Exhibit_14_-_Exchange_Operations_Ecosystem_Mngmt_Approach.docx

Exhibit 14 – Exchange Operations and Ecosystem Management Approach

Purpose This Exhibit evaluates Bidder’s ability to operate, support, and continuously improve the Exchange in a steady-state environment, including coordination across issuers, Oklahoma Enrollment Partners (OKEPs), and other ecosystem stakeholders within an EDE-first State-Based Exchange model supporting both distributed enrollment through Oklahoma Enrollment Partners (OKEPs) and direct enrollment through a consumer portal.

general instructions

· Page Limit: 25 Pages

· Font: Minimum 11-point (Arial, or Calibri)

· Margins: Minimum 1 inch

· Line spacing: Single or 1.15

· Tables and diagrams are encouraged and count toward page limits

· Avoid marketing language; focus on execution detail

· All content within each Exhibit, including bidder instructions, narrative responses, tables, and supporting detail, shall count toward the applicable page limitations unless otherwise specified.

Response expectations The Bidder shall describe:

Marketplace Operational Model (End-to-End) Bidder Instructions: Marketplace Operation Model (End-to-End) Bidder should describe the overall operating model for the Exchange. This should clearly outline solution capabilities, bidder responsibilities, State staff, and partner responsibilities. This should include considerations for upcoming federal regulatory changes that may remove provisional eligibility and require consumer confirmation of self-attested data.

Include:

· End-to-end operational workflows across eligibility, enrollment, case management, and issue resolution

· Roles and responsibilities across the State, Bidder, issuers, and OKEPs

· Interaction model between OKEPs, a consumer portal, and back-office operations

· Approach to ensuring operational consistency across multiple enrollment channels

· Operational coordination and workflow management across multiple enrollment channels utilizing shared eligibility, enrollment, notices, and case management services

Bidder Response: Marketplace Operation Model (End-to-End) In this section, the Bidder shall provide its complete written response to the instructions stated above. Responses must be clearly labeled and organized in accordance with this Exhibit.

Annual Exchange Operational Activities Bidder Instructions: Annual Exchange Operational Activities Bidder should describe how the Bidder will support recurring Exchange operations. This should clearly outline solution capabilities, bidder responsibilities, State staff, and partner responsibilities.

Include:

· Open Enrollment (OE) planning, execution, and monitoring

· Renewal planning, execution, and monitoring

· Special Enrollment Period (SEP) processing and validation

· 1095-A tax form planning, execution, and monitoring

· Plan management support, including coordination with issuers

· Reconciliation activities (e.g., enrollment and issuer reconciliation)

· Readiness planning for annual operational cycles

· Coordination of annual operational activities across OKEPs and a consumer portal

Bidder Response: Annual Exchange Operational Activities In this section, the Bidder shall provide its complete written response to the instructions stated above. Responses must be clearly labeled and organized in accordance with this Exhibit.

Service Center Support Bidder Instructions: Service Center Support Bidder should describe the service center support model, document management, and escalation structure. This should clearly outline solution capabilities, bidder responsibilities, State staff, and partner responsibilities.

Include:

· Tier 2 (Exchange Operations) and Tier 3 (Vendor Technical) support model, including responsibilities and escalation criteria

· Coordination with Tier 1 (Consumer Support) support provided by contact center staff and/or OKEPs

· Case intake, routing, and resolution workflows

· Handling of complex eligibility and enrollment issues

· Document management processes, including intake, indexing, and retrieval

· Integration with system workflows and case management tools

Bidder Response: Service Center Support In this section, the Bidder shall provide its complete written response to the instructions stated above. Responses must be clearly labeled and organized in accordance with this Exhibit.

Back-Office Operations (Casework and Administrative Processing) Bidder Instructions: Back-Office Operations Bidder should describe operational processes that support eligibility and enrollment functions. This should clearly outline solution capabilities, bidder responsibilities, State staff, and partner responsibilities.

