Enhanced Direct Enrollment Outlier Detection
(Marketplace) Enhanced Direct Enrollment (EDE) allows consumers to apply for and enroll in an exchange plan directly through an approved partner's UI, without being redirected thr…
IT System Utilization Optimization
(Marketplace) The FFE application usage patterns vary and are dependent on differing environment usage periods. CMS resources are currently manually scaled, not allowing immediate…
Risk Adjustment Outlier Analysis
The risk adjustment (RA) program spreads the financial risk borne by Issuers due to offering a variety of plans meeting the need of the diverse population. RA payments are distrib…
Agent/Broker Fraud Analysis (ABCQI)
(Marketplace) Agents and brokers support the consumer enrollment and eligibility process. Because of this, they have learned the intricate details of the Federally-facilitated Exc…
Help Desk Responses
(Marketplace) The Division of Issuer Management and Operations has talked with their contractor, LMI, about using an AI tool for the Help Desk contract.
Chatbot within Hub
(Other) Currently the following help support activities are handle by a human: - Personalized FAQ?s - Clarify questions with schema and onboarding, etc. - Handle "Where is 'My fil…
Independent Dispute Resolution (IDR) Eligibility Rules Engine
The current Independent Dispute Resolution (IDR) Technical Assistance (TA) process is very manual and time intensive which limits throughput. The rules engine should significantl…
Review Regulatory Comments
(Marketplace) Public comment analysis in the Letter to Issuers (LTI) and Notice of Benefits and Payment Parameters (NBPP) to streamline review of comments.
Improved Data Quality Checks
(Marketplace) Improve consumer experience by providing an asynchronous (not at the same time) solution to detect and provide near real time feedback via outreach to the consumer,…
iVeri-Fi (Test)
In October 2024, Serco will begin utilizing iVeri-Fi, (a decision service platform) to perform automated processing of remote identity proofing (RIDP) verification tasks. These t…
Plan Justification Tool
(Marketplace) Identify trends/patterns within plan certification justification templates, containing free-form text data through use of natural language processing (NLP) and class…
TIC URL Automation
(Marketplace) Issuers applying for QHP (Qualified Health Plan) certification, including issuers offering off-Exchange SADPs (stand alone dental plans), must submit a Transparency…
Rx Data Integrity Review
The current process for conducting the Rx Data Integrity review is time intensive and requires reviewers to manually review online formularies in a condensed timeline. The purpos…
RA and RADV Predictive Modeling and Methodology Evaluation
(Marketplace) Risk adjustment data validation (RADV) is the audit of HHS-operated Risk Adjustment (RA). KPMG, the main RADV contractor, seeks to conduct predictive modeling and…
RADV Medical Record Review
(Marketplace) RADV entails the review of enrollees' medical records to determine if diagnoses submitted to CCIIO for purposes of calculating RA transfers actually exist. This medi…
Issuer Expansion/Market Entry Prediction
CCIIO FO conducts targeted outreach to issuers likely to enter the markets or expand to other states
SBC Content Review
(Marketplace) The SBC Content Review identifies cost-sharing discrepancies between the Plans and Benefits Template and SBC Form. If there are discrepancies in the numerical values…
MFT UI Chatbot
Hub/MFT team manually supports operations related to onboarding, Q/A, file tracking and technical inquiries. ? Monthly Average of inquiries: ? ~800 Email inquires ? ~40 Jira/SN…
MLMS Upgrade MILA from CARLA to Druid
New chatbot proposed by CMS MLMS team will be integrated into the existing MLMS application. It aims to improve user experience, designed to maintain or boost deflection rates, an…
Interoperability URL Review Automation
Enable the team to save time and man hours, cost savings