The future for Health Information Exchanges is looking better for 2014 but there will be some challenges. Achieving success in this area will require knowledge and the technical flexibility to adapt.

Broadly, there are three HIE groups based on technological and operational preparedness. The first group has deferred investments in technology foreseeing low enrollments. This group will wait for the market to mature before investing further.

The second group predicts high enrollments and is going “all-out” on the exchange market, making technological investments and allowing for automation and flexibility.

The third group is taking a careful approach. These payers estimate an unknown number of enrollments and have invested in some services, but not all of them.

The federal and state exchange preparedness has been tough in this first-ever public exchange enrollment period. Plans have been frequently changed in order to cope up with changing requirements.

There could be further delays in federal and state exchanges as was witnessed in the case of Healthcare.gov. It is still uncertain what the 2014-15 reporting period will hold as people continue enrolling.

The next challenge will be in January 2014 when first billing and claims will be submitted. Payers will have to deal with both electronic and paper systems in addition to calculating/reconciling subsidies and credits.

Claims processing will be tough because of subsidy calculations against out of pocket expenses and new networks created for the products. Any new market faces challenges in the beginning and this will be no different. Well thought-out plans will be an advantage in this situation.

Flexibility and adaptability guarantee payer success in the exchange market. The ability to cope up with changing technological and regulatory requirements will guarantee success. This is an important time for the health insurance industry and there will be plenty to learn in the upcoming months.