Software release updates will now have visibility into the features and fixes that affect our EDI files.
Topic: Common Dates
Where: From Exports, Plans tab, new sub-tab called ‘Common Dates’
Details: New sub-tab was created to set common dates in the files. Common Effective Date was re-labeled ‘348 – Common Effective Date’ and moved from the Plans sub-tab. New ‘356 – Common Eligibility Date’ was created.
348 – Common Effective Date: Enrollment start date is transmitted in the DTP*348, coverage start date. In the instances of a plan change, carriers may want to see a common effective date for anyone who was enrolled prior to the plan change. When common effective date is set, if coverage start date is before the common effective date, transmit the common effective date. If coverage is after the common effective date, transmit the coverage start date.
356 – Common Eligibility Date: Employee’s eligibility is calculated based on the employee’s hire date and plan’s entry/waiting period rules, and written to the file in the 2000 Loop, DTP*356. The Common Eligibility Date is the date the plan was originally offered by the carrier. Common Eligibility Date should be used when the carrier wants to report the date employee was originally eligible for the plans with that carrier.
Company decided to change carriers and offer a new medical plan with Aetna 1/1/2013. All employees eligible prior to 1/1/13 would receive a DTP*356 = 1/1/2013. At renewal, the employees eligible prior to 1/1/2014 will receive a DTP*356 = 1/1/2014.
When Common Eligibility Date is set to 1/1/13, employees who were hired and eligible prior to 1/1/13 (value stored as employee’s hired eligibility date) will get their DTP*356 set to 1/1/13, and employee’s eligible for the plan after the common eligibility date will get their DTP*356 set to their hired eligibility date.
Topic: Eligibility Dates - COBRA
Where: Eligibility Dates
Details: Employees who are terminated or change ‘class’ are no longer having their eligibility dates unset so the filed can continue to report their DTP*356 based on their original eligibility. If employees were previously terminated and do not have an eligibility date, there is a new field called ‘Prior Eligibility Date’ from the COBRA tool, Manage link. This new field can be set, and will be used in the eligibility calculation logic. This new field and change to the logic fixes an issue with COBRA members writing correct DTP*356 of the files.
Topic: HD04 by Benefit Amount
Where: From Exports, Plans tab, new sub-tab called ‘HD04’
Details: New sub-tab was created to set a plan based HD04 by benefit amount. This feature will be used when sending non-medical model plans in an 834, such as life and disability, when the carrier needs the benefit amount reported in the HD04. From the plans tab, select the HD04 sub-tab. Set the Plan Coverage Description to ‘Benefit Amount’ for each plan that needs the benefit amount reported. If set, the benefit amount will be written in the HD04. For plans that are not set to benefit amount, values can be configured under the Loops tab.
Topic: COBRA Maintenance Effective Date – DTP*303
Where: 2000 Loop, DTP*303 Logic Change
Details: Maintenance Effective Date is a member level date segment used to send the effective date of a change to a member’s information. For active coverage, the DTP*303 is the coverage start date. For ended coverage, the DTP*303 is the coverage end date. For COBRA, we updated the logic to send the ‘COBRA eligibility from’ date for active COBRA and ‘COBRA coverage End’ date for ended COBRA.
Topic: Email Notification
Where: File Settings Tab, the ‘Notifications List’ option
Details: Add an email to the Notification List to receive confirmation of file generation. This build fixed an issue that prevented the automated transmission when a valid email was not added to the notifications list.