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Scenarios: SHOP Enrollments

Scenarios: SHOP Enrollments. February 14, 2013 1:00-3:00 PM. Agenda. WA HBE Technical Meeting Schedule. SHOP Initial Enrollment Timeline. SHOP Ongoing Enrollment Timeline. General SHOP 834 Guidelines. Initial enrollment – 834 changes sent after cutoff along with 834 audit

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Scenarios: SHOP Enrollments

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  1. Scenarios: SHOP Enrollments February 14, 2013 1:00-3:00 PM

  2. Agenda

  3. WA HBE Technical Meeting Schedule

  4. SHOP Initial Enrollment Timeline

  5. SHOP Ongoing Enrollment Timeline

  6. General SHOP 834 Guidelines • Initial enrollment – 834 changes sent after cutoff along with 834 audit • Ongoing enrollment – 834 changes sent daily, 834 audit sent monthly • Each Issuer will have separate folders, within this there will be a Test and Prod folder • Inbound - Used to drop the inbound files that need to be submitted to the Exchange (820 if Issuer receives payment directly) • Ack - Trading partner should look for acknowledgements to the files submitted in this folder. 999 and custom error reports will be available for all the files submitted by the Trading Partner • Outbound – outbound transactions generated by the Exchange will be available in this folder (834 and 820 files) • Error – Any inbound file that is not ASC X12 compliant or is not recognized by the Exchange will be moved to this folder

  7. Folder Structure

  8. General SHOP 834 Guidelines • The files are named such that the Individual Market and the SHOP Market are separate files and thus don’t need separate folders. • <TPId>.<market>.<QHPId>.<datetimestamp>.<TxID><Frequency>.<O> • Example of file name: 165760000.I.1234.12262012211315.834.M.O • When acknowledgements are produced, append an “A” on the end of the file so we know which file was acknowledged • It has been suggested that if we do not have data that we produce an empty file so Issuers know our process ran

  9. General SHOP 834 Guidelines • Enrollment is sent at QHP/Plan level • Within each enrollment, we send employer, employee, dependent information • ISA • GS for QHP • ST for each enrollment • 1000A – Sponsor Name (Employer Name) • 1000B – Payer (Issuer Name) • 2000 – Member Level Detail (For each employee and dependents) • 2100A – Member Name • 2100C – Member Mailing Address • 2100D – Member Employer • 2300 – Health Coverage • 2700/2750 – Reporting Categories • SE • GE • IEA

  10. REMINDER: Carrier Workshops Washington Health Benefit Exchange will be hosting Individual Carrier Workshops. • The purpose of these Workshops is to provide continued support of Exchange implementation for Carriers by providing a setting to discuss impacts and changes specific to each carrier. SCHEDULE: Workshops will be held every Monday from 12:00pm – 2:00pm WHERE: HBE Olympia- 521 Capitol Way S Olympia, WA 98501 or Webinar hosted. HOW TO SCHEDULE A WORKSHOP: Please email Brad Finnegan at Brad.Finnegan@wahbexchange.orgwith a preferred date and a list of expected attendees.

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