pronounced: “eye-dee-ahn”

Error management with Ideon, Part 2: Auto-reconciliation

By Jashan Ahuja
Group Product Manager – Enrollment

In Part 1 of our error management blog series, we explored Ideon’s ability to process errors in a centralized and consistent way. Now, in Part 2, we delve into our industry-leading auto-reconciliation feature, which proactively identifies discrepancies between platform and carrier systems.

It’s a scenario all too common in the group benefits industry: a benefits administration (BenAdmin) platform sends enrollment data to a carrier via an EDI file and waits a week or more — with no visibility into whether the information was accepted — only to receive back an unreadable report of errors and discrepancies.

Now imagine a world with lightning-fast data exchange, two-way communication, and seamless reconciliation between platforms and carriers. The platform would receive a notification within minutes that lists all discrepancies between the two systems.

Ideon’s automatic reconciliation system makes the above not only possible, but easy to implement and scalable across carriers. It’s an industry-first feature that offers the capability of proactive data reconciliation between the platform and carrier systems.

In our prior blog, we explored Ideon’s ability to standardize and expose errors generated by carrier systems, transforming them into a consistent, human-readable, and actionable format. That crucial feature forms the foundation for closing the feedback loop with carriers. But Ideon doesn’t stop there. In this blog, we examine auto-reconciliation, a revolutionary process that identifies and surfaces discrepancies in near real-time, even before the data has been sent to the carrier

What is auto-reconciliation?

Auto-reconciliation is an essential component of Ideon’s data exchange process, significantly streamlining the enrollment workflow for carriers and benefits platforms alike. This innovative process flags discrepancies before data reaches the carrier’s system, dramatically reducing downstream errors that could otherwise wreak havoc on carrier operations—and members.

Here’s how it works: Ideon’s reconciliation engine proactively pulls all member and coverage information for a group from the carrier, converts it to our data model, and compares it to the platform data on a field-by-field basis.

The comparison encompasses 18 data points, also known as “discrepancy parameters,” including demographic data (e.g., birth date, SSN), coverage details (e.g., plan start date, plan volume), or even the existence of a member or their coverage in one system but not the other. We’re able to specify the source of any discrepancies for our partners and provide both platform and carrier values, creating a clear, actionable pathway to resolution.

Consider the example below, where a carrier’s system contains a different birth date compared to the one entered on the benefits platform. Without validation, this discrepancy would inevitably lead to errors for this subscriber. However, by matching the carrier’s existing information with the enrollment record, Ideon can promptly detect the discrepancy and return the record to the platform for correction.

"errors": [
    {
      "id": "a37ecd06-5d97-46e4-9b4e-dcde6a03246f",
      "member_id": "a37ecd06-5d97-46e4-9b4e-dcde6a03246f",
      "plan_id": "a37ecd06-5d97-46e4-9b4e-dcde6a03246f",
      "coverage_period_id": "a37ecd06-5d97-46e4-9b4e-dcde6a03246f",
      "discrepancy": {
        "parameter": "birth date",
        "carrier": "1/1/93",
        "platform": "2/1/93"
      }
    ]

 

During our processing, we reconcile 18 different critical fields, as well as verify the presence of the member in the carrier’s database. 

Annual earnings

Birth date

Coverage

Dependent

Employment end date

Employment start date

Employment status

Gender 

Marital status

Plan ID

Plan end date

Plan start date

Plan volume

Primary care provider

Residential address

Social security number

Subscriber

Wage frequency

 

Additional features

Ideon’s auto-reconciliation system boasts several features for fast, accurate data exchange, smooth operations, and an enhanced member experience.

Deduplication

Automatic reconciliation operates daily, comparing new discrepancies against open ones from the previous run and resolving any that are no longer relevant. This keeps carrier and platform systems in sync with current data and ensures the list of open discrepancies is directly relevant.

Frequency + Timing

Automatic Reconciliation runs as frequently as daily for carriers supporting an API-based, automatic census retrieval. Resolved discrepancies are closed every morning, while newly identified ones are opened.

We are currently expanding our auto-reconciliation functionality with carrier partners that don’t yet support a daily census.

