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Chiapas CSR


Chiapas CSR - Cost Share Reduction Reconciliation Tool For Health Exchange

The Centers for Medicare and Medicaid Services (CMS) has required all Qualified Health Plans (QHPs), which participate in the Affordable Care Act (“Obamacare”) to submit the Cost Share Reduction Reconciliation results of the 2014 and 2015 benefit years by April 30th, 2016.  

The Cost Share Reduction Reconciliation is the mechanism by which CMS reimburses the QHPs for offering higher Silver Tier benefit plans with more affordable copays, coinsurance, and deductibles for income-qualified recipients.  To calculate the reimbursement amount, however, QHP’s have to re-adjudicate all of the higher Silver Tier claims to regenerate the member payments as if they were enrolled in the Base Silver Tier benefit plan, which having higher copays, coinsurance and deductibles.  This is a significant technical hurdle.  

Chiapas EDI Technologies, Inc. has developed Chiapas CSR, a technology aimed at accomplishing exactly this task – re-adjudicating member claims from a the higher Silver Tiers to to the base Silver Tier.  As an appreciation of the existence of Obamacare and a gift to all QHPs as to alleviate the stress of custom developing a tool for the Cost Share Reduction Reconciliation, we are now announcing to open source this technology and release it free of charge to all Qualified Health Plans.  

Everything necessary to implement a complete Standard Method re-adjudication system is included in the distribution of this Chiapas CSR.  However, Qualified Health Plans are invited to contact us if they still need a technical assistance to put this technology into production.