Edge servers are the secure systems that plans must use in the exchanges to transmit data related to risk adjustment to the Department of Health and Human Services, under the Affordable Care Act. According to HealthScape Advisors, there are several obstacles that plans might encounter when using their edge servers, including the process of resubmission when data is rejected.
And there are risk implications for issuers within the complex edge-server program:
Financial Risk: The amount of reinsurance and risk adjustment payments that an Issuer will receive will be completely dependent upon the accuracy and completion of file submissions. Errors in this process will cause significant financial risk and cash flow issues.
Compliance Risk: Given that Federal funds are at stake, inaccurate submissions create a significant compliance risk for Issuers.
Operational Workload Risk: Inaccurate data submissions will generate high volumes of error records that will need to be investigated, corrected and resubmitted.
Source: HealthScape Advisors