WASHINGTON – June 7, 2016. Gorman Health Group (GHG), the leading consulting firm and solutions provider in government-sponsored healthcare programs, has launched a new reconciliation service with a focus on reducing the volume of enrollment and payment discrepancies while building best practices within Issuers’ Finance and Enrollment departments.


After months of delays, the Centers for Medicare & Medicaid Services (CMS) began paying Issuers based on the Federally-Facilitated Marketplace (FFM) system of record versus the Issuer’s perspective for the first time since the launch of the Exchange. Prior to this shift, Issuers invoiced the FFM each month based on their system and irrespective of being out of synch.


“As with all government-sponsored health programs, the importance of lining up your enrollment data with the government is critical to being paid accurately and starting the member experience off on the right foot,” said John Gorman, GHG’s Founder & Executive Chairman.


GHG holds extensive expertise in the reconciliation of government-sponsored health programs and has been supporting Issuers since 2007. As an extension, our Reconciliation Services Division helps clients navigate the ever-changing landscape of FFM and State-Based Marketplace (SBM) reconciliation while building a cohesive strategy with a wide range of consulting and technology services. Utilizing a best practice approach, GHG’s expert reconciliation team supplements an Issuer’s current staffing model with a focus on reducing discrepancies, enabling timely and accurate policy-based payments (PBPs) from the FFM, and other positive, downstream impacts. Our reconciliation team also leverages GHG’s Valencia™ reconciliation tool, which currently manages approximately 42% of the 12.7M Exchange market overall.


“The sheer volume of aging discrepancies feeds into other manual processes Issuers support in the Exchange business,” explained Diane Fischer, GHG’s Senior Consultant. “Helping Issuers get their heads above water allows them to focus on their reconciliation strategy simply by calculating the financial impact of a broken member. Living through the chaos of Medicare Part D ten years ago triggers the same guiding principles we applied then and apply today.”


Through our Marketplace reconciliation services, organizations will be able to track and resolve enrollment and payment discrepancies and be able to quantify the financial impact of their reconciliation efforts. GHG’s reconciliation experts will equip Issuer’s with the knowledge to predict their monthly payment (prospective and retrospective) and build a process to respond to the Exchange or internally when actual payment does not equate to what was expected.


“Now that discrepancies represent real dollars, the stakes are much higher,” continued John Gorman. “We are excited to support Issuers through this new service and, most importantly, ensuring all plans have an active reconciliation strategy in place.”


About Gorman Health Group | Gorman Health Group (GHG) is a leading consulting and software solutions firm specializing in government health programs, including Medicare managed care, Medicaid, and Health Insurance Marketplace opportunities. Since 1996, our unparalleled teams of subject matter experts, former health plan executives, and seasoned healthcare regulators have been providing strategic, operational, financial, and clinical services to the industry across a full spectrum of business needs. Further, our software solutions have continued to place efficient and compliant operations within our client’s reach. Learn more at www.gormanhealthgroup.com and follow us on Twitter @gormanhealth.


Release Date: 06/07/2016