Reconciliation

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

Ideon's API surfaces differences between the carrier data and your data, before and during production.

We highlight discrepancies as early as possible, to reduce their impact and total number found during Carrier testing:

1. During Ingestion - information is missing, or misformatted

2. After Creation - pre-send validations audit existing data, such as:

   1. Addresses

   2. Communication Segments

   3. Social Security Numbers

   4. Benefit Amounts

3. Pre-Production & Ongoing Maintenance

   1. Carrier Error Reports (EDI)

   2. Proactive Census Requests (API)

Ideon refers to these reconciliation issues as "Enrollment Discrepancies".

We recommend implementing two features to make the best use of this data when available from Carrier APIs:

Enrollment Discrepancies API

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

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 Discrepancy as "resolved," you can do so with a single easy endpoint.

POST /errors/:id/resolution

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

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

Identifying Reconciliation Discrepancies

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 Discrepancies. Similarly, if any existing errors 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 Discrepancies much earlier than a Carrier reports them. This feature is dependent on the Carrier allowing Ideon to retrieve census information from their system.