As part of our reconciliation process, we carefully consider the timing of data in and out of our system. When our system receives a data element that hasn’t been sent to the carrier yet, our reconciliation logic takes this into account by comparing the carrier’s data with the previous version of that data field. Once the field is transmitted to the carrier, it is incorporated into the next reconciliation cycle, with a buffer for carrier processing time. This thoughtful approach prevents noise, such as unwarranted and erroneous discrepancies.

Surfacing Discrepancies

All actionable enrollment discrepancies—originating from either auto-reconciliation or carrier error reports—are returned in a consistent, normalized format. Partners can access this information through:

      • direct GET requests via our API endpoints
      • proactive push notifications using webhooks, or
      • our standardized Enrollment Discrepancies CSV, delivered periodically

By centralizing Enrollment Discrepancies, we enable a more efficient and streamlined operational process, allowing benefits platforms to view errors generated by carriers and the results of auto-reconciliation all in one place.


Impact

Leveraging our unique, central position between platform and carrier systems, we have quantified the volume of out-of-sync data. After analyzing data from hundreds of groups and thousands of members, we found that about 8% of employee enrollments have a critical coverage issue, i.e. incorrect coverage dates, plan information, or birth date, or they’re missing entirely from either the carrier or platform system. For one specific platform-carrier combination, we saw 10.3% of subscribers with at least one error that affects enrollment accuracy. Additionally, 80% of groups with more than 20 subscribers had one or more critical errors.

Overall, proactively identifying coverage-affecting errors is critical for reducing inaccurate enrollments and downstream issues. Automatic reconciliation allows groups to detect and resolve discrepancies before the initial transmission to the carrier. This improves success rates for the initial transition of groups into production and allows for faster, more accurate group setups, ultimately resulting in a better member experience.

Coming soon – Part 3: Account structure consolidation and mapping

Enrolling members in the correct plans with the correct carriers all starts with precise, streamlined setup processes. In the next blog in this series, we’ll detail how Ideon enhances a platform’s mapping capabilities, making it easier to configure complex group setups when employers have multiple plans, classes, and divisions.

Employee Spotlight: Tyler Henn

At Ideon, we’re proud to have such a talented, diverse team leading the charge for a better and more connected health insurance and employee benefits industry. Our ongoing Employee Spotlight series showcases the people behind our product and unveils what life is like at Ideon. Next up… Tyler Henn, our Quality Assurance Coordinator!

Name: Tyler Henn
Department: Data Ops
Title: Quality Assurance Coordinator!
Location: New York

Work

How long have you worked at Ideon?

Two and a half years.

Tell us about your day-to-day.

My day-to-day involves a lot of quality checks on our data — ensuring everything is the way it is supposed to be. I also work on automating our validation checks and coming up with new ideas to further improve our data accuracy.

How have you grown professionally while on our team?

This is my first full-time job, so I have grown quite a bit over the years. All of my co-workers at Ideon have helped to shape me with a focus on being professional and respectful of everyone I work with. They always push me to do better and come up with new ideas to further exceed our goals.

What excites you about the future of Ideon?

I am really excited about Ideon’s growth. Over the last two years I’ve been privileged to witness the company expand from 40 employees to over 100! Seeing that growth is motivating, inspiring, and it’s a big part of why I’ve enjoyed my time at Ideon.

What do you like about Ideon’s company culture?

I love the overall atmosphere of my team and the company as a whole. Everyone is super supportive and I think Ideon really pushes to make sure that our company culture is welcoming and enjoyable.

Life

Favorite activity when you’re not working? 

I love to play the board game Catan! And I have found a new obsession with Reality TV.

Favorite place you’ve traveled?

My favorite place I have traveled to would definitely have to be France.

Interesting fact about yourself… Go!

I can’t think of anything, so I am just going to go with the generic response –  I am left handed!

Ideon Insights: Beam’s Elek Pew talks distribution strategy as a tech-focused carrier

Welcome to the second episode of Ideon Insights, our monthly interview series featuring thought leaders and innovators driving the benefits industry forward. In this episode, we had the pleasure of speaking with Elek Pew, Head of Digital Partnerships at Beam Benefits, an ancillary benefits provider known for its innovation and digital-first approach.

