Evensun provides ACA‑focused software tools and consulting services that help health plans automate EDGE server submissions, reconcile advance premium tax credits, and optimize risk‑adjustment returns. Their SQL‑based solutions run in a secure, HIPAA‑compliant environment and are complemented by data‑integrity reviews and strategic guidance to improve cash flow and compliance.
Funding
Funding not disclosed
Founders
Product
Problem
Health plans participating in the ACA marketplace often struggle with complex risk adjustment calculations, EDGE server submissions, and premium tax credit reconciliation, leading to cash‑flow gaps, compliance risks, and missed revenue opportunities.
Solution
Evensun provides a suite of software tools and consulting services that streamline ACA‑related financial operations. The EDGE Server Submissions product supplies licensed SQL code and AWS‑hosted instances, enabling plans to generate and submit required files with full control and reduced reliance on external vendors. The Advance Premium Tax Credit Reconciliation tool identifies and captures missing premium payments, improving cash flow and member experience while lowering administrative costs. Their SQL‑based Risk Adjustment Toolkit helps plans maximize risk‑adjustment returns by validating data integrity and optimizing HCC scoring. Complementary consulting services offer member‑level performance analysis, data‑integrity reviews, and strategic guidance for designing, marketing, and operating profitable Marketplace plans. All solutions are delivered in a secure, HIPAA‑compliant, SOC 2‑type II environment.
Target Audience
Primary customers are ACA health plans and at‑risk entities ranging from small carriers (≈2 k members) to large plans (≈1 M members) that need to manage risk adjustment, EDGE submissions, and premium tax credit processes.
Features
- Licensed T‑SQL code and documentation for DIY EDGE server file generation, compatible with Amazon AWS EDGE instances
- Full‑service EDGE submission option with monthly data handling, weekly submissions, and deadline support for plans up to 100 k members
- Premium tax credit reconciliation engine that detects uncollected APTC, automates adjustments, and integrates with existing billing systems
- Risk Adjustment Toolkit that runs SQL‑based HCC models, validates claim data, and highlights gaps affecting risk scores
- Consulting engagements for member‑level performance analysis, data integrity audits, and end‑to‑end Marketplace plan strategy
- Secure, HIPAA‑compliant platform with SOC 2 Type II audit certification