APTC Reconciliation Engine

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

Advance Premium Tax Credit calculator implementing ACA §36B rules. Handles FPL lookup, benchmark plan selection, and expected contribution percentages.

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

X12 834 enrollment transaction gateway for CMS SBMI submissions. Handles initial enrollment, changes, terminations, and effectuation with audit trails.

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.