In this Q&A, Elek provides insights into the evolution of the benefits technology ecosystem and the unique advantages that come with being a digitally native carrier. He also delves into how Ideon complements and enhances Beam’s digital distribution strategy, enabling seamless integration and collaboration within the industry.

For Elek’s complete thoughts on digital distribution, partnership strategy, and more, watch the video here.

Below we’ve highlighted six key moments from the conversation.

 

IDEON: How has the transformation of benefits technology informed your distribution strategy?

ELEK PEW: Technology is really at the forefront of everything today. Efficiency is king, especially in the small group market. We see that brokers care most about being really quick and efficient, so we pride ourselves on meeting those distributors where they are — whether that’s XYZ quoting or enrollment platform, or Beam’s own digital tools.

If they use a third-party system to quote business, we’ll find a way to integrate with that platform whether it’s through Ideon or directly. We’ll meet them where they are.

 

The benefits ecosystem is getting more complex. How do you choose the right partners?

There are a few things we think about when it comes to partnership strategy.

    • Do we potentially have access into a limited marketplace, where Beam is one of three or four benefits providers? 
    • What does the partner’s technology stack look like in terms of their ability to integrate? If a new partner comes to us and says, “we’re already integrated to Ideon” — that’s great for us. We know there’s not a ton of work to activate that new partner, compared to a net-new direct connection.
    • How do they think about API connectivity? Are we living in a file-based world? We’ll meet people where they are, but that’s definitely something we think about.
    • Are they willing to offer all of our product lines? Beam was historically a dental-first company, but now we’re focused on Beam as an ancillary benefits provider.

 

How does Ideon fit into your distribution strategy?

We definitely see the value in the partnership with Ideon from a middleware standpoint. As Beam has transitioned from Beam Dental to Beam Benefits — bringing on voluntary life, accident, hospital, and critical illness — our ability to turn those products on through one connection to multiple players in the ecosystem is game-changing. It’s a powerful thing that we want to continue to invest in.

We’ll connect to third-party platforms directly if that’s their preferred method, but we’ll meet folks where they are. Some will say, “we want to connect through Ideon,” and we’re more than happy to make that happen. It makes our jobs a lot easier knowing we have a trusted player in the middle, ensuring that our data is presented accurately and the data Beam gets back is in top fashion.

 

What are the advantages of being a newer, tech-focused benefits carrier?

Beam is well positioned in the market because, at our core, we’re a digitally native company. The idea of exposing our core functionality—enrollment, admin, quoting, etc.— and embedding our products into the benefits ecosystem really is inherent in how Beam has built core capabilities.

We’re able to go to market really quickly with new platform integrations because we’ve built our systems with the concept of exposability in mind. Now that the market is moving to third-party platforms, we’re well positioned to be able to connect and meet distributors where they are in the marketplace.

 

Why are rating APIs valuable for Beam and brokers?

Without a rating API, rates could only change once per quarter and it didn’t allow for customization — rates were prepackaged.

With a rating API like the one we’re building with Ideon, we’re able to take in real-time census information and generate a rate based on that specific employee population. We’re able to arrive at much sharper rates because we have more information about the group. It also enables our back office operations to be more efficient because we receive information about the group from that initial employee census.

With an API, we know it will only return rates and plans where Beam will 100% be able to offer the plan — rates are always bindable.

 

What’s a benefits technology trend you’re excited about over the next few years?

Instantaneous policy issuance — Beam is moving there, and I think the benefits industry overall will move that way, following in the footsteps of the P&C space. The group installation process is still painfully manual today.

The industry has made a lot of progress in terms of carriers accepting enrollment information from platforms and loading it into carrier systems, and we’re seeing instantaneous quoting making its way to the market with rating APIs. The next step is to bridge the gap between the two — take a quoted product, win it, turn it into a bindable policy, then have it ready for employees to enroll in coverage. That experience — quote to bind to enroll — we’re now seeing the foundation that will allow us to get there.

Stay tuned for new episodes of Ideon Insights each month. Subscribe to our newsletter below to stay in-the-know about Ideon and receive our latest content directly to your inbox.

