April Advanced Training: 834 EDI engine

Transcription

1 April 2018 Advanced Training: 834 EDI engine

2 AGENDA 1. General product overview & strategy 2. Implementation 3. File configuration & testing 4. Advanced tools 5. File maintenance 6. Best practices

3 What is EDI? EDI stands for Electronic Data Interchange EDI is the secure electronic transmission of enrollment and demographic info from one system to another Member specific demographic information (EE & Dep) Coverage start and end dates Company & plan specific codes Trading Partners Entities conducting business electronically EN is a SaaS, so the licensee is the trading partner ANSI 834 Federal definition EN s product

4 EDI on the EN Platform EDI Marketplace Data Exchange ANSI 834 Engine COBRA Cafeteria Carrier Broker Med, Den, Vis, RX 2 file types DOL & QE Specific to the events associated with COBRA CDH & Café: Company, Demo & Enroll Carrier-specific: Company, Demo & Enroll *If Colonial or Unum worksite products, Third Party App may be an option ALL Company, demographic & Enrollment

5 ANSI 834 Files Officially: ASC x12n 834 files (Benefit Enrollment & Maintenance) HIPAA law required that all health plans or health insurance carriers accept a standard enrollment format for health care products only ANSI 834 is the national standard and there is a Federal Companion Guide 2 versions 4010 or 5010 EN supports both Products supported M/D/V Carriers cannot charge a fee

6 Defining EN s 834 EDI engine Self-service broker tool to configure and securely transmit enrollment & eligibility to carriers Supported file types: 834 format only for medical, dental, vision, Rx and some telemedicine 4010 or 5010 formats Full or maintenance files only (NOT change files) Five parts of the engine: 1. Library of preconfigured carrier templates & associated documentation 2. Tool to configure company-specific fields 3. File generation tool (auto or manual) 4. Encryption & Transmission tool 5. Scheduler to automate file transmission on a recurring basis

7 834 Carrier Configuration/Template EN sets carrier level options when configuring the template Examples include: Auto-drop terms typically 14 days How to handle ended cancelled coverage End before start vs. null coverage How to handle COBRA dates COBRA paid thru sends +1 Skip DTP349 for active COBRA What maintenance date to send (DTP303) Send latest DTP303 date Send DTP303 for dependents Set Header & Footer rules as dictated by carrier ST02/SE02 numeric only

8 When to use Employee Navigator s 834 EDI module 834 EDI is most effective for groups with: Greater than 100 employees Multiple lines of coverage with 1 carrier Simplified class structure High Turnover Agency has a in-house resource to support clients and files or has committed to outsourcing

9 Basic Assumptions We re assuming you: Have joined previous EDI training sessions Have configured 834 files on EN or other platforms Are familiar with the ANSI 834 format If you have not completed items above, please: Join Module 10 training Review our EDI Forum on the Support Site Listen to the Intro to 834 EDI webinar (Feb 2018)

10 April 2018 Implementation & Associated Docs

11 834 Implementation Process Notify Carrier of intent to implement 834 file Collect Implementation Documents Determine if new or existing template Copy template from library Company level configuration Enter & Test Transmission Settings File Testing Adjustments to move to production

12 Contact carrier to request 834 implementation Contact your account rep Transfer you to carrier s EDI team & EDI analyst assigned Collect implementation documents EDI Questionnaire examples Companion Guide Group Structure Testing document Transmission credentials

13 EDI Questionnaire Defines File Expectations Who is the Trading Partner Contacts transmission & error reporting Basic file expectations Broker completes these forms You will not be moved onto the next step in the implementation process without completing this document

14 Sample Questionnaire (UHC)

15 Companion Guide Carrier s technical 834 specs to identify required values on specific carrier platform Not so standard standard 1 Companion Guide per carrier platform This is the document EN uses to build a carrier shell New Configuration: 7-10 business days and one-time $750 fee Will you bill XYZ? No, EN bills the licensee, you can pass through Existing Configuration: Confirm the version/matches the EN configuration If version does not match, send to EN in ticket for comparison

16 Group/Account Structure Carrier creates and shares a document to outline the specific requirements for that individual plan sponsor , Word Doc, Excel Includes the following information: Header & Footer values (Plan Sponsor name, Sender, etc) Group specific values (Group Policy #, network code, coverage tier)

17 Scheduler & Transmission Credentials Scheduler Set frequency to automatically generate a file during nightly job process Typical frequency : 1x per week on Wednesdays You can set a higher frequency >> more error reports Transmission Engine Select the method how the file is securely transmitted to the carrier s portal EN Supported transmission types FTP or SFTP Unsupported: FTPS, SSH with RSA, FTP without PGP PGP encryption Optional additional layer of security Pretty Good Encryption 1 PGP key per carrier** Industry standard: SFTP with or without PGP encryption

