COLLINSVILLE, Conn. — Penstock Group announced today the launch of ClearFile, a comprehensive solution offered to health plans to streamline the regulatory filing process to obtain and maintain qualified health plan (QHP) certification. Joe Boyle has joined Penstock as president of regulatory solutions and will lead ClearFile. Penstock is an affiliate company of Goodroot, which launches and grows companies dedicated to increasing access and affordability in healthcare.
ClearFile is a regulatory-as-a-service solution that ensures health plans maintain access and certification in the QHP marketplace and frees them from cumbersome and time-sensitive interactions with federal and state regulatory agencies. When health plans are not compliant with certification requirements, they face removal from federal and state exchanges for up to five years, which results in lost revenue and missed strategic growth opportunities.
“We understand every facet of the regulatory filing process, and we guarantee 100 percent success when it comes to QHP certification,” says Boyle, who previously specialized in individual and public exchange Affordable Care Act health plan filing at both Aetna and WellSense Health Plan (formerly Boston Medical Center HealthNet Plan). “When health plans aren’t compliant, they’re at risk for significant fines, legal penalties, negatively impacted quality scoring and, most importantly, member disruption.”
ClearFile keeps up with ever-changing federal and state regulations, and can handle every detail of the filing process, thereby lifting the burden off of health plans’ internal teams. This frees up time for employees and dollars that can be reinvested in the business.
“Penstock was born from a commitment to lower healthcare costs by developing unique solutions that address waste, remove errors and streamline the complex regulatory environment for health plans,” says Penstock president Laura Collier. “ClearFile will be a key part of this mission by drastically reducing administrative resources and work for health plans on a part of their business specifically designed to be as affordable as possible.”
Over 14.5 million consumers opted for health insurance coverage through the federal and state exchanges in 2022, an increase of 20 percent from 2021. As this number continues to rise, there will be more opportunities for health plans to grow their business and deliver more choices to potential members. Completing the filing process correctly and on time is critical for health plans looking to enter the marketplace, or to recertify.
“Since the implementation of the Affordable Care Act, QHPs have played an integral role in providing coverage to people who need it most,” says Goodroot CEO Michael Waterbury. “Our team at Goodroot believes QHPs could play an important role in reinventing healthcare one system at a time. Through streamlined filing and guaranteed certification, ClearFile helps increase member access to critical healthcare services and provides more options for those on the exchange when it comes to choosing a QHP.”
Penstock is a healthcare payment integrity and reimbursement company dedicated to reducing costs for healthcare payer organizations and their members. Through a combination of leading-edge technology and top-level industry expertise, Penstock not only identifies and recovers overpayments, it zeroes in on and eliminates the root cause of medical billing and processing errors in order to produce lasting change for its clients.
Goodroot is a community of companies reinventing healthcare one system at a time. With a shared mission of increasing affordability and access in healthcare, Goodroot provides business infrastructure to help visionary healthcare professionals launch their own companies to fix chronic problems in the system. Goodroot affiliate companies — AlignRx, Breez, CoeoRx, Emry, Penstock, RemedyOne and Sola — offer innovative services and strategic guidance for healthcare stakeholders such as employers, brokers, PBMs, health plans, third-party administrators, pharmaceutical manufacturers and hospitals.