Employee Spotlight: John Emge

At Ideon, we’re proud to have such a talented, diverse team leading the charge for a better and more connected health insurance and employee benefits industry. Our ongoing Employee Spotlight series showcases the people behind our product and unveils what life is like at Ideon. Next up… John Emge, our SVP of Carrier Sales!

Name: John Emge
Department: Carrier Sales
Title: Senior Vice President of Carrier Sales
Location: South Carolina

Work

How long have you worked at Ideon?

I have been part of the Ideon team for one incredibly exciting year.

How have you grown professionally while on our team?

While I had been in the benefits technology industry for thirteen years prior to joining Ideon, I have grown in my understanding and appreciation of the various stakeholders in the benefits market (carriers, insurtechs, brokers, employers). I have learned that while they all acknowledge the need for improved data quality and data integrations in order to operate effectively and serve the members, each stakeholder has their own unique capacity and priorities.

My current focus is on actively listening to the market to understand how Ideon can best empower carriers and platforms at the crossroads of their data and business strategies. By doing so, we’ll drive meaningful and positive change in the industry.

What excites you about the future of Ideon?

We are helping solve problems in our industry — efficiently. When we meet with carriers and platforms, I clearly see our joint path ahead and our mutual desire to work to transform our industry through improved data management.

What do you like about Ideon’s company culture?

I really like our leadership — and I don’t just mean our executive team. Leadership is every member of the team who wakes up and approaches each day with an attitude of “how can I make a positive difference for our team today?” and “how can I contribute to supporting others in their objectives today?” “How can I help drive this company forward in our mission?” I consider myself very fortunate to work as part of a team in which this is the dominant mindset.

What attracted you to Ideon’s mission?

It’s simple: I believe that Ideon is going to help drive positive change with our partners. Benefits is an enormous industry, but what it is really about is families having the coverage they need, when they need it, for their health and financial protection. When they go to the hospital on that unexpected night, it needs to be there. For that to happen, all of the steps in the process must occur from quote, to card, to access, to claim. Whether that process functions correctly for that family is driven by data flow and data quality. Our industry has, for too long, accepted integration projects that take a year or more for point solutions and it has institutionalized post-impact data clean up or manual data entry that causes errors. We are helping to create a better way.

Life

Favorite activity when you’re not working? 

I love traveling, camping, and backpacking with my family.

Favorite place you’ve traveled?

Southern tip of Patagonia in Chile while backpacking. It is so remote and beautiful. It is rugged and peaceful at the same time. The people that we met on the trail were wonderful. They had all made a hard personal effort and choice to be there and that makes a difference in a lot of ways – and not just on the trail.

Interesting fact about yourself… Go!

I enjoy scuba diving and searching for megalodon teeth and fossils that are 3.6M to 20M+ years old. When I was a kid, I developed an early interest in archeology (King Tut was all the rage) so that and enjoying scuba diving is likely where it comes from.

Five datasets powering today’s healthcare navigation platforms

Over the past few years, three trends have intersected: healthcare costs increased, the healthcare system became more complex, and digitally native employees started expecting employers to provide technology for HR and benefits tasks.

Enter healthcare navigation platforms — digital tools that guide employees to better, more informed healthcare decisions based on cost, quality, and other criteria.

These platforms provide a wealth of information on doctors, hospitals, prescription drugs, and medical procedures. They also help employers to manage their healthcare costs by providing transparency into the pricing and quality of healthcare services.

Of course, offering an intuitive, modern user interface is essential for any healthcare navigation platform. But the breadth and quality of data behind the scenes, powering the features, often have the biggest impact on the overall user experience.

Here are five key data elements that some leading navigation platforms have integrated into their experience.

Provider network data
This includes information about the doctors and hospitals in a particular health plan’s network, including provider locations, specialties, and more. This is a foundational dataset, providing employees with detailed information about the PCPs and other healthcare providers in their network. Navigation platforms can help employees to make more informed decisions about where to receive care, as in-network providers are usually more cost-efficient than out-of-network.

Provider quality data
This covers the quality of care provided by different doctors and hospitals, as well as patient satisfaction ratings. This may also include outcome-based metrics. Platforms integrate provider quality data into their experiences to help employees choose healthcare providers that are more likely to provide excellent care.

