Marketplace
State & Federal Modular Platform
MARKETPLACE is a suite of robust, stand-alone modules designed to integrate into highly scalable ACA marketplaces for government. Each module within the ecosystem can work as a standalone offering, be added to existing systems, or be seamlessly combined to create a robust, end-to-end marketplace solution. With its modular and scalable approach, MARKETPLACE enables agencies to streamline critical processes, reduce administrative burdens, and proactively respond to changing regulatory environments.
CITIZ3N’s fit-for-purpose marketplaces, ensure rapid deployment and complete peace of mind:
SBM Platform
State-Based Marketplace
The SBM platform is utilized by multiple state exchanges and over 100 health plans across the country, processing billions of dollars in member premium payments each year. The platform streamlines administrative processes, improves member satisfaction, and addresses regulatory compliance challenges in government-sponsored and affiliated programs.
SHOP Platform
Small-Business Health Options Program
The small group market is a crucial segment, as most U.S. companies have fewer than 50 employees, leading to significant coverage gaps in the workforce. SHOP allows state-based exchanges the ability to sell small group plans to employers, simplifying the process of shopping, enrollment, and billing for small group health insurance coverage.
ICHRA Platform
Individual Coverage HRA
With the ICHRA platform, governments can supply employers of any size the ability to offer an end-to-end Health Reimbursement Arrangement (HRA) to their employees. Employers have access to administrative tools to manage employee enrollments, review reimbursement requests, and generate reports for record-keeping and compliance.
FEHB Platform
Federal Employee Health Benefits
The FEHB platform is a comprehensive, all-in-one health benefits platform that offers an end-to-end solution for federal agencies. The platform streamlines administrative processes, improves employee satisfaction, and addresses regulatory compliance challenges in government-sponsored and affiliated programs.
PLATFORM MODULES:
Shopping Module
The SHOPPING Module makes health plan enrollment and eligibility easy for both consumers and payers.
- Product Catalog: The Product Catalog component helps reduce human error and streamline the cataloging process with a single repository for all plan data. It allows health plans to securely upload and update plans directly.
- Decision Support: The Shopping Module includes multiple out-of-the-box decision support tools for enrollees, including a selection guide, payment calculator and plan comparison tool.
- Eligibility: The eligibility component supports initial and ongoing eligibility determinations for various programs, including Medicaid and CHIP.
Enrollment Module
The Enrollment module plays a crucial role in helping individuals select and enroll in a health plan that meet their needs and budget and it helps exchanges and insurance carriers increase accuracy, improve efficiency, and comply with regulatory requirements.
- Payload (EDI): The Payload Electronic Data Interchange (EDI) gateway enables the secure transfer and reconciliation of data between the marketplace and carriers’ core administrative systems.
- Enrollment: The enrollment component is a fully configurable user portal with backend enrollment processing capabilities. The fully scalable portal has automatic load balancing and scaling which processes over a million transactions per day.
- Reconciliation: The reconciliation component plays a crucial role in managing health insurance plans, particularly in the context of government-regulated marketplaces. Enrollment reconciliation verifies and aligns the data between the insurance carriers and exchange to ensure accuracy and consistency.
Payment Module
As a national leader in enrollment and premium payment processing, MARKETPLACE payment module processes over $3 billion in member premiums each year, for over five million concurrent members. The payment module facilitates accurate billing, collection, and payment processing.
- Billing & Payments: Supports all premium payment types to maintain coverage. Invoices are processed each day across millions of members.
- Reports & Analytics: The Reports & Analytics component provides users with comprehensive insights and data analysis related to payment transactions and financial performance. This functionality helps organizations mitigate compliance risks and maintain regulatory compliance.
- Automated Reconciliation: Reconciliation is done every day for previous day’s deposits. All items can be validated using the Payment Summary Report in the DATAHUB reporting module.
RegMail Module
REGMAIL is a suite of plug-and-play, integrated, SaaS software and technology solutions that enabled both the creation and distribution of regulated digital and print communications.
- Digital Communication: Deliver PDF or HTML documents with rich information and dynamic, interactive content.
- Print Communication: State-of-the-art equipment, technology, and processes enable consistent and timely job completion.
- Fulfillment Services: As a USPS-designated full-service mailer, REGMAIL improves delivery accuracy and provides the lowest possible postage rates.
DataHub Module
DATAHUB, is a powerful and indispensable intelligence module for government. It provides agencies with the means to make data-driven decisions effectively by seamlessly connecting to a wide array of data sources, including the CITIZ3N’s Electronic Data Warehouse (EDW), a centralized hub for comprehensive data.
