Health exchange consulting tailored to your needs

Regardless of your state’s position on Medicaid expansion and program integration, states continue to establish new requirements that demand immediate compliance. Our team has broad experience and credibility advising on Exchange readiness, implementations, assessments, and remediation. Our experts can help you implement compliant and effective programs that will coordinate with your state’s health priorities and exchanges while also being audit-ready. We can help you implement a new health insurance exchange compliance program or improve on your existing program to better serve your organization. Our health exchange consulting includes:

  • Audit readiness preparation, gap assessments and remediation support
  • Ongoing monitoring of new requirements and compliance support
  • Compliance support for exchange formulary rules and requirements
  • Assistance with integration of specialty pharmacy programs into HIX offerings
  • Operational assistance with requirements for prior authorizations, exceptions and appeals

With constantly evolving exchange regulations, keeping up with compliance can be challenging. Let us be your partner in navigating this complex landscape. Our consultants stay on top of the latest state and federal requirements so you can focus on delivering quality care. We’ll conduct a thorough assessment to identify any gaps and provide clear guidance for remediation. Throughout the process, we keep the bigger picture in mind to ensure your exchange offerings align with your larger business goals.

In addition to compliance expertise, we bring deep operational knowledge across all facets of exchange integration. We can assist with formulary configuration, utilization management protocols, claims adjudication, provider contracting, and more. Rely on us for end-to-end support – from designing exchange plans to implementing the technology infrastructure required for success.