Cost information
This is data about the cost of different medical procedures, prescription drugs, and other healthcare services. By providing employees with transparent pricing information, these platforms can help them shop for healthcare and make more cost-effective choices.

Patient reviews
Reviews and ratings of different healthcare providers from other patients who have received care from them. Armed with this information, employees can find healthcare providers that are more likely to provide a positive patient experience.

Claims data
Information about the healthcare services that employees have received, including the cost of those services and any out-of-pocket expenses that they may have incurred. By giving employees access to claims data, these platforms can enable them to better understand their healthcare benefits and how to use them.

All of these data sources are crucial for powering the new age of healthcare navigation platforms. By aggregating this data and presenting it to employees in an easily understandable format, these platforms can help to demystify the healthcare system and empower employees to make better decisions, resulting in significant cost savings for employers and improved health outcomes for employees.

For navigation platforms, collecting and integrating all of this data from disparate sources may seem like a colossal undertaking, but that’s generally not the case. Much of this information is now readily available via APIs. For example, Ideon offers structured, normalized provider-network data to navigation platforms via an API.

There are several healthcare navigation platforms on the market today, each with its own unique set of features and capabilities. Some examples include Healthcare Bluebook, Garner Health, HealthJoy, Accolade, Castlight Health, and others. Though their user experiences vary significantly, all rely on the power of data.

Employee Spotlight: Meghna Misra

At Ideon, we’re proud to have such a talented, diverse team leading the charge for a better and more connected health insurance and employee benefits industry. Our ongoing Employee Spotlight series showcases the people behind our product and unveils what life is like at Ideon. Next up… Meghna Misra, our VP of Product!

Name: Meghna Mirsa
Department: Product
Title: Vice President of Product
Location: San Francisco Bay Area

Work

How long have you worked at Ideon?

A year and a half and I must say that every day has been challenging and exciting!

What attracted you to Ideon’s mission?

On the heels of Covid (or really, in the midst of it all), I wanted to build products that had a far-reaching impact on the health and well-being of our society as a whole. Ideon’s mission to transform the benefits experience for all was very compelling. The opportunity to facilitate an era of benefits selection that closely resembles an Amazon-like experience, where products are easy to understand and critical data flows freely throughout our ecosystem — it all was super exciting to me.

How have you grown professionally while on our team?

Not having an insurance or benefits industry background, the learning curve for the domain and market landscape has been steep for me. But I have been very fortunate to be surrounded by an amazing group of people who I continue to learn from and grow with.

What do you like about Ideon’s company culture?

For me, it is Ideon’s culture of empowerment and accountability where everyone is encouraged to do their best work. The work environment has changed post-COVID and we find ourselves largely working with remote teams. In this environment, communication, transparency, and a high do-say ratio has become even more critical and makes navigating remote work very easy.

As a product leader, what are some qualities that help create great products?

I believe that it’s a trifecta of qualities that enables someone to build products that drive maximum impact on the customer experience and business: insatiable curiosity, a problem-solving mindset, and relentless customer focus! Product leaders must have a fire in their belly to solve meaningful problems, ponder and question the status quo, and never lose sight of what matters most to customers.

Life

Favorite activity when you’re not working? 

Getting lost in a good book – there is no activity that I enjoy more than reading.

Favorite place you’ve traveled?

Hands down, Florence, Italy. Apart from the city’s culture, renaissance art and architecture, and amazing food, it has an energy that is alive yet relaxed, the air is buzzing with creativity, and there is beauty everywhere you look!

Interesting fact about yourself… Go!

I greatly enjoy skydiving and am looking forward to getting the USPA-A license (solo certification).

Ideon Insights: Selerix’s Lyle Griffin talks LDEx and benefits data exchange

Welcome to the first installment of Ideon Insights, a new monthly interview series featuring thought leaders and innovators driving the benefits industry forward. In our first episode, we sat down with one of our technology partners, Lyle Griffin, president of Selerix, a leading benefits administration solution for brokers, employers, and carriers.

In this Q&A, Lyle shares his thoughts on the LIMRA Data Exchange (LDEx) standards, how the industry can facilitate more LDEx adoption, and how benefits data exchange will evolve over the next few years. Selerix and Ideon are both members of the Data Exchange Standards Committee tasked with developing the LDEx standards for the workplace benefits industry.

