How Massachusetts is Verifying Health Exchange Users

The state’s new residency check system may be an answer to other states thinking about the same verification issues.
by | September 5, 2012
 

By Brian Heaton

Massachusetts is now using real-time address verification technology to more accurately confirm the residences of those using its online health insurance exchange.

When a customer logs on to the Massachusetts Health Insurance Connector Authority (Health Connector) to shop for an insurance policy, the user’s residency status is verified by identity management solutions provided by LexisNexis. Previously the state relied on its own manual process and the due diligence of insurance carriers to make sure people were actually living in Massachusetts.

Massachusetts was one of the first states to debut an online health insurance exchange. The state’s new residency check system may be an answer to other states thinking about the same verification issues.

State law requires most Massachusetts residents 18 years or older to purchase health insurance. Those individuals and families applying for Commonwealth Choice -- an unsubsidized, non-group Health Connector program for individuals and families -- are required to live in the state.

Online since May 1, the new verification process uses LexisNexis’ data analytics and linking technology, which according to the company, intelligently analyzes billions of records to quickly identify and connect relevant information. When someone registers and accesses the Massachusetts Health Connector, the system instantaneously accesses LexisNexis’ data.

A computer algorithm then searches the data and verifies that the residency information is correct. If a person’s residency can’t be established, he or she can still continue shopping, but must submit to Massachusetts proof of residency documentation in the form of a utility bill or mortgage statement in order to be enrolled in the insurance program selected.

“We feel it has been a very successful implementation,” said Scott Devonshire, CIO of the Massachusetts Health Connector. “The key for us is [the verification process is] not a gate.” “It has not bogged down the shopping experience at all,” Devonshire said. “We haven’t had any negative feedback per se from users of the site.”

Clint Fuhrman, director of Government Health Care Programs for LexisNexis, explained that the company’s technology is able to compile broad data about someone’s identity over the course of time.

“We’re not going out to a bunch of federated databases and pulling this from 30 different places,” Fuhrman said. “We have all the information in one database that we maintain, that’s constantly being updated and the linking is looking for changes in identity. So we essentially know that person before that call is made, and when it is, it’s a sub-second turnaround.”

LexisNexis wasn’t the only vendor Massachusetts considered. Devonshire said the state looked at several companies and the decision came down to two main factors: the ability to differentiate whether the address provided by a customer was residential or business, and to determine with a degree of certainty that the individual identifying himself at a particular address actually resided there.

Prepared for Change

Massachusetts’ initial contract with LexisNexis runs through Dec. 31, 2013, with three one-year options available after that. Massachusetts pays LexisNexis 21 cents per transaction for each individual who is run through the residency verification process.

How the implementation of the Affordable Care Act may change that process is still up in the air. States are waiting on regulations from the federal government. The law requires the establishment of online health insurance exchanges by Jan. 1, 2014.

Devonshire was confident that the LexisNexis technology would meet whatever federal requirements would be issued in regard to residency and address validation. He doesn’t see any gaps in functionality on the horizon. But Massachusetts is keeping its options open.

For now, Devonshire believes there’s always room for the state to try and improve and narrow false positives when it comes to residency validation. But given the transient nature of people, there’s always going to be some folks Massachusetts can’t validate.

“That’s really what it’s about for us -- the validation of the residency,” Devonshire said. “We’re not trying to set a trap for anybody, but we want to make sure people are who they say they are and they live where they say they live.”

Government Technology  |  Government Technology

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