Audio 1 866 244 8528 passcode 474987 plan management meeting november 19 2013
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Audio: 1-866-244-8528; passcode 474987 Plan Management Meeting November 19, 2013. Agenda. Policy/Legislative Update. Michael Arnis Associate Policy Director. Provider Directory. Dustin Arnette Plan Manager. Provider Directory. Post “go-live” feedback National Provider Identifier (NPI)

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Audio 1 866 244 8528 passcode 474987 plan management meeting november 19 2013

Audio: 1-866-244-8528; passcode 474987Plan Management MeetingNovember 19, 2013



Policy legislative update
Policy/Legislative Update

Michael Arnis

Associate Policy Director


Provider directory
Provider Directory

Dustin Arnette

Plan Manager


Provider directory1
Provider Directory

  • Post “go-live” feedback

  • National Provider Identifier (NPI)

    • Making this a required data field

  • Future Enhancements:

    • Static “inbound” folder

    • Expanded search radius

    • Adding clinic name to search and results

    • Search by issuer

    • Specialty search

  • New entrants and transition for 2015


Monitoring and compliance
Monitoring and Compliance

Dustin Arnette

Plan Manager


Monitoring and compliance1
Monitoring and Compliance

  • Ensure ongoing compliance with certification criteria after initial certification

  • Federal regulations applicable to operation of a State-based Marketplace (“SBM”)

  • Additional details in the Guidance for Participation documents:

    • Section 2.4 – Monitoring and Compliance of Qualified Health Plans (p. 17)

    • Section 2.3 – Monitoring and Compliance of Qualified Dental Plans (p. 13)


QHP & QDP Compliance and Monitoring Dashboard

May 2014

Fictitious data for discussion purposes only


QHP & QDP Compliance and Monitoring Dashboard

May 2014

Full Carrier Report (excerpt)

Fictitious data for discussion purposes only


QHP & QDP Compliance and Monitoring Dashboard

May 2014

Summary of Noncompliance

Fictitious data for discussion purposes only


QHP & QDP Compliance and Monitoring Dashboard

May 2014

Complaint and Enrollment Metrics

Fictitious data for discussion purposes only


2015 plan management preparation
2015 Plan Management Preparation

Susanne Towill

Senior Plan Manager


Reflection on 2014
Reflection on 2014

  • Lessons Learned

    • Communication methods

    • Benefit data translation

    • Timeline and flow

    • Third party QA

  • Feedback Requested

    • What worked well for you?

    • What can be improved for this year?

    • Other thoughts?

  • Further feedback can be sent to: [email protected]


Preparing for 2015
Preparing for 2015

  • Communications:

    • Bi-Monthly Meetings

    • Alternating Bi-Monthly Newsletter

    • Plan Management Webpage refreshed

  • Timeline & Flow

    • Coordinating drafting with federal and state requirements

  • Guidance for Participation

    • Goal to publish drafts in December and final February 1st.

  • CMS Data Templates

    • Providing feedback to CMS


Guidance for participation
Guidance For Participation

Zach Snyder

Plan Manager



Needed revisions
Needed Revisions

  • Update Regulations

  • Plan Management Timeline

  • Checklist

  • Suggestions?


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