For Lyle’s complete thoughts on all-things LDEx, APIs, and data connectivity, watch the video here.

Below we’ve highlighted five key moments from the conversation.

IDEON: What’s the current state of LDEx adoption?

LYLE GRIFFIN, SELERIX: There are probably a dozen or so carriers that have stepped up and implemented LDEx in a really robust way. We’ve also been pleasantly surprised at the number of technology platforms that have been involved in developing the standard. That dialog between platforms and carriers is something that has been very refreshing.

What are the benefits of LDEx?

One, is just the speed of implementation, being able to set up your data connections quickly. Knowing that they’ll work as advertised is also very important.

As we move to API engagements, you’re really going to see the benefits. If we can move to something where we’re exchanging data in real-time, or as close to real-time as possible, the benefits back to the client or end-user are incredible.

Why is Selerix an advocate for data standards?

We’ve been very committed to implementing the standards since Day 1. What my team is telling me — the people who set up EDI connections with carriers — they’ve been very adamant that LDEx is good for them. They like it any time they can engage with people using the standard because it’s a concise way to start that dialog with the carrier. Having a common language really helps expedite the process.

How does Ideon help carriers and technology platforms use the LDEx format?

One of the most important things that [Ideon] brings to the table, is a fully formed view of how that data exchange ecosystem should work. Having a robust way to work with people on error resolution, initial engagement, data intake, being able to connect with an API or by exchanging files — I can see where this would be a very attractive proposition, not to have to build all of your business processes from scratch to take advantage of what a company like Ideon has to offer.

What’s the future of data exchange in the benefits industry?

In the long run, I think everyone’s vision is one of an interconnected ecosystem, an interconnected market, where trading partners exchange data more frequently and much more reliably than they do today. That’s what this is all about. As an industry, we’re still talking about this stuff, we’re still working on these challenges. So I think it’s going to take a while to realize that vision.

 

Stay tuned for new episodes of Ideon Insights each month. Subscribe to our newsletter below to stay in-the-know about Ideon and receive our latest content directly to your inbox.

Meet Brix — Now part of the Ideon ecosystem

At Ideon, we’re regularly expanding our network of carriers and technology platforms, from industry leaders with 100+ years of history to startups at the forefront of health and benefits innovation. We’re proud to introduce a new addition to the Ideon ecosystem: Brix, a group life insurance carrier offering affordable plans to small businesses.

In this video, John Flueckiger, Brix’s founder and CEO, shares the origin story of Brix, insights on their digital strategy, and how working with Ideon enables third-party platforms to quote Brix’s plans.

Here are three key takeaways from the video:

  • Brix offers an easy and inexpensive way for small businesses to provide life insurance coverage to their employees.
  • Through partnerships with other insurance providers, Brix offers employees the opportunity to enroll in additional life insurance coverage tailored to their individual needs.
  • Brix leverages technology and agile distribution to provide a seamless digital process for brokers and employers. And, by leveraging Ideon, Brix gains representation on some of the leading third-party quoting platforms for group benefits brokers.

To learn more about Brix, check out the video and visit Brix.co. Platforms interested in quoting Brix products via Ideon’s API can contact us, here.

Employee Spotlight: Jacob Waters

At Ideon, we’re proud to have such a talented, diverse team leading the charge for a better and more connected health insurance and employee benefits industry. Our ongoing Employee Spotlight series showcases the people behind our product and unveils what life is like at Ideon. Next up… Jacob Waters, our Senior IT Support Specialist!

Name:Jacob Waters
Department: Business Operations
Title: Senior IT Support Specialist
Location: Colorado

Work

How long have you worked at Ideon?

In March, I will have worked at Ideon for one year. The time has flown by!

What projects are you excited to work on?

I am always excited to learn new ways of automating processes. In the next few months, IT will be tasked with implementing automatic software patching and management. This will help mitigate the need for direct interaction with IT and will be managed behind the scenes.

How have you grown professionally while on our team?

From a previous job, I participated in a HITRUST audit. However, I did not see the process in its entirety. During our recent HITRUST audit, I was able to be fully involved from start to finish. This has enabled me to add more skills to my toolbelt for future projects.

