Ideon Blog

By Zach Wallens, Ideon’s Communications Manager

The busy season is upon us yet again. And, yet again, health and benefits industry stakeholders are preparing for a mostly digital open-enrollment season in year two of the Covid-19 pandemic. Brokers are quoting the latest benefits products and formulating client proposals; employers are debating whether to stay the course or offer different health insurance and benefits in the coming year; and employees are familiarizing themselves with the digital tools that will guide their selections.

The focus for benefits administration (BenAdmin) platforms and other BenAdmin providers, as usual, is delivering high-level customer experiences through technology that eases the enrollment process rather than inhibits it. But given this emphasis on customer experience, there is another essential consideration for benefits technology vendors: data quality. Even the most user-friendly, feature-rich benefits software can earn a reputation as a front-end failure if data accuracy and quality are problematic during open enrollment.

The good news: BenAdmins have tools at their disposal to rectify—or, at least, minimize—data quality issues. 

The better news: BenAdmins need not rebuild their data infrastructure from the ground up to significantly improve quality. 

Rather, BenAdmins can lower their risk of data snafus by working with specialized vendors, whose solutions improve the speed and accuracy with which enrollment-related data is sent and received. With that in mind, here are three potential hazard areas that BenAdmins should keep an eye on—and how to avoid them.

1. Product-specific data. 

Employees need… 

• An easy, streamlined way to review specific criteria they deem most important among the health plans offered by their employer. 
• Confidence that they understand which plans meet their criteria, and will fit their budget. 
• Help navigating the complexities of choosing not only health insurance, but also ancillary products (vision, dental, life and disability) that best suit their needs. 

API Middleware solutions can… 

• Ensure data accuracy remains king, by aggregating plan and provider data directly from health plans and ancillary carriers. In doing so, they help BenAdmins maintain fidelity to their plan library and provider directory—plus the thousands of data points associated with each plan—without risking damage to employees’ health, financial well-being and goodwill. 
• Shift the burden of data accuracy to the API vendor, enabling BenAdmins to confidently display product-specific information without fear of inadvertently misleading employees.

The Takeaway: The pathway to choosing the most appropriate health plan and ancillary benefits begins with employees having access to accurate, in-depth, comparable information about their options. Low-quality or outdated data, for example, can lead an employee into thinking that a plan covers their primary care physician, only to learn, post-enrollment, that the doctor recently dropped out-of-network. In third-party APIs, UX-focused BenAdmins have found a secret sauce for maintaining quality data. 

2. Group and member-level enrollment data. 

Employees need… 

• Confidence that group and member information won’t fall prey to human error as it is manually keyed into enrollment apps. 
• A seamless, delay-free receipt of their insurance card and, ultimately, use of their health insurance and benefits.

API Middleware solutions can… 

• Connect carriers and BenAdmins and exchange accurate data between them (in fact, that’s their specialty). 
• Enhance the quality of enrollment data by validating whether the submitted information meets carrier-defined business rules and other criteria, before the data even reaches the carrier. 
• Allow BenAdmins to quickly and accurately identify and revise data issues, minimizing the chance of a lengthy enrollment delay for an employee.

The Takeaway: There will always be some risk of typos and other mistakes in enrollment data transferred from BenAdmins to carriers and benefits providers. After all, enrollment still involves some degree of human data entry. But for BenAdmins, the objective should be minimizing the amount of errors that reach carrier systems. API middleware partners can do that. 

3. Plan, class, and division mapping. 

Employees need… 

• Confidence they will get enrolled in the correct plans with the correct carriers
• BenAdmins with streamlined operations based on correct plan maps.

API Middleware solutions can… 

• Enhance BenAdmins’ mapping capability to ensure groups and employees are enrolled in the right plans for the right coverage periods. 
• Offer unique visibility into what’s under the hood at carriers and BenAdmins, making it easier to configure complex group setups when an employer has multiple plans, classes, and divisions.

The Takeaway: As with many things related to health insurance and benefits, what should be simple often is not. Where a group or employee may believe that they are enrolled in “Carrier PPO 123,” the carrier might identify that plan, internally, as “Carrier PPO NY ABC.” Or the same plan could have different IDs depending on the state or employee classification. This can generate massive confusion and even instances where employees or groups get enrolled in the wrong plan. Some larger businesses with numerous classes and divisions of employees might offer upwards of, say, 10 medical plans and several ancillary plans. Carrier-connectivity partners can help BenAdmin vendors relieve this pressure. 

And that’s no small thing. At a time when fully-digital, employee-facing enrollment capabilities are nearly universal, maintaining highly accurate data can be a true differentiator. Thankfully, there are partners, such as Ideon, that have considerable experience helping BenAdmins enhance their data quality without much development effort and investment.

 

Interested in learning more about middleware solutions? Download our guide on outsourcing carrier connectivity.