Partners

The Project:

NFP Health supports the Individual and SHOP exchanges for the State of New Mexico (beWellnm). beWellnm hired NFP Health to replace its existing SHOP vendor in 2018. A complete end-to-end SHOP solution was built and launched in three months. The solution includes both front and back-end technologies, including:

  • Eligibility and enrollment portal for employers, agents, and administrators to shop and compare plans for their employees, conduct maintenance transactions for qualifying life events, and renew coverage at the end of the policy year
  • Financial Management to support monthly billing, payment processing, and delinquency management

Three years later, in the fall of 2021, NFP Health and Optum partnered to launch New Mexico’s first individual Exchange. NFP Health built the State a financial management solution and Customer Engagement Center.

NFP Health’s financial management system (FMS) provides beWellnm with a state-of-the-art premium aggregation and billing solution that manages all facets of its financial operations. This includes monthly billing, delinquency management, payment processing (debit card, credit card, ACH, check), bank reconciliation, carrier premium remittance, reporting, and noticing.

The FMS also integrates with several third parties:

  • Medical and Dental Carriers: XML and EDI transmission
  • Bank Integration: ACH and lockbox processing
  • CMS Integration: APTC and 1095 reporting
  • Print Vendor Integration: XML for monthly statements
  • Salesforce Integration: Case management

The Customer Engagement Center (CEC), located in Albuquerque, NM, opened its doors in mid-summer 2021. The state-of-the-art call center handles customer communication for the Exchange, including phone, email, and web chat. The office also provides mail room functions for the State.

Several enhancements were made to the CEC in 2022, including:

  • Added Pay-by-IVR functionality to existing call plans allowing for unattended phone-based credit card payments. The solution is PCI-compliant and has dramatically reduced the number of manual payments.
  • NFP Health added beWellNM’s call-taking teams to the CEC IVR and CRM solutions to help improve the client’s technology and gain efficiencies by using a single call center technology platform.

The Results:

  • Launched end-to-end SHOP solution in three months, including data conversion with a 100% success rate
  • SHOP financial operations have a perfect track record for billing, invoicing, and premium aggregation
  • Built, integrated, and launched the State’s first Individual Exchange
  • Designed, built, and staffed a new call center during the height of the pandemic
  • Implemented new security and privacy programs to meet the compliance demands of CMS and the State (MARS-E)

beWellNM