What attracted you to Ideon

The biggest thing that attracted me to Ideon was its people. Prior to being hired at Ideon, I spoke to a few employees that I knew at the company. Based on their experience and my interview, I knew that I was going to be surrounded by a good group of people. I enjoyed my previous job, but once I met with my Ideon teammates, I knew that this would be the best place for me. I could not be happier with my choice. The people, culture and ability to build knowledge without roadblocks is what makes this a special place.

What do you like about Ideon’s company culture?

Working at Ideon has been a refreshing experience. Right from the beginning I was able to develop great working relationships with my peers. Everyone is extremely knowledgeable and always willing to help out. Ideon’s culture allows us to develop solutions without constraints, helping us move forward in a timely manner.

Life

Favorite activity when you’re not working? 

In my free time I enjoy playing basketball with my friends, working on home improvements and landscaping. I also enjoy spending quality time with my family.

Favorite place you’ve traveled?

My favorite place to travel was Nassau in the Bahamas. The beaches looked exactly like a Corona beer commercial. I have an upcoming trip in March to go to Hawaii for the first time, which might bump the Nassau trip to No. 2 on my favs list. That is just a guess.

Interesting fact about yourself… Go!

My brother and I owned a gaming cyber cafe called Tazraz. We held several tournaments for Starcraft, Team Fortress Classic, and Counterstrike.

Error management with Ideon, Part 1: A centralized, consistent experience

By Jashan Ahuja
Group Product Manager – Enrollment

In Part 1 of a series detailing our enrollment API’s features and capabilities, Ideon’s product team examines error reporting and management — how it works, what benefits platforms can expect, and the advantages of a centralized workflow.

Historically, it’s been an operational and technical nightmare for benefits platforms to exchange group and employee enrollment information with medical and voluntary carriers. No matter the carrier’s method of data exchange — EDI, API, portals, etc. — getting data from platform to carrier was rarely a simple task.

But once connected, it’s smooth sailing, right? Not quite. As benefits platforms’ operational teams know all too well, sending data is only part of the equation. The carrier must accept and confirm the change, and that’s where things start to get really complicated. Usually, the biggest challenge is handling and rectifying enrollment data errors—every carrier sends discrepancies in a different format, and their error reports are rarely human-readable.

At Ideon, we’re powering a new era of connection between carriers and tech platforms. One that’s better, faster, and more secure than the industry status quo. In this blog, we explain Ideon’s error-handling features, from standardizing carrier error messages to resolving errors via API, and how they create a far more efficient and accurate enrollment experience.

What are enrollment discrepancies?

It’s hard to find someone with experience in benefits who doesn’t think that data errors and discrepancies are a problem. Some examples include account set up issues, incorrect employee demographic information (social security number, birth date, etc.), coverage date errors, and more.

Today, most carriers report errors in non-standard formats, often via email and spreadsheets. These reports are usually delivered on a weekly basis, and the information they contain is rarely easy to understand. The result is a slow, manual, and resource-intensive error-handling process that poses a challenge to benefits platforms and their operations teams.

What’s the impact?

We analyzed the data from hundreds of groups and thousands of members and found that about 8% of employee enrollments have a critical coverage issue, i.e. incorrect coverage dates, plan information, or birth date, or they’re missing entirely from either the carrier or platform system. Importantly, more than 80% of groups with 20+ members have critical errors.

And these errors have significant ramifications for the entire benefits ecosystem – from carriers and benefits platforms, to brokers, employers, and employees. The downstream impact ranges from lost revenue and broker commissions, to operational inefficiencies and employee experience issues.

Carriers are missing out on millions in potential premium. In one recent migration of about 200,000 employees onto the Ideon platform, our technology identified errors resulting in nearly $1 million in lost premium for the carrier.

For the employers in that migration, we saved more than 30K employees from potential coverage issues — all from one migration of approximately 200K lives. Ultimately, inaccurate data can cause serious problems for employees. Everyone in our industry can relate to the countless access-to-care issues that occur during open enrollment because of erroneous data. Or, imagine a life insurance claim for an employee who wasn’t enrolled accurately — there would be an emotional and financial impact on a grieving family, while the employer and platform would likely suffer reputational harm.