Include:

· Case management workflows and processing activities

· Error handling and manual intervention processes

· Handling of discrepancies, appeals support (if applicable), and corrections

· Coordination with issuers and CMS for issue resolution

· Processing timelines and service expectations

Bidder Response: Back-Office Operations In this section, the Bidder shall provide its complete written response to the instructions stated above. Responses must be clearly labeled and organized in accordance with this Exhibit.

Issuer and Partner Coordination (OKEPs, Brokers, etc.)

Bidder Instructions: Issuer and Partner Coordination Bidder should describe how they or the State will coordinate with external partners. This should clearly outline solution capabilities, bidder responsibilities, State staff, and partner responsibilities.

Include:

· Operational coordination model with issuers and OKEPs

· Communication channels, cadence, and governance structure

· Issue tracking and resolution across entities

· Partner support model, including onboarding and ongoing support

· Approach to managing partner performance and accountability

· EDE Ecosystem Coordination

· Coordination of activities across multiple enrollment channels

· Handling of cross-entity issues and data discrepancies

· Ensuring consistency of eligibility, enrollment, and plan data across partners

Bidder Response: Issuer and Partner Coordination In this section, the Bidder shall provide its complete written response to the instructions stated above. Responses must be clearly labeled and organized in accordance with this Exhibit.

Change Management and Training Approach Bidder Instructions: Change Management and Training Approach Bidder should describe how operational changes are introduced and supported. This should clearly outline solution capabilities, bidder responsibilities, State staff, and partner responsibilities.

Include:

· Change management process for system updates, policy changes, and operational adjustments

· Communication of changes to internal staff, issuers, and OKEPs

· Training strategy for operations staff and partners

· Training and operational readiness support for enrollment operations

· Ongoing training model and refresh cycles

· Maintenance of training materials and user documentation

Bidder Response: Change Management and Training Approach In this section, the Bidder shall provide its complete written response to the instructions stated above. Responses must be clearly labeled and organized in accordance with this Exhibit.

Operational SLAs and Performance Management Bidder Instructions: SLAS and Performance Management Bidder should describe how operational performance will be measured and managed.

Include:

· Monitoring and reporting on operational performance

· Continuous improvement approach based on performance data

· Escalation and remediation processes for SLA breaches

· Operational performance monitoring across partner-operated and consumer-facing enrollment channels

Bidder Response: SLAS and Performance Management In this section, the Bidder shall provide its complete written response to the instructions stated above. Responses must be clearly labeled and organized in accordance with this Exhibit.

System Monitoring and Issue Resolution (Operational Perspective) Bidder Instructions: System Monitoring and Issue Resolution Bidder should describe how system issues are identified and resolved within operations. This should clearly outline solution capabilities, bidder responsibilities, State staff, and partner responsibilities.

Include:

· Coordination between technical operations and business operations teams

· Coordination of operational issue management across multiple enrollment channels

· Intake and triage of system-related issues

· Communication with stakeholders during incidents

· Approach to minimizing operational disruption during system issues

· Root cause analysis and issue prevention strategies

Bidder Response: System Monitoring and Issue Resolution In this section, the Bidder shall provide its complete written response to the instructions stated above. Responses must be clearly labeled and organized in accordance with this Exhibit.

Post-Transition Operational Stability Bidder Instructions: Post-Transition Operational Stability Should describe how operations will stabilize following implementation and transition from FFM. This should clearly outline solution capabilities, bidder responsibilities, State staff, and partner responsibilities.

Include:

· Stabilization and operational readiness activities supporting OKEPs and a consumer portal following go-live

· Hypercare support model following go-live

· Monitoring of early operational performance and issue trends

· Coordination with issuers, OKEPs, and CMS during stabilization

· Approach to resolving initial defects and operational gaps

· Transition to steady-state operations

Bidder Response: Post-Transition Operational Stability In this section, the Bidder shall provide its complete written response to the instructions stated above. Responses must be clearly labeled and organized in accordance with this Exhibit.

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