Knowledge Center
Premium Billing Knowledge Center
In-depth guides on premium billing strategy, compliance, and technology.
Premium Billing for Health Plans - Questions Answered.
Everything health plan leaders need to know about premium billing, from evaluating software vendors and navigating common pain points to understanding must-have features, ACA compliance requirements, and replacing legacy systems.
Evaluating Premium Billing Software Vendors
A framework for assessing vendors, from billing accuracy and compliance to scalability, integration depth, and total cost of ownership.
Read guide Health PlansPremium Billing Pain Points & Challenges
The most common billing problems health plans face, including billing errors, retroactive adjustments, delinquency management, and member experience issues.
Read guide Health PlansPremium Billing Features & Capabilities
The must-have features of a modern premium billing platform, from rules-based configuration and payment processing to reporting and member portals.
Read guide Health PlansACA & Regulatory Compliance in Premium Billing
How ACA rules, grace periods, CMS requirements, and state regulations shape your billing platform requirements and operational processes.
Read guide Health PlansReplacing Legacy Premium Billing Systems
How to build the business case, manage the transition, and avoid common pitfalls when migrating off a legacy billing platform.
Read guideWhite-Label Billing for Benefits Administrators - Questions Answered.
Everything product and technology leaders need to know about adding billing to their platform, from the build vs. partner decision and integration requirements to go-to-market strategy and partnership operations.
Read the full guideBuild vs. Buy vs. Partner
The decision framework for adding billing capabilities, risks of building in-house, total cost of ownership, what to look for in a white-label partner, and why benefits administrators choose to partner.
Read guide Benefits AdministratorsCapability & Integration Requirements
What billing and payment capabilities benefits administrators need, how white-label platforms integrate with enrollment systems, and the technical requirements for serving employer groups.
Read guide Benefits AdministratorsGo-to-Market & Revenue
How to generate revenue from billing, add billing as a service offering, compete with platforms that have native billing, and go to market quickly with a white-label solution.
Read guide Benefits AdministratorsRisk, Operations & Partnership Model
What implementation looks like, how support works, SSO and data portability, regulatory change management, and evaluating the total cost of a billing partnership.
Read guidePremium Billing for State Medicaid Programs - Questions Answered.
Authoritative answers to the questions state technology teams and program managers ask about premium billing for Medicaid expansion, CHIP, buy-in, and other premium programs.
Read the full guideReducing Delinquency & Collection Challenges
With 40-50% delinquency rates common in Medicaid premium programs, collection strategy is the difference between a viable program and one that costs more to administer than it collects.
Read guide State MedicaidTechnology & Procurement
MMIS integration, RFP requirements, build vs. buy decisions, and implementation timelines for state Medicaid billing systems.
Read guide State MedicaidCost & ROI
Total cost of ownership, cost-per-dollar-collected metrics, and the budget justification framework for premium billing platforms.
Read guide State MedicaidCompliance & Program Management
Federal waiver requirements, CMS reporting, termination due process, and eligibility change handling for premium programs.
Read guide State MedicaidProgram Design & Feasibility
Which states charge premiums, program taxonomy, administrative cost analysis, and the viability question for Medicaid premium programs.
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