Manual Enrollment
Once you confirm member has no existing account and a manual enrollment is needed, what should your first step within facets be?
Open the Enrollment Screen and click CTRL + N.
What screen(s) would we update if the same policy ID has two consecutive segments that have different QHPs, the same premium amounts and the same APTC amounts?
Eligibility, Enrollment Source and Premium Override
What are the six demographics we look at when checking whether facets accounts are duplicates? (Bonus: How many of these need to match to be considered duplicates?)
Full Name, Date of Birth, Social Security Number, Address, Phone Number and Email (At least three need to match)
Policy A goes from 01/01/26 until 04/30/26 and version 1 shows it was received on 12/31/25
Policy B is active from 03/01/26 until 12/31/26 and version 1 shows it was received on 02/14/26
What kind of request would we send out through view to solve this overlap?
Manual Retrigger to Term
True or False: Multiple policies can be merged into one membership within ORMB if they have the same product ID.
True
Please mention at least three different methods you can search within facets to validate whether member has an existing account before manually enrolling them
Last Name + DOB, Last Name + Address, Exchange Member ID, Family Link, SSN, Policy ID
What screens are reviewed when an error states that a partial end to end is needed?
Eligibility, Enrollment Source, Subsidy Billing, Premium Override, Broker/Sponsor & Billing Entity
Once you have established that there are duplicate accounts, how do you determine which one to keep?
We will always keep the members’ oldest account.
What kind of manual request form would we submit if a policy shows up as cancelled in ORMB but active in CSP Facets?
ORMB Manual Request for Eligibility
How can you tell whether a member is active, termed or cancelled within ORMB?
Look at the membership section at the bottom of the Person tab.
What screens do we have to add/review when manually enrolling a dependent?
Indicative, Eligibility, Rate Data, Enroll Source and Member Special Data
What should a member’s suspend billing indicator within the Billing Entity Screen be for an account that is billed via ORMB?
X- Inactivate Billing & Delinquency
Would you consider these duplicate accounts?
(Account 1: 1234 & Account 2: 1223)
No, we do not have 3 matching demographics between both subscribers.
After voiding a duplicate account, you realize there are ORMB payments that need to be transferred to the member’s active account. What kind of request should you fill out within VIEW?
ORMB Payment Review – Transfer of Payment
Under which tab and section within the Customer 360 information screen can you find the member’s payment information?
Billed vs Paid within Account
Which pieces of information do we need to add within the member special data screen at the time of manually enrolling a member?
MEME-BSRC (Billing Source) & HLTH-FPDT(File Processing Date)
How do we know whether we need to request an ER&R or whether there is already one being worked on?
Search within VIEW for the Policy ID and check if there is an Open ER&R View Doc for whatever it is that needs to be updated via ER&R.
Would you consider these duplicate accounts?
(Account 1: 1333 & Account 2: 1323)
Yes! We would void account 1333 and keep member active under account 1323.
HICS wants to cancel policy A (01/01/26 until 12/31/26) and reinstate policy B (cancelled 01/01/26) until 05/31/26. What would we request to get SEED updated?
A Special Retrigger to cancel Policy A and ER&R Request to Reinstate Policy B
What is the difference between a Regular Bill and an Off-cycle Bill?
Regular bills are generated on the 5th of the month prior to the month of coverage. Off cycle bills are generated when updates to member’s financial info and/or eligibility within facets occur.
What should you check immediately after setting up the member’s Billing Modeling?
The suspend billing indicator within Billing Entity
HICS wants cancelled policy A (01/01/26) to be reinstated until the end of the year. Two weeks after the HICS note was left within the account, Policy B (07/01/26 – 12/31/26) is loaded into SEED. What should we do?
Add a 6/30/26 term line with CMS HICS reason code in eligibility. Add policy B within facets in all relevant screens effective 07/01/26. We will now reinstate policy A until 6/30/26.
Would you consider these duplicate accounts?
(Account 1: 1367 & Account 2: 1376)
Although these accounts belong to the same person, they are not duplicate accounts because they have different group IDs.
Member has Policy A (03/01/26 – 04/30/26) that HICS wants reinstated until the end of the year. The termination reason that SEED is showing is CMS HICS/8. The enrollment data history for Policy A shows two lines. The first line is an unsuccessful issuer effectuation line with a date of 6/30/26 and a successful issuer termination line with a date of 05/06/26. There are no PUPs within facets.
What type of request would we fill out in view to reinstate Policy A? How would you update eligibility?
Manual retrigger to reinstate + Select 03/01/26, Term 04/30/36 CMS HICS, Reinstate 05/01/26 Manual Reinstatement
How can we tell which month(s) are being billed within a specific bill reflected in the Billed vs Paid section of the Account tab?
You click on the blue hyperlink showing the Bill ID within the Account tab of Customer 360 Information and look at the different financial segments within that Bill.