Brady is chief marketing officer at Acero Health Technologies, a company that sets up software systems for health insurers and health plan administrators. It has already put together cost-sharing subsidy tracking and reconciliation systems for a handful of QHP issuers. Some sell QHPs through state-based exchanges, and some sell QHPs through the exchanges run by the U.S. Department of Health and Human Services (HHS).
So far, Brady said, he hasn’t heard Acero insurer clients complaining about how the cost-sharing subsidy system works. In the Acero Health customer universe, “everybody’s paying claims right now,” Brady said. “Our clients are receiving the money.”
CMS has not yet developed the final data format for the cost-sharing reduction reports that QHP issuers will have to send CMS in 2015, to reconcile the cost-sharing subsidy amounts that CMS actually paid in advance with what CMS should have paid. But the reconciliation reports will not be due until 2015, and Brady said he is confident that the insurers using his company’s system are collecting the right data to feed into the final reporting system.
Brady acknowledged that he only knows what’s happening at Acero Health client insurers, and that they wouldn’t necessarily rush to him with news of problems. But, at this point, he said, “I’m not aware of any problems.” He said he thinks the insurers he works with are using an interim system developed by HHS to send estimated CSR amounts to the Centers for Medicare & Medicaid Services (CMS) — the arm of HHS that runs the exchanges. He believes CMS is sending the insurers money back.
Some other insurance information technology specialists have said they think the Patient Protection and Affordable Care Act (PPACA) public exchange programs may be facing serious back-office processing problems.