America’s current status of HIX:

  1. The deadline for states to declare their intentions on whether they will build their own exchange or have the government do it has been extended to Dec 14.
  2. Some states are currently undecided, but policy leaders are warming up to HIX overall now that the election is over and there appears to be more cooperation. 
  3. The exchanges will be accessible by individuals to purchase their own insurance as well as employers to shop for their employee benefits.
  4. 63% of Americans would prefer the exchange to be state run rather than federally run.
  5. States can decide whether to allow open access to all insurers or work only with a panel of payors that meet certain requirements and regulations.
  6. States have traditionally regulated which payors can sell plans. “Without a state run exchange, states could be dealing their own regulators out of the equation,” as warned by Mississippi’s insurance commissioner Mike Chaney. In other words, if the state wants to let the government run their exchange, they should expect that more payors will be able to sell—and that the state regulations will no longer matter.

Healthcare practices will need a firm closed loop denial prevention process to help them successfully navigate these healthcare industry changes while protecting their bottom line.