Transcript Document

Maryland Health Benefit Exchange
Implementation Advisory Committee
Meeting
August 7, 2014
A service of Maryland Health Benefit Exchange
Welcome & Approval of Minutes
Michele Eberle
Acting Director, Plan & Partner Management
Maryland Health Benefit Exchange
A service of Maryland Health Benefit Exchange
Producer Data Discussion
Christopher Yeiser
Manger, Producer Operations
Maryland Health Benefit Exchange
A service of Maryland Health Benefit Exchange
Producer Data – Legacy HIX
During 2014
834 Enrollment File – 2 Data Elements
• Broker Name
• Broker National Producer Number (NPN)
Broker File – 10-12 Data Elements
• Plan was to send monthly
• Only got sent once
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Broker Data 2014
Why we used NPN
Nationwide
Permanent
Not assigned by you or us
Not private, no HIPAA concerns
Easily cross-referenced with NAIC online tools
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Broker File - 2014
Agency Name if we had it
NPN
Broker Name and
Contact Info
Agency Tax ID
if we had it
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Broker Data – 2015
Planning for Broker Data 2015
834, Deloitte spec – 3 data elements
– Broker Name
– Broker License Number (not NPN)
– MHBE-assigned account number
Broker File
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Scheduling/Frequency… first file Feb. 1?
Data Fields – Same fields as 2014? Add License No.?
Format – XML, CSV, other?
Where do we send?
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THANK YOU!
Comments & Questions
Christopher Yeiser
Manager, Producer Operations
[email protected]
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HIX System Updates
Ryan Goold
Program Management Office
Maryland Health Benefit Exchange
A service of Maryland Health Benefit Exchange
Carrier Relations – Existing System
EDI Operations Status
Major activities with carriers winding down
• Life Events Testing – CareFirst done through Cycle 3,
Evergreen not participating, UHC Kaiser in Cycle to
targeted to complete 8/15/14
• Reconciliation – All to be delivered by tomorrow 8/8/14
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Carrier Relations – Existing System
Life Event Operations Status
Backlog Reduction
– Life events that were reported since Jan 1- 45% have been
processed
Developed operational and technical processes
– Outreach strategy
– Policy for SEP
– Outreach underway for aging out dependents
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SHOP Direct Enrollment Process
Modifications
Stephanie Lee
Manger, Producer Operations
Maryland Health Benefit Exchange
A service of Maryland Health Benefit Exchange
MHC SHOP Direct Enrollment
Policy & Procedure Key Updates
Procedure
– Removed all reference to Third Party Administrator (TPA) as it relates to selling
certified Qualified Health & Dental Plans.
– Step 1a. Carriers identifies to the SHOP-authorized producer or employer
certified QHP/QDP plans for sale on the SHOP Exchange and off the
SHOP Exchange.
– Step 6. The carrier has the employer and its employees complete a carrierspecific enrollment process and provide the employer with an exact
premium quote.
– Step 7. Third Party Administrator (TPA) for premium payment collection.
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MHC SHOP Direct Enrollment
Policy & Procedure Key Updates (cont.)
Procedure
– Step 11. Address (City, State and Zip Code) of the employee to be included as
part of the monthly “snap shot file” membership file form carriers.
– Step 12. If an employer group is listed on the carrier's membership file and MHBE
does not have a completed application on file, MHBE will request the
point of contact from the carrier.
– Step 12. A letter will be mailed to the employer requesting they submit an
application and inform them of the inability to receive tax credits without
an eligibility determination from MHBE.
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Comments/Feedback
We welcome any comments/feedback by close of business Monday,
August 11, 2014 to the following email address.
[email protected]
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SHOP RFP & Renewal Plan
Update & Next Steps
Michele Eberle
Acting Director, Plan & Partner Management
Maryland Health Benefit Exchange
A service of Maryland Health Benefit Exchange
SHOP RFP
RFP technical & oral presentations complete
Review committee final recommendation by Friday
Present to MHBE board August 19th
Meet with awardee(s) and commence planning
Establish working groups to address issues
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TPA – MHBE interactions
Carrier – TPA interactions
Employer Eligibility determinations
Broker of Record / TPA changes
Appeals process & workflow
Reporting
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RENEWAL PLAN
Continued work with CMS to approve plan
Close to finalizing
Likely individuals who do not come back into the
system to renew will be auto-renewed in an onExchange plan without APTC or CSR
Understand need to complete and publish the final
renewal plan
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HBX System Update
Dennis Glorioso
Program Management Office
Maryland Health Benefit Exchange
A service of Maryland Health Benefit Exchange
System Update
Today
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HBX User Acceptance Testing
Dennis Glorioso
Program Management Office
Maryland Health Benefit Exchange
A service of Maryland Health Benefit Exchange
Carrier Testing Agenda
Validate Rates
Plan Shopping
EDI Testing
Timeline
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Glossary
SIT – System Integration Testing
UAT – User Acceptance Testing
EDI – Electronic Data Interchange
Release 1 – Plan Management
Release 2 – Eligibility & Enrollment
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Validate Rates
Carriers want to ensure rates submitted and approved by MIA are
correctly loaded into the system
Four cycles to validate rates
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Validate Rates – Initial Preview Testing
August 18 – August 22
Utilizes the last templates submitted
Deloitte will send screenshots to carriers from the SIT environment:
– Templates have been previously loaded
– Screenshots from plan shopping
– Specific to each carrier
Provide premium rates per plan by rating area
APTC amounts will be set to zero in order for the plan rates to be
consistent across the income levels
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Validate Rates – Initial Preview Testing (cont.)
