Feb 28, 2023
Proactively detecting enrollment issues: Noyo vs Other Solutions
The industry is well aware that data discrepancies between the ben-admin, broker, and carrier frequently cause billing and access-to-care issues. Here are main differences of how Noyo is making it easier to proactively identify and resolve them.
The industry is well aware that data discrepancies between the ben-admin, broker, and carrier frequently cause billing and access-to-care issues.
How widespread are these coverage issues? Here’s what we found:
After connecting a sample of groups to coverage at the carrier, Noyo’s sync technology found an average of 44 issues per group that could directly impact member coverage, with 95% of groups having at least one coverage-impacting error eg missing enrollment, invalid SSN, incorrect effective date, missed termination etc.
In this article we’ll highlight the main differences of how the Noyo data platform is making it easier to proactively identify and resolve enrollment issues compared to other API solutions. We’ll look at the design and capabilities of each solution, as well as real-life workflows.
Our view is that better enrollment experiences don’t result from just having better pipes (eg API vs EDI), the right automated systems need to be in place to clean data, keep it in sync, and provide transparency. Without these systems, bad data can just move more efficiently.
Here are the main takeaways:
Noyo is different because our technology can read data from the carrier system in near real-time. This capability enables powerful, automated features that prevent errors and make enrollment data more useful.
Only Noyo audits the carrier system directly to confirm every member change is processed correctly, providing automatic feedback if there's an issue.
Noyo enables real-time transaction monitoring, just like tracking a package to your door, but for member enrollments.
The way Noyo keeps data in sync is very different than other solutions. Noyo schedules frequent, automated syncs direct from the carrier system to proactively identify issues before they can impact members.
Read data directly from the carrier system in near real-time
Noyo builds and maintains proprietary integrations with insurance carriers that enable read/write access. In other words, Noyo can send data to the carrier, and then look inside the carrier system to see what happened. Other solutions on the market cannot do this without relying on a carrier-generated report or manual workflow.
Why does this matter?
Here’s a few examples of the features that only Noyo provides because of our unique ability to read data out of the carrier system:
Faster group connections: Brokers can click a button and connect a group to coverage at the carrier. Noyo then automatically retrieves the group account structure, plans, and enrollments, reducing group connection times to days.
Confirm every member change: Automatically confirm changes directly within the carrier system when they’re processed and again on the effective date. Find out immediately if something went wrong. We call it round-trip confirmation.
Real-time monitoring: Noyo tracks the status of every member change as data is received, processed, and confirmed by the carrier, and then verified again by Noyo. It’s like tracking an order to your door.
Proactively identify issues: Noyo schedules frequent, automated syncs that surface coverage-impacting discrepancies between the ben-admin and carrier system—catch and resolve issues before they impact members.
Automate open enrollment: Noyo pulls down new plans and structures from the carrier when they’re available so that platforms know when they can map to the new structure and begin sending enrollments. No more email chains, file scheduling, and finding out there’s an issue when it’s too late.
These features are consistent across our carrier integrations, even if carriers do not have APIs in place. We meet carriers where they are and adapt their systems so they can offer an experience that meets The Noyo Standard for syncing data.
How are other solutions different?
Send only: Other solutions can only send data to the carrier, similar to EDI. While APIs may be in place to receive data from the ben-admin, the data is being outputted to the carrier in a method that can’t support read/write capabilities. Put simply, other solutions can send the mail but cannot confirm that it was received.
Dependent on carrier to report issues: Other solutions must rely on the carrier to audit their own data, typically by providing an error report (XML/CSV). In some cases, the middleware solution may periodically receive census files that get diffed with records from the ben-admin to surface issues. In either case, the auditing process is only as reliable as the carrier's ability to report data out of their system.
Relying on the carrier to produce reports presents a few challenges:
Many carriers struggle to generate error reports quickly and reliably (or at all!). This means the process will be inconsistent across connections.
Relying on carriers to provide census files and error reports persists existing shortcomings with EDI. Carriers may not identify or accurately communicate all issues, and humans are often required to initiate reports and/or interpret them.
Ingesting carrier reports and posting the results to an API–no matter how optimized–still adds another bottleneck where more issues and errors can occur.
Automatically confirm every member change without relying on the carrier
Where other solutions wait for the carrier to provide a report and then translate that report through a combination of human and machine-led processes, Noyo simply checks the carrier system directly.
There are two types of automated audits that Noyo runs for every member change across all of our carrier connections:
1. Data validation and carrier business rules
Before data even reaches the carrier, Noyo ensures every request conforms to standard data validations eg valid carrier ID, SSN/DOB formatted correctly, no duplicate enrollments etc. For every carrier, we embed hundreds of carrier-specific rules to check data against eg eligible zip codes and plans, classification/bill groups, and coverage windows. If there’s an issue, the Noyo API provides an immediate response in an intuitive, human readable format.
2. Round-trip confirmation
After a request meets the above validations, Noyo will automatically run a second series of checks. First, Noyo checks the carrier system shortly after a request is accepted by the carrier to see if it was processed and also to update its status (more about real-time statuses below). Second, Noyo will check the carrier system again on the change’s effective date as an added failsafe just to confirm everything was processed as expected. At any point, if there’s an issue, Noyo either resolves it internally or works with the ben-admin to get it resolved quickly.
