With the time-sensitive and challenging requirements to meet this, Federally Facilitated Marketplace Qualified Health Plans (FFM QHPs) must be prepared to deliver:

  1. Provider Search: Publish and maintain an up-to-date, accurate and complete provider (i.e. doctors and facilities) directory that is easily accessible to prospects and members, such as via a website
  2. Provider Data: Provider data must be made publicly available in a specific machine-readable JSON format
  3. Prescription Look-up: Publish and maintain an up-to-date, accurate and complete formulary (i.e. list of covered drugs) that is easily accessible to prospects and members, such as via a website.
  4. Prescription Data: Prescription data must be made publicly available in a specific machine-readable JSON format

The changes are not trivial, as carriers need to create, publish and maintain up-to-date and accurate JSON files, and an easily accessible and searchable formulary and provider search experience by October 18, 2015. This is an added burden on top of preparing for open-enrollment on November 1, 2015.

Creating these specific JSON files often require analysts and programmers to go through a large set of data files and write complex algorithms. Zipari has already completed this task, and has tools in place to turn any carrier’s provider and formulary data into the proper specific JSON format mandated by CMS.

Once these machine-readable JSON formats are created, Zipari’s Scout Provider Search and Script Formulary Lookup solutions use these files to provide an elegant user experience for prospects and members to find doctors, facilities and prescriptions.

Implementing these CMS mandates are not trivial, and without Zipari’s Provider Search and Prescription Lookup, would require a lot of work in a short amount of time. However, since Zipari’s solutions are out-of-the-box products that can simply be configured to use a new JSON file, updating your consumer-facing provider and formulary search solutions is as simple as switching a SIM card from an old phone to a new phone. Just plug in the carrier JSON file, change the logo and branding, and Zipari’s solutions provide a feature-rich, mobile-friendly solution that prospects and members will immediately know how to use.

Making sure that doctors and drugs are covered within a plan, are two of the most critical decisions when deciding what health insurance to buy. Making provider and prescription lookup easy for prospects and members will increase customer acquisition and lead to higher customer retention and greater member satisfaction.

Some of the additional benefits of Zipari’s Provider Search solution is that it empowers members to make informed decisions when choosing a doctor or facility, while driving prospects to the payer’s shopping solution. Provider Search is continuously learning about prospects and members and automatically generate emails, surveys and other interactions to engage and acquire new customers.

Some of the additional benefits of Zipari’s Prescription Lookup is that it integrates with shopping solutions to help consumers make intelligent decisions while choosing health plans, improving user experience and conversion rates, while also helping drives up the use of generics. The result is significant savings for both consumers and carriers.

Being prepared and ready for the 10/18 deadline is paramount for payers, and Zipari’s solutions can be rapidly deployed to help carriers meet this deadline.

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This post was authored by Krishan Patel, VP of Product.