QHP filings touch five systems. A missed handoff between any of them can delay certification. Here's how data moves from SERFF through to CMS.

In this episode, ClearFile President Joe Boyle maps the full QHP filing ecosystem: how CMS, state divisions of insurance, SERFF, HIOS, and MPMS each play a distinct role, where data moves between them, and where issuers most often lose track.

He also covers Plan Finder Product Data Collection, MPMS validation versus cross-validation, system access management, and what new market entrants underestimate about company setup timelines.

This episode details:

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Filing season can move quickly, especially when federal guidance arrives late, state deadlines shift and filing updates create downstream changes across documents, templates and systems.

In this episode of Regulatory Joe, ClearFile President Joe Boyle breaks down how health plans can retain control during ACA filing season by prioritizing state filing risk, strengthening version control, managing system access and keeping communication moving across internal teams, regulators and reviewers.

This episode covers:

Filing season does not require a perfect process. But health plans do need clear ownership, clear accountability and clear communication to reduce risk and keep submissions moving.

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ICHRA adoption is accelerating—but for health plans, the real challenge isn’t strategy. It’s execution.

In this episode of Regulatory Joe, ClearFile’s Joe Boyle sits down with Lindsey Miller of Softheon to break down what ICHRA actually changes for health plans across enrollment, billing, member experience, and long-term individual market strategy.

They explore where operational complexity is already showing up, why many plans may already have ICHRA members without knowing it, and how fragmented workflows across enrollment pathways, payment models, and communications are creating new pressure points.

The conversation also dives into what it takes to operationalize ICHRA at scale—from data strategy and member identification to reconciliation processes and ecosystem coordination across employers, brokers, and technology partners.

If you work in ACA product strategy, enrollment operations, billing, or regulatory compliance, this episode breaks down what to prepare for as ICHRA continues to grow.

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In this episode of Regulatory Joe, Joe Boyle sits down with Greg Fann of Axene Health Partners to break down what the proposed 2027 NBPP could mean for catastrophic plans and ACA market strategy.

The conversation explores how expanded eligibility could affect bronze plan relevance, low-premium positioning, and decision-making for issuers heading into the 2027 filing cycle. It also looks at where catastrophic plans actually fit in the ACA market today—and why this targeted policy change could create broader strategic implications than it may seem at first.

Joe and Greg also discuss how carriers may respond, what to watch across state-level dynamics, and why this change is most relevant for a specific segment of the market rather than a broad affordability solution.

If you work in ACA product strategy, pricing, regulatory filing, or exchange operations, this episode breaks down what matters most as you prepare for the 2027 cycle.

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ICHRA can introduce operational risk long before it shows up in membership.

For health plans, it functions as a new distribution pathway inside the individual market, which means added complexity across enrollment, billing, and premium flow—not a separate product strategy.

This episode of Regulatory Joe focuses on where that complexity actually shows up, including enrollment pathways, payment coordination, lockbox flow, and internal ownership across product and operations teams. It also covers why early alignment matters, especially as plans prepare for filing season and evaluate ICHRA growth.

If you’re responsible for individual market strategy, enrollment, or billing, this is where ICHRA decisions start to create real impact.

The PY2027 Notice of Benefit and Payment Parameters (NBPP) introduces several proposed policy changes that could reshape ACA marketplace strategy for health plans.

In this episode of Regulatory Joe, Joe Boyle breaks down the most important provisions in the 2027 NBPP and what they could mean for issuer portfolio strategy, enrollment operations, and marketplace participation across states.

The proposed rule was released later than usual in the regulatory cycle, creating a compressed timeline for issuers evaluating potential impacts ahead of the next filing season.

Together, these proposals could influence how issuers approach plan portfolio design, enrollment verification workflows, and multi-state regulatory strategy as the ACA marketplace continues to evolve.

For regulatory and compliance teams, the key question isn’t just what the rule says — it’s how these changes could affect operations, filings, and strategic positioning for plan year 2027.

Episode Guide:

Watch the episode for Joe’s breakdown of the provisions regulatory teams should be tracking now.

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Ghost enrollees in the ACA marketplace can distort enrollment reporting, affect risk adjustment transfers and increase CMS scrutiny. Even small pockets of unsupported enrollment can ripple through operations and financial reconciliation.

In this episode of Regulatory Joe, Joe Boyle breaks down what ghost enrollees actually are — and what they are not. Low utilization alone isn’t the issue. The risk shows up when enrollment patterns, premium payment behavior, repeated plan switching or grace period activity don’t align with normal member behavior.

EPISODE GUIDE:

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Enhanced APTCs expired at the end of 2025, shaping ACA 2027 filing assumptions. With no subsidy extension in place (and any new legislation still uncertain), issuers have to build Plan Year 2027 assumptions off current law—not best-case scenarios.

In this episode of Regulatory Joe, Joe Boyle explains why APTC expiration is more than an affordability headline: it changes enrollment behavior, reshapes the risk pool, and creates downstream pressure on risk scores, quality strategy, and operational capacity.

You’ll learn where plans feel the impact first (membership projections, rate/benefit planning, cross-functional alignment) and how to stay filing-ready while federal and state guidance develops: anchor to last year’s approved baseline, stress-test multiple scenarios, plan for uneven state responses, and set internal decision cutoffs early to avoid late-cycle filing churn.

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Cost sharing has always been foundational to plan design. But heading into the 2027 filing cycle, it’s carrying more weight (and more risk!) than usual.

In this episode of Regulatory Joe, Joe Boyle breaks down how issuers should be thinking about cost sharing heading into the next filing cycle. He explains why plans should anchor decisions to last year’s final, state-approved designs and federal EHB benchmark plans, even as assumptions continue to evolve

 Joe also walks through how to model multiple cost-sharing scenarios, use available competitive data to inform decisions, and manage changes through version control and clear cutoff dates so plan and benefits templates stay aligned through submission.

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Healthcare interoperability isn’t just about standing up APIs—it’s about ensuring the data being exchanged is accurate, consistent, and usable across systems.

In this episode of Regulatory Joe, we’re chatting with Will Tesch (CEO of TESCHGlobal and HealthLX) about how health plans can meet interoperability requirements and prepare what for what’s coming next.

Joe Boyle and Will break down why interoperability efforts often stall after go-live, what semantic accuracy really means in practice, and how CMS requirements like CMS-9115-F and the upcoming CMS-0057-F rule are raising the bar for operational readiness.

They also explore single sources of truth, canonical data models, and why prior authorization workflows will be one of the biggest interoperability challenges facing health plans in the years ahead.

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