Transcript Document

Washington Health Benefit Exchange
RECONCILIATION PROCESSING
May 24, 2013
9:00 – 10:30 AM
Agenda
Topic
Facilitator
Time
Welcome and Introductions
Courtney Eiswald
9:00
Reconciliation Overview
Courtney Eiswald
9:10
Process
Courtney Eiswald
9:20
Carrier Requirements
Courtney Eiswald
9:40
Carrier Questions
Courtney Eiswald
10:00
2
Overview-Requirements
▪ Carriers are required to perform enrollment and
payment data reconciliation at least monthly
▪ Report discrepancies to the Exchange
▪ Business errors
▪ File transactional errors
3
Overview-Requirements
▪ Demographic changes must be reported to the
Exchange
▪ Encourage individuals reporting changes to carriers to report changes
to the Exchange
▪ Discrepancy reports will be manually processed by
Exchange staff, updates to enrollee data will be
passed in the daily 834 transaction
▪ Exchange will need a primary contact(s) for questions related to
business errors
▪ Exchange will need a primary contact(s) for questions related to file
errors
▪ Exchange will have a Reconciliation Team as a primary contact for
carriers
4
5
Membership Error Report
▪ Carriers send standard error reconciliation report by
the end of business each Tuesday for the daily 834
files sent during the previous week
▪ No Error report sent for daily files the week following the receipt of
the monthly 834 Audit file.
▪ For example, the Weekly Carrier Membership Error Report on
04/16/2013 will cover the Enrollment Transactions sent from
04/08/13 – 04/14/13.
▪ Report all QHPs in one report
▪ File name will make a distinction between plans
▪ No errors or discrepancies, send an empty report
with “No errors found”
6
Membership Error Report
▪ Provide enough information that will allow
Exchange staff to identify and resolve the
discrepancy.
▪
▪
▪
▪
▪
▪
Subscriber ID
Dependent ID (if necessary)
Enrollee name
Type of error i.e.
Description of error
Amount
▪ Send file via the SFTP error folder with standard file
name
7
Membership-Urgent Resolution
▪ Errors that prevent the carrier from establishing
membership or providing coverage.
▪ This would include retroactive transactions or enrollment, but not
transactions impacting future effective dates.
▪ Examples
▪ Invalid Social Security Number. Must be in the format ###-##-#### or
#########.
▪ Error, no coverage specified.
8
Membership-monthly audit
▪ Carriers to submit the standard HBE Error Report by
the end of business on the 5th business day after the
audit file is posted
▪ Audit report will be available on the morning of the 24th of every
month.
9
10
Payment Reconciliation
▪ Carriers to reconcile the full 820 payment file with
the ACH
▪ Carriers to reconcile the full 820 payment file with
membership
▪ Carriers to complete the error report by the end of
the fifth business day after the full 820 payment file
was generated.
11
Payment Reconciliation-make up
▪ Carriers to reconcile the “make up” 820 payment
file with the ACH
▪ Carriers to reconcile the make up” 820 payment file
with membership
▪ Carriers to complete the reconciliation report by the
end of Tuesday for the make up files sent the during
the previous week along with the discrepancies
from the 834.
▪ For example, the Weekly Carrier Payment Error Report on 04/16/2013
will cover the Payment Transactions sent from 04/08/13 – 04/14/13.
12
Acknowledgement Files
▪ Carriers to generate a receipt file for each file
received
▪ Generate a 999 acknowledgement file each time a file is received by
the carrier and able to be read/processed
▪ Generate a TA1 file that identifies problems in the interchange control
structure
13
14
Sample Carrier Discrepancy
15
Next Steps
▪ Testing: Contact Paul Price at
[email protected]
▪ Enrollment: Contact Courtney Eiswald at
[email protected]
▪ Reconciliation: Contact Courtney Eiswald at
[email protected]
▪ Technical: Don Cotey
[email protected]
16
17