General
How do you know that a file is from the EFI team?
Electronic Eligibility File Kickouts folder type
What is a change file?
A file that contains only the members that have changes being reported.
What is a fatal error?
Required element missing that stops the processing of that member.
What is an excluded subgroup?
Bonus: Where do you find the excluded subgroups?
A subgroup that is not being reported on the file.
Bonus: Located in the case comments of the original case and/or kickout case.
What is Alight (aka Hewitt)?
A third party that reports eligibility and premiums to Kaiser.
How many business days does CSC have to complete an EFI file?
Bonus: which field in the Kickout case tells you the date SLA began?
5 business days
Bonus: CSC Receipt Date field.
What is the definition of a full file?
The group is reporting all members on the file.
What error reports are generated for CO, GA and NW regions?
Front End and Batch Reports
How do you know if your file was processed using the Membership Application Gateway (MAG) process?
Bonus: Where is the MAG source file located?
MAG indicated in the priority field of the kickout case.
Bonus: I:/CSC_Apps/GAE/Output
How do you know you have an Kickout Case/file for Alight?
States Alight or Hewitt in the Input dataset name.
A group can only cancel what percentage of it's membership before AAR must reach out to the group to verify.
*prompted by an email from the EFI dept
10% of total membership
*AAR has 1 hour to respond to the EFI dept email
Define source file
the electronic file submitted by a group (i.e. all their paper applications in one file)
Provide some examples of Batch Errors.
Bonus: If a group in CO requests to cancel a member retroactively, what does the AAR need to do?
Possible Cancel by Omission, existing date is too retro, zip code, activity date too retro, indiv is deceased cannot add
Bonus: Validate if the group is small group and required to follow CO House Bill 1353 before processing per contract.
Where do you find the name of the source file in the Kickout case?
In the Dejaview in the Output Data Set
What resource is used for National Groups to determine how many regions the group exists in and any special rules for the group
National Purchaser Specs
If a group uses Account.kp.org and/or paper applications in addition to EFI, what is important for the group to do and why?
They need to make sure that the members on the applications or enrolled online are added to the EFI file or they could be cancelled when the EFI files runs.
What is a TPA?
Third Party Administrator - Liaison between the group and Kaiser for eligibility and financial transactions (Connexis, Alight, Towers Watson, etc)
In the NW Region, why is it important to work the medical and dental file kickouts together?
The exclusions on the Medical will be dental and the exclusions on the Dental will be medical, working them together prevents double work.
How do you know if your case has a performance guarantee or is an open enrollment file?
OE ($) or PG in the priority field of the case
What page in the Alight website shows the subscriber eligibility information (plan name, effective date, etc)?
Coverage Summary
If an EFI group submits a request in an email or on a spreadsheet to enroll a member (off cycle request), what does the AAR do?
The AAR can enroll the member and report or reply to the group advising them to add the member to the next EFI file or they could be cancelled.
What is an Automatic File Compare and what reports are generated?
Used to manually compare the data on the source file to CM. Adds, Cancels and Selected Discrepancies are the reports.
What are the error report names for HI?
Bonus: What needs to be done with members that do not have a HRN in CM?
Adds, Cancels, Selected Discrepancy, Front End Error
Bonus: If no HRN is found, the information must be sent to HI MPI. The file cannot be completed until the member(s) is enrolled.
What is the EDR?
Bonus: What are the tabs on the EDR?
Spreadsheet created by AAR using batch report and front end error. Contains member info that was rejected from the electronic processing.
Resolved, Reported, Recurring, Email and sometimes HI MPI for HI
Where is the discrepancy report sent for Alight Groups?
To the Discrepancy Management email address.