For a detailed look at how inaccurate data impacts every benefits industry stakeholder, read this recent blog by Ideon CEO Michael Levin.

Enrollment discrepancies via Ideon

The processes outlined above remain the industry status quo: manual error handling through spreadsheets and emails, inconsistent carrier formats, and a barrage of harmful errors that affect all stakeholders.

At Ideon, we’ve developed a revolutionary alternative for benefits platforms where enrollment discrepancies are centralized, standardized, and actionable. Here are three ways our solution differs from the typical process:

  • Many-to-one – Ideon translates all of the enrollment “errors” generated by carriers into a uniform and ingestible format.
  • Standardized messaging – Each enrollment discrepancy has a “message,” which is a standardized version of the carrier error translated into a human-readable format.
  • Centralized communication – Benefits platforms view and resolve all enrollment discrepancies, from multiple carriers, directly through Ideon’s API endpoint, allowing for a streamlined and centralized user experience and eliminating the need for other communication (e.g. e-mails and slack messages).

Centralized error management via Ideon’s API

Ideon’s error reporting solution helps platforms prioritize and rectify discrepancies by providing insight into the severity of each discrepancy and who’s responsible for fixing it. Regardless of the carrier or the original data source, platforms get a consistent, simple API experience.

In this section, we examine Ideon’s key error management features and highlight how platforms interact with our API.

(Image: Example of an API response sent from Ideon to a benefits platform. The response details an unresolved enrollment discrepancy, the party responsible for rectifying the issue, and other pertinent information.)

Severity – For each enrollment discrepancy we expose a Severity (“Info”, “Warning”, or “Failure”) that highlights the impact of the issue. A “Failure” enrollment discrepancy indicates a blocker to a member’s enrollment, whereas “Info” and “Warning” enrollment discrepancies provide visibility into informational updates or future changes required, for example when a dependent is due to age out in a couple of months.

Assignment – Each enrollment discrepancy has a Responsible Party and can be assigned to “Ideon” or “Partner”. This provides visibility into enrollment discrepancies that are currently being managed by our Enrollment Operations team and allows users to easily identify enrollment discrepancies that they need to address.

Status – Enrollment discrepancies have a status of “Unresolved”, “Resolved”, or “Returned”. This allows our teams to stay in-sync on each individual enrollment discrepancy. When we initially surface an enrollment discrepancy, it is in an “Unresolved” status. The status is updated to “Returned” when any comments are added and “Resolved” when a resolution message is provided.

Resolution – Partners are able to add a resolution message to an enrollment discrepancy via a simple API endpoint. This updates the status of the enrollment discrepancy to “Resolved”. If the issue still remains when the carrier re-attempts to process the data then the enrollment discrepancy can be reverted back to an “Unresolved” status so the history is retained.

Comments – Partners are able to interact with our operations team entirely via the enrollment discrepancies API endpoint by threading comments directly on the original enrollment discrepancy. This allows for efficient interaction between our respective Operational teams without needing additional tools or e-mails.

API and webhook transmissionPartners can pull down enrollment discrepancies directly from our API via a GET endpoint. We also provide enrollment discrepancies via Webhooks or a standard periodic CSV report.

(Image: Example of an API response sent from Ideon to a benefits platform. The response details a RESOLVED enrollment discrepancy.)

In summary, managing and rectifying enrollment data errors and discrepancies is a critical aspect of the benefits workflow. At Ideon, we understand the pain points of the industry and have developed a solution that streamlines the process by: standardizing error messaging; delivering a centralized resolution experience for benefits platforms; and helping them prioritize and, ultimately, resolve each discrepancy. Platforms can easily manage enrollment discrepancies, from multiple carriers, directly through our API endpoint, allowing for a streamlined experience without back-and-forth email communication.

Coming soon — Part 2: Auto reconciliation overview

Standardizing errors is a big step forward, but did you know Ideon can proactively identify them whether or not the carrier actually reports them? In the next blog in this series, we’ll dive into Ideon’s auto reconciliation feature, an industry-first capability that automatically compares data in the carrier and platform systems, surfacing discrepancies in near real-time.