MDwise Using XpandHCR to Reconcile ACA Reimbursements

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Acero’s Solution Powers MDwise Efforts to Calculate Cost-Sharing Reduction Subsidies

Solution Calculates ACA Cost-Sharing Subsidies

Solution Calculates ACA Cost-Sharing Subsidies

XpandHCR’s unique, granular approach to calculating our CSR expenses provides us with the operational data necessary to proactively reconcile the incurred amounts with the federal pre-payments

Acero Health Technologies, a leading software solution innovator for national and regional health insurance companies, is pleased to announce today that MDwise Inc., Indiana’s only nonprofit health insurance company, is using Acero’s automated XpandHCR application to calculate, track and reconcile eligible, Affordable Care Act (ACA) cost-sharing reduction (CSR) subsidy reimbursement amounts.

XpandHCR™ addresses potential issuer ACA financial risk by calculating, in synchronization with an issuer’s core systems, incurred CSRs or receivables according to the federal government’s “CSR standard calculation” method.

While CMS offered issuers alternative, “CSR simplified,” calculation methods, the standard method is the only method that ensures accurate CSR reimbursements relative to incurred disbursements. The CSR credible simplified method requires difficult-to-meet enrollment thresholds while the non-credible simplified method appears to consistently result in lower issuer reimbursement amounts when compared with standard calculation results.

Using XpandHCR and the CSR standard method, MDwise’s eligible CSR reimbursements appear to be trending over 20% higher than the non-credible simplified results using the same 2014 claims data set,” said Terry Cole, CFO for MDwise. “In addition, XpandHCR’s unique, granular approach to calculating our CSR expenses provides us with the operational data necessary to proactively reconcile the incurred amounts with the federal pre-payments while also accounting for MDwise’s unique product requirements.”

Acero’s dynamic, scalable solution provides the issuer with the transactional data to support granular and aggregate transparency.

“We’re pleased to support MDwise in its commercial ACA marketplace strategy,” said Alan Merchant, CEO of Acero Health Technologies. “Since CSR subsidies obscure an issuer’s true plan payment experience, concurrent processing of CSRs at the claim-line level will also help issuers accurately identify true medical expenses.”

Identifying true medical expenses net of actual incurred CSRs will facilitate more accurate premium pricing in future years and ongoing calculations of risk corridor and MLR amounts.

For more information about XpandHCR, go to http://www.acerohealth.com/products/xpandHCR.

About Acero Health Technologies
Acero Health Technologies, an innovative information technology company, offers robust transactional software solutions to health insurance issuers. Acero’s solutions provide issuers with the means to leverage existing systems in solving for new business and regulatory challenges. The Acero team has significant insurance and technical experience developing sophisticated, enterprise software solutions for benefits administrators. Acero’s PlanXpand® engine powers several technology solutions including XpandCDH™, a powerful tool for issuer-administered consumer-driven health plans, and XpandACC™, an application that facilitates real-time integration of shared accumulators across multiple benefit administrative systems. For more information, visit http://www.acerohealth.com.

About MDwise
MDwise is Indiana’s only nonprofit health insurance company focused on giving uninsured and underserved Hoosiers the compassionate service and care they want and need. MDwise’s services are currently provided to more than 300,000 members in partnership with over 1,400 primary medical providers and a statewide array of specialists, hospitals and other providers. In addition, MDwise is a Qualified Health Plan issuer in the Health Insurance Marketplace. MDwise’s services offer a coordinated, comprehensive approach to managing the cost and utilization of Indiana’s health care services. For more information, visit http://www.MDwise.org.

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