Advanced Premium Tax Credit Reconciliation
In FFM states, 80% of premium is covered by Advanced Premium Tax Credit. You need a trusted partner to help ensure you capture 100% of the premium revenue you have earned and navigate the ever-changing regulations from CMS and complex operational rules.
Policy Based Payments
The early days of the Exchange permitted issuers to receive their APTC payments based on submissions of Excel spreadsheets to HHS on a monthly basis; since those early days, HHS and OIG have continually increased the oversight and accountability around APTC and User Fee payments to issuers.
Recent guidance from the NBPP requires issuers to report overpayments to CMS at any time when they are discovered, but issuers will only have 3 years to correct discrepancies that could result in a payment to the issuer.
Evensun can help you reconcile your policy based payments, improve your processes for managing enrollment discrepancies and HICS cases, and help you dispute your RCNO records with the Exchange.