In summary, Noyo is continuously cleaning data, first, before member changes even reach the carrier system, and second, as those changes are being processed. These automated workflows are enabled across all of Noyo’s sync carrier connections.
How are other solutions different?
Limited carrier business rule validations: Other solutions do not embed custom business rules from each carrier to check data against. Without these upfront validations, brokers and ben-admins have to deal with the fallout when bad data enters the carrier system.
No direct confirmation: Other solutions rely on inferred logic to confirm member changes. For example, if a change is accepted by the carrier without flagging an issue, the middleware will label it as “synced”. This is very different than Noyo looking inside the carrier system twice to see what actually happened and instantly reporting the results.
Why is direct confirmation so important?
We find that carriers frequently accept changes without completing them as intended. For example, during this past open enrollment period, Noyo round-trip confirmation automatically surfaced nearly 2,500 discrepancies that could impact member coverage.
These were enrollment issues that had been received by the carrier. Additionally, for the majority of these issues, Noyo was able to resolve them without any intervention from the ben-admin.
This article explains the impact and functionality of Noyo round-trip confirmation in detail.
Real-time monitoring within a complete dashboard experience
Every member change submitted through Noyo can be tracked to completion in near real-time. We think of this service like tracking an order to your door, but for enrollments. Transaction statuses can be monitored via API GET request or within a dashboard experience.
If a customer were to reach out with an escalation, understanding the issue is as easy as searching the member’s name in the Noyo dashboard. Ben-admins and brokers have a centralized way to manage issues across carriers, as well as API endpoints to develop their own internal tools if needed.
Here’s a breakdown of end-to-end transaction statuses. Each status includes a timestamp. Additionally, a historical log of statuses for each change can be accessed via API.
noyo_acceptedWe’ve confirmed receipt of the member change requestcarrier_acceptedThe carrier has accepted the changecarrier_processingThe carrier is processing the changecarrier_completedWe’ve confirmed that the changes were made by the carriernoyo_verifiedRound-trip confirmation shows that the change was made successfully on its effective date
And if there’s an issue, Noyo makes it clear what happened, where it happened, and what the next step is.
carrier_rejectedThe transaction failed because the carrier did not accept the changes requested and could not be resolvedcarrier_reviewIndicates a transaction is stuck and the carrier owns the next stepnoyo_reviewIndicates a transaction is stuck and Noyo owns the next stepcanceledThe transaction was canceled by the ben-admin platform
Understanding the status of a change is critical, but so is completing the transaction quickly.
Where other solutions do not share how fast they can process data at the carrier, Noyo processes and confirms member changes within 4 days or less; 95% of transactions are received by the carrier within 15 minutes, and the majority of transactions are completed almost instantly.
How are other solutions different?
No real-time tracking: Other solutions do not provide detailed statuses or “order tracking” directly from the carrier system. There is no automation in place to detect issues as they occur. Instead, other solutions focus on reporting errors after the carrier identifies them (if at all) by ingesting error reports and serving the data over API. Brokers and ben-admins are expected to understand and fix the problems.
No central dashboard experience: No user interface is provided to monitor transactions or reconcile issues. Ben-admins and brokers must build their own tools to handle these workflows.
Proactively audit group data at the carrier to catch issues before they become problems
One of the most powerful capabilities of having read/write integrations with carriers is the ability to automatically refresh group data, a feature that Noyo has pioneered in our space.
Noyo schedules automated syncs with each carrier. This proactively surfaces mismatches between what the ben-admin expects and what’s actually in the carrier system. The discrepancies that Noyo identifies are typically issues related to effective dates, missing enrollments, coverage differences, and critical demographic data like incorrect SSN or DOB.
When Noyo discovers potential coverage issues, we first try to resolve them automatically, and if input is needed, our team works with stakeholders to get them resolved quickly.
During this past open enrollment period, where we saw a roughly 4x increase in transaction volume, 92% of member changes were automated without any involvement from our customers. Because Noyo is continually auditing and resolving issues, our connected partners only need to pay attention to a small percentage of their total volume.
Additionally, Noyo not only surfaces potential issues but also exposes the group account structure, plans, and enrollments after each sync with the carrier. Platforms are able to GET an up-to-date view of the carrier’s data to power other workflows.
How are other solutions different?
Not fully automated or proactive: Other solutions ingest group data via a file or census report from the carrier and compare it to records from the ben-admin. The “diffing” process can be automated to varying degrees, but it still requires the carrier to report data out of their system, which means the inputs are often slow, manual, and inconsistent across connections. Brokers and ben-admins are often required to send a request every time they want to run a reconciliation on a group.
Limited capabilities: Other solutions do not expose the group account structure, plans, and enrollments after each sync. Noyo round-trip confirmation also compliments Noyo's proactive auditing capabilities so ben-admins have multiple ways to catch issues: 1. as they're being processed 2. During continuous, automated syncs. Other solutions do not offer these comprehensive checks together.
Noyo is more than middleware. We are building toward a future where member data can be used and understood in new ways. The pipes (API, EDI, or APIs on EDI rails) won't solve data quality issues alone. Clean, trusted data requires the right systems in place.
If you’re thinking about the automation that’s needed to audit and clean enrollment data, don’t hesitate to reach out. Noyo is scaling these systems today for ben-admins and carriers of all shapes and sizes.