EDE Phase 2 - An advanced Insurance quoting system with Healthcare.gov integration
A US health insurance brokerage company engaged Cappers, Inc. as their technical partner for their entry into US State and Federal Insurance Marketplaces. Working directly with the Center for Medicare & Medicaid Services (CMS) and third party auditors, Cappers planned, developed, tested, deployed and now services a secure, HIPAA-Compliant, turnkey, branded insurance quoting system which integrates seamlessly to provide Direct Enrollment (DE) and Enhanced Direct Enrollment (EDE) with www.healthcare.gov.
HEALTHCARE.GOV BARRIERS TO ENTRY
- A premier US health insurance provider grew to the point where they needed to enroll clients directly into www.healthcare.gov, rather than risk losing clients in the open marketplace.
- The 1996 Health Insurance Portability and Accountability Act (HIPAA) mandates strict national standards to protect patients' Protected Health Information (PHI). The US Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule to direct the use and disclosure of PHI by “Covered Entities” subject to the rule.
- The Center for Medicare & Medicaid Services (CMS) is a US government agency charged with overseeing the Children's Health Insurance Program (CHIP), and state and federal health insurance marketplaces.
- CMS promulgates rigorous technical requirements which serve as both roadmaps and, due to their technical complexity, sometimes impediments to direct enrollment.
PLANNING FOR SUCCESSFUL SAAS INTEGRATION
Cappers' first responsibility is always protecting its clients' best interests. In this case, that meant scoping the project for cost, feasibility, and budgeting to make sure the project was a good move for the client.
Cappers was responsible for planning, implementing, and servicing custom cloud-based architecture, to include automated secure communication with www.healthcare.gov and various third-party API service providers.
Cappers had to anticipate and protect against security threats, according to CMS regulations, and in cooperation with a third-party auditing company.
Beyond achieving and maintaining HIPAA Certification, Cappers had to process and adhere to thousands of pages of regulations during planning, execution, testing, and deployment phases.
The solution had to satisfy thousands of test case scenarios promulgated by CMS to simulate individuals and families with myriad health insurance needs and varying levels of plan qualifications.
Finally, Cappers is responsible for answering CMS questions during the final review stage.
SHEPHERDING THE PROJECT THROUGH TO A SUCCESSFUL CONCLUSION
- Cappers delivered a secure, HIPAA-Compliant, turnkey, branded health insurance quoting system which integrates seamlessly to provide Direct Enrollment and Enhanced Direct Enrollment at www.healthcare.gov.
- The system has been submitted for final review by CMS.
