Document Upload & Verification

Data Matching Issue lifecycle management with verification request generation, consumer notification, document collection, resolution tracking, and CMS DMI procedure compliance.

System Verification Issue detection and resolution with automated CMS notice generation, verification deadline tracking, and coverage conditional status management per EDE requirements.

Remote Identity Proofing via Experian/LexisNexis for CMS-mandated identity verification. Supports knowledge-based and document-based proofing per EDE API specifications.

Centralized gateway for CMS Federal Facilitated Exchange Hub APIs including RIDP, eligibility, enrollment, and plan management with circuit breaker, retry logic, and rate limiting.

CMS-specific audit trail implementation with immutable event logging, audit report generation, third-party audit support, and CMS inspection readiness dashboard.

ACA eligibility engine implementing MAGI-based income calculation, Medicaid/CHIP threshold checks, and QHP eligibility determination per 45 CFR 155.305.