Apttus Quote-to-Cash for Healthcare

Accelerate Plan To Policy & Delivering Affordable Care

Healthcare Must Adapt

Healthcare reform continues to drive a number of changes in the payor market. ACA guidelines and competition require frequent updates of plans and rules, thereby increasing the cost of plan and price maintenance. The ACA has resulted in a large number of consumers that are covered by healthcare insurance, and that buy plans on-line. Payors need to keep costs and claims low, stay competitive, and churn out quotes & renewals in a very short window of time, especially during open enrollment. Manual & spreadsheet based quoting & contracting systems were already resulting in inefficiencies & revenue leakage. Now, due to the above challenges, the inefficiency & revenue leakage problem faced by payors has exacerbated.

The Apttus Solution

Apttus Quote-to-Premium connects every critical business process, from broker and inquiry, to assessment, quote proposal generation, premium billing, and policy renewals. Start delivering customer-centric health insurance solutions across the entire customer lifecycle, while ensuring ACA compliance and profitability.

Set Up

  • Rollout multi-line configurable & bundled plans
  • Easily setup underwriting rules & workflows
  • Rapidly onboard brokers, agents & groups through self-serve portals & wizards

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  • Present individual, & group quotes through guided plan selection in broker & ecommerce portals
  • Easily manage census data to drive quotes
  • Speed up quote reviews & approvals

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  • Effectively convert quotes to policies & enroll subscribers
  • Manage renewals, plan, contract, & regulation changes
  • Capture broker & agent obligations & fees on contract

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  • Effectively manage billing & payments
  • Measure broker & agent performance & ensure accurate commission payouts
  • Easily integrate to external systems for eligibility & claims validation

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  • Leverage contract & claims analytics into renewals & price adjustments
  • Lower costs via administrative spend analytics
  • Reduce claims & member costs via wellness & education programs

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Solutions for the Entire Organization


Gain insight into member needs, plan benefits, and member service history across all service areas and channels.

  • Quote-to-Premium gives healthcare payers and partners a 360-degree customer view, including policy info, premium payment history, deductible tracking, claims history, preferred providers, and much more
  • With on-demand analytics, healthcare payers and partners can develop a holistic approach to marketing and selling customer-oriented solutions, managing member services and policy renewals, while effectively recommending optimal healthcare providers

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Persona_ECommerce_SalesSales & Operations

Allow sales agents, brokers, and channel partners to quickly navigate complicated health plan configurations, optional benefits and policy documents.

  • Set up regional health plan product catalogs and price lists that are state compliant with clicks, not code
  • Efficiently manage complex rating configurations and tiers for group, individual, Medicare, and add-on services across all service areas
  • Help brokers and partners grow deals faster, by enabling the creation of professional proposals, which seamlessly flow into policies
  • Recommend plans and optional benefits based on policy history, benefit utilization, trends, predictive analytics and drive upsell/cross-sell opportunities

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Persona_CLM_FinanceFinance & Customer Service

Optimize premium billing and accelerate service delivery.

  • Generate premium bills for any plan and offer customers multiple payment methods
  • Gain visibility into the latest policy info, premiums, and cost sharing. Track customer healthcare spending against policy parameters.
  • Proactively initiate renewals from current policies, factoring in existing benefits and rates

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Additional Resources

tmforum Frameworx 14.5 Conformance Certified Solution

TM Forum eTOM Certfication for Apttus Quote-to-Cash

Innovations in Digital Commerce to Survive and Thrive

Selling in an Omni-Channel World

The ultimate Guide to Quote-to-Cash

Ultimate Guide to Quote-to-Cash