing support and optimization of our technology solutions.
Our ability to navigate complex regulatory environments and deliver compliant solutions is strengthened by our relationships with state agencies, including Medicaid and other health and human services agencies, as well as federal agencies such as the IRS and CMS.
Transparent Process
In upholding our value of transparency and commitment to our clients, our deeply experienced project management team keeps all partners regularly updated on project status, risks, and necessary communications. During implementation and M&O, all partners are apprised of any issues and their timely resolution, and after Go Live, a dedicated team addresses all client needs, providing a responsive and collaborative environment that addresses – and resolves – issues.
A Cost-Effective Solution Delivered on Time
We are proud to say that our implementations have a 100% success rate, as measured by on-time delivery of all requirements within budget. We understand the importance of maintaining fiscal responsibility, and our clients receive dividends through sustainable operations and state-specific development and outreach initiatives. Our solution aligns with strategic objectives of implementing a cost-effective, user-centric, predictable and scalable marketplace – all enhanced by customer-friendly, comprehensive contact center services. Our expertise has consistently led to outcomes that not only meet but exceed client expectations.
Our technology and operational expertise are constantly refined through a rigorous product roadmap that guarantees continuous improvement and innovation while keeping the underlying technology up to date, secure, and reliable. We lead in churn management between Medicaid and exchanges by continuously refining our Account Transfer and auto-determination processing and expanding real-time eligibility determination functionality.
A Thorough MAGI Medicaid Eligibility Process
We understand the importance of accuracy and timeliness when delivering eligibility results. Our solution supports MAGI Medicaid eligibility determination, from initial application entry and verification processing to eligibility determination. We are currently assessing MAGI Medicaid eligibility in Idaho, Nevada, New Jersey, and Pennsylvania, and determine MAGI eligibility in Virginia.
To ensure all beneficiaries continue receiving vital services, we collaborate with our state Medicaid partners by looking across all programs and structuring an eligibility assessment or determination that is in line with state policies. We work with our clients to review their MAGI income-based programs, document their eligibility rules, and cross-reference each aspect of a rule to data we capture as evidence. This structured approach ensures eligibility assessment and determination places an applicant and each member of their household into the proper program based on their circumstances and state requirements.
Accountability
In our commitment to our clients, we recognize their mission to help people get the assistance they need. Our seasoned management team boasts an extensive history of successful exchange management and a rich understanding of each SBE.
Throughout each implementation, we have demonstrated remarkable adaptability, developing processes that handle both predictable events and unforeseen circumstances. For example, in response to the public health emergency unwinding, GetInsured built functionality that enables states to conduct automatic eligibility determinations on Account Transfers (ATs) received from Medicaid and to include data in the AT to minimize gaps in coverage, among other churn-reducing measures.
Continuous, Collaborative Improvement
Helping consumers get the assistance they need on time and with minimal disruption means knowing that each exchange and the people they serve have unique needs that require specialized processes. Our platform reflects this belief: instead of enforcing a one-size-fits-all solution, we offer a Saas product that provides each State with hundreds of configurable options within our secure and compliant platform. These extensive configuration opportunities align with each State’s distinct policies and preferences and deliver a user-centric and cost-effective solution – core principles that align perfectly with our clients’ strategic goals. Our experienced product engineering team continually enhances our product to address regulatory changes, incorporate technical advancements, and respond to user requests.
Minimal Risk that Helps People Get the Assistance They Need
With our field-tested playbook of best practices, assets, and processes, we bring extensive experience in exchange eligibility along with Medicaid assessment and determination. By collaborating with each client, we help SBEs maximize continuity of coverage for residents transitioning between Medicaid, CHIP, other human services programs, along with Qualified Health Plans. Most important, we seamlessly align with each client’s mission to enhance access, enrollment, and continuity of care so people have the resources they need and deserve.
