EMB Workflow
What is the difference between an I834 and IC834?
Incoming vs Outgoing
A Manager approval is required on this item if an Off Exchange member is granted reinstatement due to issuer error. What is the form called?
Exception Form
What happens if an enrollee doesn’t make a binder payment timely after enrolling through HealthCare.gov?
Member is cancelled never effective
What is the purpose of the 1.04 Smart Link queue?
File links to existing member or creates a new member
Name one goal HICS has this year
Get AI to read and action cases
How often are IC834s generated?
Name at least 4 ways an Off Exchange enrollment can be received.
Email, USPS Mail, Fax, Broker
Maria Ray enrolled in a plan on December 15th through Washington for coverage starting January 1. She paid her premium on January 5. When is her coverage considered effectuated?
Jan 1st
What type of a ticket should be opened for an urgent system issue (Ex: Users cannot log in)
INC
What are the three ATMOS automations called?
Diane, Reggie and Homelander
Name 4 types of IC834s sent back to CMS?
Reinstatement,Cancel, Term, Effectuation
Name 2 current direct enrollment brokers
Health Sherpa, eHealth, Take Command, Gravie, Willis Towers Watson, Benefit Bay, Thatch
Which state claims are paid for two months during the grace period?
TX
What is the ticketing system used to track development work with Softheon?
LH
What is the refund threshold that requires Supervisor/Manager approval?
1499
What type of files can we ingest into SFTN
I834, I820, manual payment files
How much membership do we have in Off Exchange today?
48k
Name the states that offer additional subsidies in which an enrollee may be eligible.
CA, WA, NJ
How many levels are there in the smart link logic and name 3 demographics used.
5
What is MLR and when does it usually kick off?
Medical Loss Ratio - Kicks off in May
When an I834 EDI file has an error what exception can the file fall to?
TA1/999 Exceptions
What does the acronym ICHRA stand for and define what it is.
Individual Coverage Health Reimbursement Arrangement - Paid by employers
What is the grace period to add a newborn to an existing policy for WA, OH and AR
WA - 21, OH -31, AR - 91
What is the enrollment transaction folder creation workflow in SFTN?
EDI, Transaction Set, Member Detail, Health Coverage, Member Enrollment, Member, Subscriber
Name three types of single member migrations
Delta Load, Full Clear, ATC, New