Scenarios
Income
17,000 (CSR 20,000 (CSR
Tier 1)
Tier 2)
25,000 (CSR
Tier 3)
50000
(QHP)
Age
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County
Each of these scenarios will run four times using a
county from each rating area.*
Each Plan
For each scenario, a screenshot will be taken for every
plan that appears when shopping for plan. These plans
will be sorted by metal level.
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*Harford, Charles, Montgomery, & Frederick counties
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Validate Rates – Release 1 UAT
August 8 – September 8
August 8 – August 22: MHBE PMO will perform UAT on Release 1
with test plan data previously submitted.
August 25: MHBE PPM will perform UAT on Release 1 with MIAcertified SERFF plan templates.
– Once the plan data is uploaded, an Excel extract will be downloaded and sent to
Carriers for review on August 27.
– Carriers to provide feedback by September 4.
Will provide Excel extract template beforehand.
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Validate Rates – Release 2 EDI SIT
August 14 – September 19
– If the templates submitted to Deloitte are the same plans approved by MIA, EDI
testing can be used to validate rates
– Carriers are expected to load these files and validate the data as done in
Production
– Scenarios will be shared later in the presentation
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Validate Rates – Release 2 UAT
September 22 – October 17
All defects, enhancements, changes, etc. will follow MHBE’s defect
management process.
Since Release 1 goes live on 10/1, any changes identified during this
phase will require updates to Production.
May require resubmission of templates to MIA.
4-hour training session will be arranged for carriers in September.
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Validate Rates – Release 2 UAT (cont.)
September 22 – October 3: unstructured carrier UAT testing
– Offsite carrier personnel with access to the system.
– Carriers can run multiple anonymous browsing scenarios to validate rates in real
time.
– If any defects are identified during the unstructured testing, carriers are required
to submit screenshots of the steps to MHBE by October 6.
October 13 – October 17: structured carrier UAT testing
– We will request three representatives from each carrier for onsite testing.
– Carrier representatives will be provided with predefined test scenarios/scripts.
– October 13 is last day for carriers to submit changes onsite.
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Plan Shopping
Ensure plans are displayed correctly with respect to regulatory,
marketing, consumer requirements, etc.
Two cycles to validate plan shopping
View CT Health
– Plan shopping will be almost identical
– Use it as a benchmark to see how plans will be displayed
– www.accesshealthct.com
Deloitte to send screenshots to carriers from the SIT environment
Release 2 UAT :: September 22 – October 17
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EDI Testing
Ensure EDI systems are correctly passing data.
Data entered in the application is transmitted as expected to the
carriers.
Release 2 EDI SIT :: August 14 – September 19
– August 14 :: Initial connectivity testing (ensure files are dropped and picked up
successfully)
– August 18 – August 27 :: Initial add & effectuation
– August 28 – September 19 :: Change/cancel after effectuation
Release 2 UAT :: September 22 – October 17
– Viewed as final validation
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EDI Testing - Scenarios
Number
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Test Case
Change plans within carrier
Change planes between different carriers
Non-payment cancellation
Non-payment termination
Dependent Gender Change
Gap in coverage
Member changes their effective date during open enrollment. Requires
cancellation record for the original effective date before receiving the new
effective date.
Newborn add prior to the parent enrollment and then terming the newborn
record once the parent was enrolled. This would require moving the
newborn to the parent record.
Dependent Date of Birth Change
Dependent Gender Change
Change coverage level and add son & daughter (from Subscriber to family) retroactive
Enrollment for a family of 6 with APTC
Dependent-only coverage scenario with multiple dependents (minimum of 4
dependents)
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Change in income for Subscriber resulting in a loss of coverage.
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Enroll family where a dependent is the child of domestic partner.
