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September 3, 2014

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Audit details problems with Nevada health exchange

Updated Thursday, April 17, 2014 | 12:51 p.m.

CARSON CITY — An audit of Nevada's health insurance exchange cites Xerox for failing to achieve key performance benchmarks, some of which could subject the technology firm to possible penalties.

Xerox officials defended their work in the report, which is to be discussed Thursday by the Silver State Health Insurance Exchange board.

The audit found instances of incorrect subsidy calculations and more than 1,000 consumer invoices in which tax credits were omitted. Additionally, about 11 percent of claims reviewed did not account for reduced out-of-pocket costs for participants based on income levels.

The 60-page report prepared by Health Claim Auditors Inc. also found that some premium information on the Nevada Health Link website was different than rates listed by the Division of Insurance.

The exchange was given a rating of "fail" in several categories, including call response timeliness and resolution time.

Xerox was awarded a $75 million contract to build and operate Nevada's online Web portal created under President Barack Obama's federal health care law. But the system has been wracked with problems since it went live Oct. 1, leading to anger and frustration from consumers, insurance agents and state officials alike.

In comments included in the audit, Xerox said "performance guarantees" were to be enforced upon effective enrollments as of Jan. 1. It also said that some benchmarks noted as "fail" were missed by a fraction of a percentage point.

Auditors, however, said the state's request for proposal listed the effective date for performance as the "go live date," which was Oct. 1.

Exchange officials reduced target enrollments to 50,000 from 118,000 because of problems with the site, and in March a board chaired by Gov. Brian Sandoval hired Deloitte Consulting, a Xerox competitor, to evaluate the system and recommend fixes. The state also gave anyone who attempted to sign up for coverage by the March 31 deadline another 60 days to try to complete their application process.

Another problem identified in the audit was multiple accounts for individual applicants. Of the files sampled, 126 or 23 percent had multiple accounts — some as many as 16 — that were created either by applicants or customer service representatives when they had trouble accessing account information.

But those abandoned or temporary accounts, estimated at more than 50,000, are not linked to account holders, meaning that when a participant calls in for assistance, a service representative "must look through all the accounts to accrual all information," the audit said.

The audit recommended Xerox link all accounts pertinent to the same participant to increase accuracy and reduce transaction times.

In its response, Xerox said the system "is working as designed for the shopping experience" and that it will work with exchange officials "to define requirements and prioritize if implementation is requested."

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