Broker & TPA JAD May 23, 2013 DRAFT DRAFT A service of Maryland Health Benefit Exchange
Broker Information DRAFT DRAFT 2
Broker Topics Transaction files – Broker XSD – Group file – 834 Individual initial enrollment with broker information & Broker of Record changes SHOP initial enrollment with broker information & Broker of Record changes DRAFT 3
Broker XSD Broker updates, additions, or terminations Daily batch Section 7.1.7 in the Carrier Integration Package Includes broker: Name, Address, PrimaryTelephoneNumber, EmailID, TaxPayerIdentificationNumber, etc DRAFT 4
Group file Sent when any changes are made to the group Daily batch Section 7.1.6 in the Carrier Integration Package Includes broker: Name, TaxPayerIdentificationNumber, PrimaryTelephoneNumber, EmailID DRAFT 5
834 Loop ID 1000C – Broker Name – Page 12 of the 834 MHBE Enrollment Companion Guide Loop ID 1100C – Broker Account Information – Page 13 of the 834 MHBE Enrollment Companion Guide DRAFT 6
Broker Topics Transaction files – Broker XSD – Group file – 834 Individual initial enrollment with broker information & Broker of Record changes SHOP initial enrollment with broker information & Broker of Record changes DRAFT 7
Individual Initial Enrollment Select a Enroll in Send 834 broker QHP to carrier DRAFT 8
Individual Broker of Record Change Current Select a new Send updated manual broker 834 to carrier process DRAFT 9
Broker Topics Transaction files – Broker XSD – Group file – 834 Individual initial enrollment with broker information & Broker of Record changes SHOP initial enrollment with broker information & Broker of Record changes DRAFT 10
SHOP Initial Enrollment 75% Send group Select a Open participation file to broker enrollment rate is met carrier(s) DRAFT 11
SHOP Broker of Record Changes Employer Current Send group file selects a new manual to carrier(s) broker process * Also applicable to BOR changes in TPA Program 2 & 3 DRAFT 12
TPA Information DRAFT DRAFT 13
TPA Program Definitions Program 1: Alternate Online Marketplace for SHOP QHPs Program 2: SHOP Back Office Administrative Systems Program 3: SHOP Online Administrative Services Provider DRAFT 14
Broker & TPA Relationship How is this relationship captured today? How often does it change? Does this require an additional transaction scenario with the Maryland Health Connection? DRAFT 15
TPA of Record Change H ow is this handled today? How often does it occur? DRAFT 16
TPA of Record Changes No TPA to Program 3 Maryland Health Connection – All employer tasks remain on the Maryland Health Connection Carrier – No change in transactions DRAFT 17
TPA of Record Changes No TPA to Program 2 – Employer’s bill payment moves to a TPA system – TPA is responsible for enrollment & payment transactions with the carrier(s) Maryland Health Connection – Employer’s enrollment and maintenance tasks remain on the Maryland Health Connection Carrier – Transactions move from Maryland Health Connection to TPA system DRAFT 18
TPA of Record Changes No TPA to Program 1 – Employer moves to an alternate online marketplace from the Maryland Health Connection – TPA is responsible for enrollment & payment transactions with the carrier(s) Carrier – Transactions move from Maryland Health Connection to TPA system DRAFT 19
TPA of Record Changes TPA Program 2 to Program 1 – Employer moves to an alternate online marketplace from the Maryland Health Connection – New TPA is responsible for enrollment & payment transactions with the carrier(s) Carrier – Transactions move from one TPA to another DRAFT 20
TPA of Record Changes TPA Program 1 to Program 2 – Employer moves from an alternate online marketplace to the Maryland Health Connection – TPA is responsible for enrollment & payment transactions with the carrier(s) Maryland Health Connection – Onboard employer as if they are new to the system Carrier – Transactions move from one TPA to another DRAFT 21
TPA of Record Changes TPA Program 1 to Program 3 – Employer moves from an alternate online marketplace to the Maryland Health Connection Maryland Health Connection – Onboard employer as if they are new to the system – Maryland Health Connection is esponsible for enrollment & payment transactions with the carrier(s) Carrier – Transactions move from a TPA to the Maryland Health Connection DRAFT 22
TPA of Record Changes TPA Program 3 to Program 1 – Employer moves to an alternate online marketplace from the Maryland Health Connection – TPA is responsible for enrollment & payment transactions with the carrier(s) Carrier – Transactions move from the Maryland Health Connection to a TPA DRAFT 23
TPA of Record Changes TPA Program 3 to Program 2 – Employer’s bill payment moves to a TPA system – TPA is responsible for enrollment & payment transactions with the carrier(s) Maryland Health Connection – Employer’s enrollment and maintenance tasks remain on the Maryland Health Connection Carrier – Transactions move from the Maryland Health Connection to a TPA DRAFT 24
TPA of Record Changes TPA Program 2 to Program 3 – Employer’s bill payment moves from a TPA system to the Maryland Health Connection Maryland Health Connection – Employer’s enrollment and maintenance tasks remain on the Maryland Health Connection – Maryland Health Connection is responsible for enrollment & payment transactions with the carrier(s) Carrier – Transactions move from a TPA to the Maryland Health Connection DRAFT 25
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