Evensun Consulting, LLC

Member Level: Bronze

Vendor Overview

Description of Services: Evensun is a consulting and services firm focused on the Affordable Care Act Individual Marketplace strategy and operations. In addition to consulting services, we also offer products to support your ACA plan:

-EDGE server submissions
-Tools for maximizing your risk adjustment opportunities -Tools for ensuring the integrity of your risk adjustment data
-APTC reconciliation
-Risk Adjustment RFPs
-Vendor evaluations
-Fractional / interim executive services for finance and risk adjustment leadership

Primary Service: Enterprise Data
Secondary Service: Consulting

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1441 Woodmont Ln
Atlanta, GA 30318

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APTC Audit Summary
CMS recently released to the public audit reports for Advanced Premium Tax Credit payments made to health plans selling in the federal marketplace in 2018 and 2019. Evensun analyzed the results and found that the average health plan is putting nearly $1 PMPM at risk due to issues in their enrollment, reconciliation, and HICS processes.


APTC Audit Reports
Last month, CMS released audit reports on the APTC payments for more than 100 health plans who offered coverage in the ACA market in 2018 and 2019. These reports suggest that carriers may be leaving $100 million a year in APTC on the table due to issues in their enrollment, billing, and reconciliation processes. This report provides a deep dive on the audit results and areas that health plans should evaluate to ensure they are minimizing audit risk and maximizing their APTC receipts.