- Customizable Dashboards: Users can fully customize dashboards to meet their specific needs. The interactive dashboards and configurable reports enable users to access real-time data and make informed decisions.
- Reports & Analytics: DATAHUB reporting provides authorized users with self-service business intelligence, analytics, and reporting on member demographics, geographic trends, transactions, and financial data with near real-time updates. DATAHUB also supports SQL queries.
- Graphs & Charts: DATAHUB boasts a rich repertoire of data visualization options, encompassing diverse formats such as bar charts, pie graphs, and heatmaps.
ClientHub Module
CLIENTHUB centralizes crucial information and functionalities into one platform, significantly enhancing the capability of customer service representatives (CSR) to manage and resolve client issues with unprecedented efficiency.
- Consolidated Portal: CLIENTHUB provides CSRs with streamlined access to a vast array of client information and tools on a single screen.
- Multi-Group Management: The platform covers a range of functionalities, including detailed views of member information, broker details, and group accounts.
- Lighthouse Ticketing Management: And to ensure there is never an issue that goes overlooked, CLIENTHUB is equipped with LIGHTHOUSE, an innovative ticketing and incident management component.
GOV•AI Module
GOV•AI is a large language model (LLM), generative AI that curates vital information from industry-specific big data, CITIZ3N’s internal databank, and client-specific data. This triangulated approach results in comprehensive insights and accurate actionable information. Click here to learn more about GOV•AI.
Frequently Asked Questions
WHAT IS CITIZ3N'S ACA MARKETPLACE STATE & FEDERAL MODULAR PLATFORM?
CITIZ3N’s MARKETPLACE is a suite of robust, stand-alone modules designed to integrate into highly scalable exchange platforms for state and federal agencies. It facilitates seamless interactions between Federal and State marketplaces and health plans, serving as an abstraction layer to isolate systems from shifting requirements. Trusted by CMS and state agencies, MARKETPLACE is utilized by multiple exchanges and over one hundred health plans across the country, processing billions of dollars in member premium payments each year.
WHAT IS THE MODULAR STRUCTURE OF MARKETPLACE?
MARKETPLACE’s modular structure provides end-to-end functionality across key areas such as Shopping, Enrollment, and Payment. Each module can function as a standalone offering, be integrated with other third-party systems, or combined seamlessly to create a robust customized marketplace to meet the needs of various agencies.
WHAT ARE THE MODULES OF MARKETPLACE AND WHAT FUNCTIONALITIES DO THEY HANDLE?
- Shopping Module: Facilitates health plan enrollment and eligibility, provides decision support tools for enrollees, and supports eligibility determinations.
- Enrollment Module: Helps individuals select and enroll in health insurance plans, enables payload electronic data interchange (EDI) for secure data transfer, and manages enrollment reconciliation.
- Payment Module: Processes member premium payments, facilitates accurate billing and collection, and provides reports and analytics for financial performance monitoring.
- RegMail Module: A suite of plug-and-play, integrated, SaaS software and technology solutions that enabled both the creation and distribution of regulated digital and print communications.
- DataHub Module: A powerful and indispensable intelligence module for government. It provides agencies with the means to make data-driven decisions effectively by seamlessly connecting to a wide array of data sources, including the CITIZ3N’s Electronic Data Warehouse (EDW), a centralized hub for comprehensive data.
- ClientHub Module: Centralizes crucial information and functionalities into one platform, significantly enhancing the capability of customer service representatives (CSR) to manage and resolve client issues with unprecedented efficiency.
- AIME Module: Artificial Intelligence Management (AIME), is a large language model (LLM), generative AI that curates vital information from industry-specific big data, CITIZ3N’s internal databank, and client-specific data. This triangulated approach results in comprehensive insights and accurate actionable information. For more on AIME click here.
DOES CITIZ3N OFFER ANY TURNKEY MARKETPLACE PLATFORMS?
CITIZ3N’s FIT-FOR-PURPOSE PLATFORMS include: SBM: State-Based Marketplace Platform SHOP: Small Business Health Options Platform ICHRA: Individual Coverage Health Reimbursement Arrangement Platform FEHB: Federal Employee Health Benefits Platform
HOW CAN I REQUEST A DEMO OR LEARN MORE ABOUT MARKETPLACE?
To request a demo or learn more about CITIZ3N solutions, simply click here to send us a message.request you can contact their sales team directly for personalized assistance and guidance tailored to your specific needs and requirements.
