Every HICS Case Tracked, Resolved, and Confirmed Closed
When CMS assigns a case in the Health Insurance Casework System, the clock is already running. The HICS Companion replaces working cases one at a time in the portal: one daily extract download becomes a work queue with a countdown on every case, and your resolutions become a Casework Upload file validated to the CMS spec before you download it.
HICS Work Queue
Casework Lives in a Portal With No API
HICS has no issuer API, and CMS terms prohibit automated access. So most issuer casework teams work cases one at a time inside the portal: open a case, read the narrative, chase down the answer, type the resolution, repeat. Deadlines live in someone's head or a side spreadsheet, nobody has a queue-level view of what is due when, and the Casework Upload file gets built by hand and hopes the formatting holds.
One Case at a Time in the Portal
- An urgent Level 1 case sits unnoticed over a weekend because nothing counts the hours
- A case submitted as resolved is still open in HICS and nobody catches it until the next complaint
- A stray tab or wrong date format bounces the hand-built upload file
- When a regulator asks what happened on a case, the answer is scattered across inboxes
With the HICS Companion
- Every case carries a deadline countdown computed from its level and assignment date
- Each import is diffed row by row, flagging the case that came back open after you resolved it
- The Casework Upload file is validated to spec before anyone can download it
- Every material action is audited, and any case exports as a single PDF packet
Built to Respect the CMS Boundary
Some vendors treat the lack of a HICS API as a problem to engineer around. We treat it as a rule to build on. A credentialed human downloads the extracts and a credentialed human uploads the casework file, exactly as CMS expects. Everything between those two steps is what the companion manages.
No Stored CMS Credentials
The companion never asks for, sees, or stores a HICS login. Your credentialed users keep sole control of CMS access.
No Screen-Scraping, Ever
No robotic automation, no headless browsers, no synthetic sessions. Nothing the companion does touches a CMS system.
HICS Stays the System of Record
The companion reflects HICS as of your last import, and it says so on every screen. A case is only closed when a later import proves CMS closed it.
If your compliance team asks how this tool touches CMS systems, the answer is simple: it doesn't.
Built Around the Downloads, Not Around the Portal
Nothing about your CMS access changes. The companion manages everything between the download and the upload.
One Daily Download
Your credentialed caseworker downloads the case and comments extracts HICS already provides, plus search results when needed. Nothing new to request from CMS.
Import and See What Changed
Drag the files in. The companion diffs them against your book: new cases, updated cases, level changes, and the case CMS still shows open after you submitted it as resolved.
Work the Queue
Assign owners, route tasks to the people who have the answer, draft the member letter from your own Word templates, and log ER&R and SEED requests with follow-up dates.
Generate, Validate, Upload
Resolutions become a tab-delimited Casework Upload .TXT, validated before download. A person uploads it to HICS, and the next import confirms CMS closed the loop.
A Casework Operation, Not a Tracker
Queue, tasks, resolution, letters, submission, and audit, built as one workflow from import to confirmed closure.
Work Queue and Timeliness Engine
Deadlines computed from case level and assignment date: 72 hours for urgent Level 1 cases, 15 calendar days for Level 2, with a configurable clock start. Statuses move through On Track, Due Soon, Critical, and Overdue, recalculated on every import with full history.
Change Detection on Import
Each import is diffed row by row: new cases, updated cases, level or category changes. Two states get surfaced: the case you submitted as resolved that CMS still shows open (needs attention), and the resolution CMS has confirmed closed (loop complete).
Tasks and Notifications
Route questions to the people who actually have the answer: multi-assignee tasks with due dates, instructions, and attached responses. Notification emails carry a case ID and a deep link, never member data.
Guided Resolution and Letters
A guided form captures all 11 Casework Upload fields with the seven outcome codes and outcome-specific validation. Member letters generate from your own Word templates with tracked versions, and finalized letters lock.
Validated Submission File
The tab-delimited .TXT is checked before you can download it: 11-character case IDs, MM/DD/YYYY dates, note length limits, no tabs or line breaks in text fields. The file you download later reproduces the submitted file byte for byte.
Audit Trail and Case Packets
An append-only audit of every material action, including document views and downloads. Export any case as a single PDF packet: narrative, comments, notes, tasks and responses, letter, and the full timeline. External ER&R and SEED requests are tracked with a Waiting-on-CMS queue view.
Who It's For
Built for issuer teams handling consumer complaint cases through HICS on the Federally-facilitated Marketplace.
Caseworkers
One queue with a countdown on every case, prev/next navigation through the day's work, and a resolution form that catches format errors before they ever reach the upload file.
Enrollment Operations Leaders
Aging, workload, on-time rate, and time-waiting-on-responses reporting from real casework data instead of a hand-updated tracker.
Functional Area Responders
Finance, claims, and member services get a focused task view of just the cases where they owe an answer, with due dates and attachments.
Compliance Oversight
An append-only audit trail, permissioned access to member data, and one-click case packets when a regulator or auditor asks what happened.
Frequently Asked Questions
Does the HICS Companion connect to HICS or store CMS credentials?
No. There is no issuer API for the Health Insurance Casework System, and CMS terms prohibit automated access, so the HICS Companion never connects to HICS, stores no CMS credentials, and automates nothing at the CMS boundary. It works entirely from the extract files your credentialed caseworker downloads, and a person uploads the generated Casework Upload file through the portal’s own upload feature.
How current is the data in the work queue?
As current as your last import, and the app tells you exactly when that was on the dashboard, the queue, and every case header. Every metric, deadline, and status reflects HICS as of the last imported extract. A case is only treated as closed when a later import confirms CMS closed it.
Who is the HICS Companion for?
Casework and enrollment operations teams at health insurance issuers who handle consumer complaint cases through HICS on the Federally-facilitated Marketplace. It is the first module in the Sevana Enrollment Operations family, which serves the operations teams that sit next to compliance.
How does the Casework Upload file validation work?
Resolutions are captured in a guided form covering all 11 Casework Upload fields, then generated as a tab-delimited .TXT that is checked before download: 11-character case ID format, MM/DD/YYYY dates, note length limits, and no stray tabs or line breaks in text fields. The file you download later reproduces the submitted file byte for byte.
Coming Next in Enrollment Operations: the Enrollment Discrepancy Workbench
Import your enrollment discrepancy reports, match them deterministically against your eligibility system snapshot, and resolve them with a guided workflow. Ask us about early access.
See Your Casework as a Queue, Not a Spreadsheet
A 30-minute walkthrough using synthetic cases: import, queue, resolution, and the generated upload file, end to end.