Reconciliation

Ideon proactively identifies Enrollment Problems so your data is in sync with the Carriers and everyone has the right elections.

Ideon's API reduces the amount of reconciliation issues that occur when the Carrier reconciles the data delivered with what they have, but rarely in this space can you be 100% clean of errors 100% of the time. That's where the Ideon system, and team, comes in to play to make the often frustrating process easier to manage.

Ideon refers to these reconciliation issues as "Enrollment Problems" and we take two approaches to ensure that every issue gets resolved and in the fastest possible way.

Enrollment Problems API

Ideon standardizes all of the reconciliation issues in Enrollment Problems via the API. With a single endpoint, you can pull down all of the outstanding unresolved or resolved Enrollment Problems.

GET /coverage_periods/:id/errors

{
  "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",
      "severity": "warning",
      "message": "Child dependent John Smith is missing from coverage. Please include the dependent.",
      "assignee": "partner",
      "status": "unresolved",
      "resolution": null,
      "created_at": "2021-05-10T13:39:22.143Z"
    }
  ]
}

You can use this endpoint to cleanly show your team all of the outstanding issues they need to correct in the data in order to be in sync with the Carrier.

Once your team has fixed an issue and is ready to mark the Enrollment Problem as "resolved," you can do so with a single easy endpoint.

POST /errors/:id/resolultion

{
  "message": "Child dependent John Smith has been added with medical coverage starting 08/01/2020"
}

The Enrollment Problems API allows for seamless communication of standard errors without the need for back and forth emails between our teams.

Identifying Enrollment Problems

Ideon works with Carriers to receive periodic Census files that detail the demographic and enrollment information the Carrier has at that moment for the Group. Ideon's system transforms that data into our schema and then automatically compares it with the current data. If there are any discrepancies, the Ideon system will automatically create new standard Enrollment Problems. Similarly, if any existing Enrollment Problems are no longer issues, the system will automatically resolve them.

This form of automated reconciliation is unprecedented in the industry and allows Ideon to proactively discern Enrollment Problems way before a Carrier reports them. This feature is dependent on the Carrier allowing Ideon to retrieve census information from their system.

Ideon's team will also receive the enrollment Reconciliation Reports from the Carrier in file format. Our team of experts reviews each issue to ensure that there isn't anything we've missed processing. If they find anything, they will upload it to the Ideon system so that it surfaces to you via the API.