Despite improvements with the HealthCare.gov website, about 10 percent of health insurance exchange applications have been inaccurately transmitted, according to Reuters, creating enrollment verification burdens for payers and the possibility of another wave of public complaints.
Like a horse played by two in a children's play, the front end of the system is moving ahead while the back end stays behind, swaying. "The Administration is creating a hell of a mess for themselves by opening the front end before the back end is fixed," insurance consultant Robert Laszewski told The Fiscal Times.
What happens once customers choose a plan on the website is the focus of collaborative insurer and governmental attention: AHIP, the Centers for Medicare & Medicaid Services and the Blue Cross and Blue Shield Association recently issued a joint statement to stress their efforts to fix HealthCare.gov, Reuters noted, as insurer representatives meet daily with federal officials to solve the problem.
HealthCare.gov sends enrollment information via electronic transmissions known as 834 files, which have had chronic problems, The Fiscal Times reported, including files never reaching insurers, duplicate transmissions, "orphaned" members who say they enrolled but never received confirmation, and files containing errors about who signed up and what plans they picked.
So while the public encounters with the site get better, insurers stand to see their problems worsen, The Fiscal Times noted.
The problematic back end of HealthCare.gov is more complicated than the front end. "The back end is where a lot of the heavy billing and transaction processing and batch processing need to go on. It's easier to build a public website than it is to build a very large-scale billing engine and transaction engine like that," said technology expert John Engates in a phone interview with Bloomberg.
Further, the federal exchange is making incorrect determinations about who qualifies for Medicaid, telling some people they're eligible when they're not, The Town Talk reported. Like 834s, Medicaid "flat files" transmitted to insurers also are riddled with errors and incomplete information, according to The Washington Post.