Summary
This document is a guide detailing the transition process from a Federally Facilitated Marketplace (FFM) to a State-Based Marketplace (SBM) for a national health plan in Virginia. It outlines the challenges faced during this transition, including the need for significant administrative adjustments and the importance of establishing seamless electronic data interchange (EDI) processes. The guide describes the collaboration between the health plan, the state of Virginia, and technology vendors such as GetInsured and Softheon, which played a crucial role in facilitating this transition. The document also highlights the results achieved, including reduced administrative work and the effective use of Softheon’s capabilities to manage shopping, enrollment, and billing processes. Furthermore, it emphasizes the importance of consistent member communication and the implementation of PayNow functionality to enhance member retention during the transition. The guide concludes with a discussion on preparing health plans for future operational changes as more states move to SBMs.