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Exchange sends same sex gender for primary and spouse
Retroactively reinstate an incorrectly terminated subscriber
Retroactively reinstate an incorrectly terminated dependent
Income change resulting in change in eligibility, new plan selection
User enrolls in a QHP, but is not currently receiving coverage and chooses
to cancel the enrollment
User enrolls in a QHP. The user is the primary applicant for a multi-member
household.
User enrolls in a QHP. The user is the primary applicant and the only
member in the household.
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Add
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Change
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Cancel
Head of Household
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EDI Testing - Scenarios
Number Test Case
User enrolls in a QHP. The user is the primary applicant and the
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responsible party for the dependent.
24 User enrolls in QHP with APTC.
25 The user enrolls in a 20 year old dependent into a dependent only QHP.
26 The user enrolls in a 10 year old dependent into a dependent only QHP.
The user enrolls in a 10 year old and 15 year old dependent into a
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dependent only QHP.
The user enrolls in a 10 year old, 15 year old and 20 year old dependent
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into a dependent only QHP.
Add
Change
Cancel
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The user enrolls into a QHP with no APTC or CSR
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The user enrolls into a QHP with APTC but no CSR
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The user enrolls into a QHP with APTC and CSR
A family of two enrolls into a QHP without APTC or CSR
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A family of two enrolls into a QHP with APTC but without CSR
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A family of two enrolls into a QHP with APTC and with CSR
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Subscriber and non-Spouse Dependent into a QHP without APTC or CSR
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Subscriber and non-Spouse Dependent into a QHP with APTC but without
CSR
Subscriber and non-Spouse Dependent into a QHP with APTC and with
CSR
A household enrolls into a family plan (AI/AN Plan)
The primary subscriber conducts multiple demographic change requests in
the same day
The primary subscriber reports income change, which cause the individual
to lose ATPC, and adds a new dependent
The subscriber changes relationship status
The subscriber is a handicapped individual over the age of 26
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Head of
Household
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EDI Testing - Scenarios
Number Test Case
43 A family of 4, goes through a divorce
44 The primary subscriber dies
45 Individual ages out at of QHP at 65
46 Dependent ages out at 26 years of age
47 Subscriber reports change in address
48 Subscriber reports change in name and marital status
Add
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Change
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Cancel
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Non custodial parents applies for coverage of dependent
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User applies as primary subscriber with a domestic partner or same sex marriage
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Subscriber enters the same SSN for multiple household members
Alter or add SSN for dependent
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Subscriber moves out of state
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Subscriber is receiving ABD benefits and desires to purchase a full priced QHP
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Primary subscriber divorces spouse
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Subscriber is granted a special enrollment due to marriage
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User has used an agent/broker to register, create an account, complete an application,
run through eligibility determination, qualify for and select a QHP.
User enrolls in a QHP, and chooses to terminate coverage after the original coverage
start date.
Initial enrollment of Household with 3 dependents:
1 in home address,
1 in different county (rating area),
1 in different state (college)
Subscriber indicates Spanish as their language
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Head of Household
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EDI Testing - Scenarios
Number Test Case
Race/Ethnicity in Household:
Subscriber=Native American,
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Spouse=Asian,
Child=Mexican
Multiple changes with differing effectuations on differing dates:
Added Dependent (baby)- previous month.
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Address change to new rating area - tomorrow
Dropping dependent (22year old moving out) - 2 months into future
63 Subscriber terminates plan after effectuation
64 Subscriber cancels plan before effectuation
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Primary subscriber or other household member completes a name change
Add
Change
Cancel
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Testing Timeline – August 2014
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
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4
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11
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SIT - Connectivity
Validation
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SIT – “Initial Add and
Effectuation” - (begin)
SIT - Plan Shopping Screenshot
using Citizen Portal - (begin)
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SIT - Plan Shopping
Screenshot using Citizen
Portal - (end)
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SIT – “Initial Add and
Effectuation” - (end)
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SIT –”Change/ Cancel
after Effectuation” –
(begin)
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Testing Timeline – September 2014
MONDAY
1
TUESDAY
2
WEDNESDAY
3
THURSDAY
4
FRIDAY
5
8
9
10
11
12
15
16
17
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SIT –”Change/ Cancel
after Effectuation” –
(end)
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UAT – Unstructured
Carrier Testing begins
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Holiday
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Testing Timeline – October 2014
MONDAY
TUESDAY
WEDNESDAY
1
THURSDAY
2
FRIDAY
3
UAT – Unstructured
Carrier Testing ends
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14
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UAT – Carrier resources
onsite
*last day to submit
defects onsite
UAT – Last day to
submit defects offsite
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UAT – Carrier
resources onsite
UAT – Carrier
resources onsite
UAT – Carrier
resources onsite
UAT – Carrier
resources onsite
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PUBLIC COMMENTS?
NEXT MEETING:
August 21, 2014
2:00 – 4:00PM
UMBC Tech Center
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