Facets/ SEED
True or False- When terming an account we should be adding a term date to all screen
False
What would the Reason Code be if SEED is showing a Term/Cancel Reason of 1?
Voluntary Withdrawl
If a policy is showing active in SEED but showing cancelled in FACETS, what should you submit?
Manual Retrigger
Define when you should use Change
is used when a member changes their QHP/Plan ID without changing to a new policy.
You should always lock your computer when leaving your workstation.
True
How can you find duplicate members?
Search by Name, DOB, SSN, OR Exchange ID.
What is Reason code 12
No reason given
What should you submit if Issuer-Assigned Member ID is missing from SEED?
Submit an ER&R
Define when Manual Reinstatement should be used
should be used when reinstating the same policy number that was terminated.
What process do you use to update term date for a 2023 policy?
ER&R
If SEED shows a term what screens should be matching?
Eligibility, Enrollment, Subsidy, & Premium override
What is reason code 2
No longer Eligible
What should you do if you are trying to cancel an overlapping policy?
Submit a special retrigger.
Define when Re-Enrollment should be used
should be used when a member terminates a policy and then becomes active with a new policy number.
If there are 2 Preaudit bypasses listed, what do you do?
Add term date to "Date 2"
If SEED shows active what screens should be matching?
Enrollment, Subsidy, & Premium override
If Term/Cancel reason code is N/A in SEED what reason do we use in Facets?
Re-enroll, retro
Per HICS case you are trying to change the effective date & it showing Initial in SEED what method should you be using?
Special Retrigger a Confirm Transaction to effectuate AND submit an ER&R.
Define Retroactive Enrollment
Applies to members enrolled after the effective date OR members enrolled after the 10th of the CURRENT month for the NEXT month.
Pend Until Paid (PUP) should only be on accounts that have a $0 responsibility amount.
False
How do you see who was in the account?
Check notes or the audit
What would Reason Code be if SEED is showing a Term/Cancel Reason of 1 & 3?
Termination of Benefits
If you are trying to term a policy for overlapping, What should the explanation be? What should the reason code be?
Termination -Nonpayment of premium & Automatic Termination
Define Initial
Applies to members enrolled before the 10th of the CURRENT month for the NEXT month.
Where do you go to remove PUP? Billing Entity