18 File Testing & Discrepancy Reports Testing is THE.MOST.CUMBERSOME.STEP Test files are created by clicking the Generate button ondemand Types/Phases of Testing 1. File format meets Federal ANSI 834 specs 2. File format meets carrier specific 834 specs 3. Members have minimum demographic values associated with their record 4. Scenario Testing, if applicable 5. Data Validation NOTE: Do not set the scheduler until file is approved for production

19 Sample Scenario Testing 1. Create test employees in EN 2. Send test file #1 and advise carrier names associated with each scenario 3. Make enrollment changes in EN associated with each scenario 4. Send test file #2 5. Repeat until approved

20 How to configure a file System Demo

21 Company Configuration 1. Gather your toolkit Group/Account Structure Transmission details Carrier File Implementation Contact EN s associated carrier documentation on support site Federal Companion Guide 2. Pull Down the carrier template 3. Map company specific values 4. Send test file repeat as required 5. Approved for production - make adjustments and set scheduler

22 January 2018 Advanced Options & System Logic

23 Company Configuration Set-up Options Option to Exclude COBRA? Engine automatically include enrollments entered via Manage COBRA Coordinate with COBRA TPA to determine who is transmitting COBRA Carrier settings dictate what we are sending where: DTP340 (COBRA Begin Date) DTP341 (COBRA End Date) DTP303 (Original COBRA Eff Date)

24 Plan Options Common Dates Effective date override tool Use when the carrier asks for DTP348 and/or 356 to match Usually see CED request for DTP356 Applies to all employees HD04 Tool to map Benefit Volume in the HD04 field Intention was to support Guardian s VL amounts But can be used for other carriers, but EN does not troubleshoot that Recommendation is to use Requested Amount Leave 2300HD04 at select and map HD04 from plan options Plan Bundles Tool used to add a bundled loop that is not set-up a standalone plan Adding a duplicate loop on each record and the only difference is the HD03 Intention was to support UHC s bundled RX plan New Transaction Sets no longer valid Originally configured for Anthem, but they changed their specs

25 Reporting Class Structure Changes Carrier may request this to be tracked in either: 2000 Loop >> DTP* Loop >> DTP*348 Used to track & send the effective date of a change to an existing member s information but coverage is NOT being added or removed. 2 values have to be turned on at the company level: 1) HRIS Field Tracking needs to be turned on for required value 2) Navigate to each affected plan and select Advanced >> EDI Change Fields and select Write Maintenance Code Date (DTP303)

26 FAQs on EN s 834 Supported Values & Logic INS03: Maintenance Type Code 5 available options based on Federal regs EN supports or 024 INS08: Employment Status Code X available options based on Federal regs EN supports 2: FT & TE Programmed at carrier level (do not try to map value) Terminated Coverage Logic EN has 2 settings 30 or 14 days EN generally sets ended coverage to pass the latter of 14 days from the coverage end date or date processed in system Ended COBRA Enrollment Logic COBRA enrollments do not auto drop from file If carrier requires ended coverage to drop, manually archive

27 EXCEPTIONS Guardian All lines of coverage with certain build requirements Other group life/disability products Yes if you keep it simple No - Dependent GL volume that is different from EE volume Other plan models if they can consume a standard 834 file Telemedicine Tricare (Selman) TPAs

28 January 2018 Maintenance

29 Open Enrollment Set-up Options Include Ended or Open Enrollments? Option dictating what records are included on an OE file Either/Or option Ended enrollments are only ended once close-out is completed Open enrollments are only open when OE is still open Passive enrollment only copies the current record to an open record To send true OE file where carrier terms by omission >> select Include Open To send coverage end dates, complete closeout, then select option to Include Ended DON T FORGET! Select future plan dates on plans tab Be mindful of other integrations (payroll or data exchange)

30 Transmission Tracking & Error Reporting Error reporting Discrepancy report that is created after a file is processed There is no common format amongst carriers EN recommend having HR review weekly error reports Transmission Tracking File Settings>Notifications: EN sends a notification when a file is successfully transmitted or when an error is encountered Use this as a tracking mechanism for weekly file transmissions Consider implementing your own tool to track file transmissions for all your clients Spreadsheet Project Management App (Ex Trello)

31 January Strategic Recommendations

32 Top Recommendations to NEW 834 users? Reduce the complexity of the company to reduce configuration variables Consolidate your carriers Centralize billing Eliminate bills going to different offices Simplify your class structure & eligibility periods Eliminate grandfathered classes Review class rules and inactivate those that are no longer used Audit your data before starting implementation!!! Review the 834 EDI forum on Support Site Complete pre-requisites for 1:1 EDI Training Complete 1:1 EDI Training

33 Best Practice Recommendations Consolidating Carriers = less 834 files to configure/manage Eliminate subgroup billing when possible Identify your agency s 834 user and subject matter expert 834 is best for group greater than 100 eligible lives Push error reporting to the client Upgrade to platinum at the breakeven point (EN tracks for you)

34 Questions & Housekeeping

35 Coming Soon 834 Data Dictionary Open Enrollment webinar Carrier-specific webinar