Washington Health Benefit Exchange
SCENARIOS: SHOP ENROLLMENTS
February 14, 2013
1:00-3:00 PM
Agenda
Topic
Welcome
• Introductions
• Purpose of the Meeting
Facilitator
Duration
Brad
10 Min
Update on Action Items
Randy
5 Min
SHOP Timelines
• Initial enrollment timeline
• Ongoing enrollment timeline
Randy
5 Min
SHOP Enrollment Scenarios
• General SHOP technical conventions
• SHOP Enrollment Scenarios 1,4,7
Cheryl
Don
60 Min
Questions, Wrap up, and Next Steps
Brad
10 Min
WA HBE Technical Meeting Schedule
Date
Agenda
February 14th
Enrollment Scenarios I (Initial Enrollment)
February 20th
SHOP Enrollment Scenarios II
(Changes & Terms)
February 21st
I&F Payment Scenarios (820)
February 28th
SHOP Payment Scenarios (820)
Comment Period
Comments due by 2/19
Comments due by 2/26
Comments due by 3/5
Comments due by 3/5
)
3
SHOP Initial Enrollment Timeline
4
SHOP Ongoing Enrollment Timeline
5
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
6
Folder Structure
Carrier
Test
Inbound
Ack
Prod
Outbound
Error
Inbound
Ack
Outbound
Error
7
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
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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
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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
[email protected] with a preferred date and a list of
expected attendees.
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