Jun 6, 2024

Taking control of enrollment errors

With this product release, Noyo is completely transforming how enrollment errors can be tracked, triaged, and resolved to prevent downstream effects on members.

Nicole Shelby, Andrew Ambrosino, and Joe Gomez

Everyone hates how enrollment errors are managed today. Ben-admin operations analysts, brokers, and group admins are stuck parsing complicated reports or manually checking portals to confirm coverage. In many cases, errors aren’t caught at all until a member escalates a problem with their coverage. 

Because the tools that exist today are limited, incidents of accidental coverage loss, expensive billing mistakes, and delayed claims result in lower margins, higher costs for customers, and poor consumer experiences. We have to do better.

At Noyo, we’ve built robust data validation right into our enrollment engine to prevent bad data from reaching the carrier. But we’re not stopping there: we’re also committed to delivering 100% transparency to our partners throughout the entire process of making an enrollment change.

This means that if the carrier failed to apply the requested changes (or applied them incorrectly), we want our customers to know ASAP. They shouldn’t have to wait for a report or contact the carrier. The information they need to take action should be instantly available, and they should have the tools to configure the experience to the needs of their operations and product. 

This vision isn't years away, it's possible with Noyo today.

We've just released a new API for deeper, more detailed change tracking, webhooks for real-time activity alerts, and a brand-new discrepancy triage experience in the Command Center. These capabilities allow our partners to craft responsive, nearly real-time error management solutions right in their own products, or to use Noyo’s out-of-the-box tooling to start addressing errors right away.

Read on for the full overview or watch the video with our product experts to dive into the details.

Complete transparency, powered by Noyo Sync

Most other enrollment solutions, for example EDI and other API middleware, can only send data to the carrier, and therefore, have little visibility into what actually happened as a result. What sets Noyo apart is we work closely with our network of carriers to build two-way integrations that give us write and read access to enrollment data, allowing us to see inside the carrier system.

When our ben-admin partners send us member eligibility changes, we use round-trip confirmation to check the carrier’s system directly for successful execution (we don't just rely on whether or not the carrier accepted a change to say it was successful). 

Our new Tracking API illuminates the field-by-field comparison we do during round-trip confirmation (across 40 fields and counting). This shows what the ben-admin sent versus what the carrier has in their system, and our partners can use this comparison to understand what changes are in-process and what’s been completed.

If the fields aren’t changed correctly at the carrier, we automatically raise a data discrepancy for immediate attention. Additionally, our ben-admin partners don't need to send a member change for a discrepancy to be detected. Noyo syncs group data with carriers in the background, and if one of our routine syncs discovers a mismatch or we discover that a discrepancy has been resolved by the carrier, we'll immediately reflect that in our system.

When a discrepancy is detected, our partners can either get an alert directly to their systems, or their teams can log into the Command Center and use our dedicated triage tool. Each discrepancy has tons of useful info associated with it: a source and classification for easy sorting, a field-by-field comparison, a full history of how it came to be, an impact score calculated by Noyo, detailed timestamps for reporting, and more.

The new API provides everything a ben-admin platform might need to build a powerful, customized error management experience for their stakeholders. Here are a few ways a Noyo-connected ben-admin might use our new endpoints: 

  • Deliver an automated, daily list of in-process changes for high-priority groups so teams can respond to customer inquiries quickly and with more context

  • Set up backend alerts for changes that have been in-process for too long, triggering an investigation before the member or broker escalates

  • Automatically surface a list of high-impact discrepancies in internal tools at a certain time each day so teams can make error resolution a regular part of their process

  • Enable analysts to set up alerts for discrepancies on specific employees or groups to provide white-glove service to top-tier accounts

  • Calculate custom severity scores to determine the correct routing of discrepancies among internal teams, reducing internal churn and speeding up issue resolution

An intuitive triage experience out-of-the-box

For ben-admins who are new to Noyo or facing resource constraints, you can still get a best-in-class error management experience without building anything new. The Command Center comes equipped with a dedicated discrepancy triage tool that draws on our API to deliver fully contextualized and prioritized discrepancies in an intuitive interface. 

We automatically surface any discrepancy with an impact score above 3 to the “Open” tab, while separating out the lower-impact errors. By filtering out the noise, we equip our customers to more quickly and effectively resolve the issues that can affect their customers.

Noyo's impact scores take into account our years of experience with carriers’ rules, business logic, operational processes, and behavior nuances: a unique combination of intelligence you won’t find anywhere else.

Teams can use the Command Center to review new discrepancies, investigate and understand existing issues, dismiss low-priority items, and escalate especially tricky situations to Noyo Support. When escalations occur, all of the correspondence can be viewed in Command Center.

Raising the bar for the member experience

Today’s new tools and features bring us one step closer to a world where no one is unexpectedly dropped from coverage or denied the healthcare they need. We believe all ben-admins, brokers, and group admins should have access to dynamic, real-time data so that coverage is trusted and accurate.

To see our complete discrepancy management solution in action, reach out for a full demo or drop into office hours to get your questions answered. We're also hosting a live demo on June 21st, you can register here to join live or get the recording.

If you do benefits, you need Noyo

The future of employee benefits is faster, easier, and more automated. Are you ready?