Healthcare Automation to Tackle Open Enrollment Challenges for Health Plans

Open enrollment is typically opted for by employees of organizations, which means they come under Medicaid, corporate insurance, and Individual Market. This process opens up every year around the same time (Nov to Jan), but people still let their previous year’s benefits carry over without checking for new benefits and then try to opt into the new plan at the last minute. Consequently, this puts huge burden on insurance companies. The traditional open enrollment process starts with huge heaps of papers that explain the benefits. 

Open Enrollment Challenges for Health Plans

  • Limited time and Huge Volume: CMS have strict guidelines about the submission of enrollment data before the deadline for payers. Failing to do so will result a lower rating or in some cases penalty. The reason health plans delay in submission is the sheer volume of the forms they have to process. Even with online forms the process is tedious due to the last minute enrollments or changes. The open enrollment date for 2022 in US is in the past, people can still enroll if they meet certain criteria. However, the enrollment for 2023 is to take place between Nov 1-2022 to January 15,2023.
  • Error Prone: Managing the huge volume of enrollment forms and processing them without errors takes skill. A few hundred may be possible through human intervention. According to CMS data, the total open enrollment for 2021 was 12 million and in 2022 it was around 14.5 million. Now even if 20 to 30% of this enrollment were automatic carryover enrollment, that still leaves 10 million new enrollment or changes to be done by payers. While some organizations have systems in place, most are still manually processing the enrollment forms. 
  • High Cost: It is no wonder health plans have to employ more  resources to make sure the open enrollment process goes smoothly, as failure may lead to penalties and undesirable outcomes. The cost for payers doesn’t end here. The cost of printing forms, and mailing physical enrollment forms can put significant dent in the payer’s pockets.  

How RPA can Help Ease Open Enrollment Nightmares for Heath Plans

Enter, Healthcare Automation

  1. RPA powered Processing: With RPA, millions of enrollments can be processed really quickly. RPA bots can scan the document, make sure each and every enrollment form is error free without much manual intervention resultantly, it reduces employee burnout and helps save cost. 
  2. Risk Assessment Automation: Every underwriter has to assess the prospective risks before issuing a policy. This is process is standard across for all payers. Typically, underwriters have to look for referenced information corresponding to the risks, and attach that with the final insurance proposal and then set the premium amount. But there are thousands of factors that come in risk assessment and it is impossible to manually look for each individual. Rule based RPA bots can check for each individual in little time.   
  3. Automated Notification: Between preparing the enrollment form and issuing the insurance policy, there are multiple documents verification that payers/ medical underwriters need to do. The open enrollment period is open for only 1-2 months in a year. That is a short period of time to process millions of enrollments accurately without delay. Typically, the medical underwriters have to assess various information to go ahead with issuing the policy and if there are any information missing, they would have to contact the prospect and send an email manually, which is herculean task considering the volume of requests underwriters have to process. With automation in place, the bots can send a notification to the prospect.  


RPA is crucial for every business and every process. Payers and open enrollment isn’t an exception. As mentioned above, RPA bots can eliminate most of the challenges health plans face during open enrollment. If you are a health plan, and are looking to implement an automation solution for the 2023 open enrollment season, drop us a note at 

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Puneeth Salian

Puneeth Salian

A writer in Healthcare domain, who is also a science and technology enthusiast. Enjoys creating interesting pieces that elucidate the latest Healthcare IT trends and advancements.
Puneeth Salian

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