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Health Plan Selects XpandHCR to Manage ACA Federal Reimbursements

Solution Enables Insurers to Calculate and Track Cost-Sharing Reduction Subsidies

LORTON, Va. (September 9, 2013) – Acero Health Technologies announces that UPMC Health Plan, the second-largest health insurer in western Pennsylvania, selects Acero’s XpandHCR™ product to calculate, track and reconcile federal Affordable Care Act (ACA) payments.

Designed to help health insurance payers address potential ACA financial risk, XpandHCR is designed to address the vexing issue of how to support the ACA cost-sharing reduction requirements based on CMS’ “standard calculation” method as outlined in recent federal regulations.

The ACA requires payers to reduce benefit cost-sharing for eligible, low-income consumers resulting in benefit plans that meet higher ACA-defined actuarial value (AV) thresholds.

Because plan premiums are not adjusted concurrently to reflect the required enhanced benefits, the ACA creates new, financial exposure for health insurers in the form of provider disbursements that must be accurately recovered from the federal government.

To address this increased exposure, XpandHCR provides insurance payers with a reliable method to calculate the actual incurred provider paid amount eligible for federal reimbursement and provides tools to help reconcile these amounts against prospective federal payments.

XpandHCR’s unique, granular approach provides carriers with the operational data necessary to proactively track issues related to the federal reimbursement and assist in reporting for the federal government,” said Alan Merchant, CEO of Acero Health Technologies.

This dynamic, scalable solution provides insurers with a transactional method to concurrently identify CSR amounts owed by the federal government providing a carrier’s finance team with the transparency it needs to account for potential health plan federal receivables and liabilities.

Acero’s technology team has years of experience creating integrated, scalable claims processing solutions for health plan administrators. XpandHCR is claim system agnostic, allowing payers to use XpandHCR regardless of whether the carrier plans to use one or multiple claims systems to support its exchange strategy.

For more information about XpandHCR, go to Acero Health Technologies

Acero Health Technologies, an innovative information technology company serving today's healthcare visionaries, allows health plans to incrementally add software solutions to address new business challenges without requiring wholesale changes to existing investments. The Acero team has significant health plan and technical experience developing sophisticated enterprise software solutions for health plans and third-party benefits administrators. Acero’s PlanXpand™ engine powers several technology solutions including XpandCDH™, a powerful tool for administering consumer driven health plans and XpandACC™, an application that facilitates real-time integration of pharmacy, medical, behavioral, vision, and dental benefits.

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September 09, 2013