WEM User Manual.book - learn: webinsure exchange manager
Contents
1. 15 Chapter 4 WorkingwithEnroliments 17 ENEOUINGNE pecs ees Oe eee ew ad Be TOKEN Pee ee 18 Filter the Enrollment List 18 Customize the View of EnrollmentList 18 Advanced Search 18 Enrollment DetailS nannanzanznnnnannna 20 NGA RAP AA 20 Member DetallS mw gad pb Wa dead RNGA uon ears dca iara 9 x os tS E Ede EMAN DM GG NA 20 sig TCTT rn 22 Hiie eee P KIA IA E EE E E E E WA 22 Chapter 5 Working with Transactions 23 Transaction Bath rores uoa era eee RR CE E Rc AAA 24 Filter Transaction Batch List 24 Customize the View of Transaction Batch List 25 Advanced Search s naam doa didi nb whee Rea orici ewe dn NG d OR dw RUE Kab a 25 Transactions 6 5466 nese ake enere cu aeete dee daeee ES 27 Filler Transaction List s gawan a we wt ow edd we PG wee Eat Ce eae e Ro de 21 Customize the View of Transaction List 27 Advanced Search 27 12355 Sunrise Valley Drive Suite 310 Reston VA 20191 www hcentive com Transaction DetailS2. 30 Transaction Member Details 30 Chapter 6 Working with Payments ees 32 PAVINGING uiu 314 9992 0292723258222392992283 290459 19 09 92292828 5321 59525997 33 FiterthePaymentList 33 Customize the View of Payment List 33 Advanced Search 33 PaymentDetails 34 Field Description 35 12355 Sunrise Valley Drive Suite 310 Reston VA 20191 www hcentive com Introduction to Weblnsure Exchange Manager In this chapter e About this Document rrr 4 e Document OvervieW 4 TargetAudience 4 e Limitations 4 e Introduction to Weblnsure Exchange Manager 5 e Patient Protection and Affordable Care Act 5 e Weblnsure Exchange Manager Overview 5 Weblnsure Exchange Manager Introduction to Weblnsure Exchange Manager About this Document Document Overview Weblnsure Exchange Manager WEM user manual provides detailed insight into each and every module of WEM Purpose of this document is to help the end user understand working of WEM Each module of this manual has been dealt in a separate chapter Cha
3. Field Description Processing Date Date and time when the transaction was processed Actions Click to view transaction details Click to view linked enrollments to this transaction Click to 5 manage the queue for this transaction F 2014 hCentive Inc All Rights Reserved Page 29 Weblnsure Exchange Manager Working with Transactions Transaction Details You can view additional details about the transaction on this page Field Description Source Exchange Name The exchange name where enrollment was registered Market Type of market a transaction is associated with Small Business Health Options Program SHOP or Individual Exchange Subscriber ID Issuer Subscriber ID The identification number given by the exchange to the subscriber The identification number given by the issuer to the subscriber Enrollment Status Total Premium Amount Current status of the enrollment Visit status list in Glossary to view the description of relevant status This field shows total premium amount to be paid by the subscriber APTC Advance Premium Tax Credit A federal subsidy that will pay a portion of an subscriber s health insurance premium CSR Cost Sharing Reductions CSRs Subsidy that is applied to reduce the out of pocket costs for the subscriber who make less than 250 of the Federal Poverty Level Total Individual RES Amount This field gives the responsibil
4. Weblnsure Exchange Manager USER MANUAL v 1 0 November 2014 Revision History 3 e 1 er uc 10 30 2014 First Draft Nitin Beri 12355 Sunrise Valley Drive Suite 310 Reston VA 20191 www hcentive com c 20 Pull e a PAA Information in this document is subject to change without notice and does not represent a commitment on the part of the vendor or its representatives No part of this document may be reproduced or transmitted in any form or by any means electronic or mechanical including photocopying without the written permission of hCentive Inc 12355 Sunrise Valley Drive Suite 310 Reston VA 20191 Copyright Information 2014 hCentive Inc All rights reserved This document is the copyrighted property of hCentive Inc It should not be duplicated used or disclosed in whole or in part for any purpose other than to evaluate hCentive s products or services This document contains confidential and proprietary information specific to hCentive Inc Products named herein may be trademarks of their respective manufacturers and are hereby recognized Trademarked names are used editorially to the benefit of the trademark owner with no intent to infringe on the trademark Corporate Headquarters hCentive Inc 12355 Sunrise Valley Drive Suite 310 Reston VA 20191 Contact Us Phone 800 984 7952 Sales sales hcentive com Support media hcentive com Partn
5. qa Figure 5 22 Advanced Search 1 Click Advanced Search to search for a transaction 2 Provide the available details based on which you want to search a transaction EDI Group Control No Interchange Control Number From Processing Date To Processing Date Bi First Name Middle Name Last Name Group ID Employer TIN Subscriber s ID Error Code EDI Transaction Control Number Figure 5 23 Searching Transaction 3 Click Search to fetch the results You search results appear 4 Your search appears in the transaction batch list Field Description Batch Number Unique number associated to a set of transactions Transaction ID Unique number associated to the transaction Source Exchange name for the transactions Destination Name of the health plan carrier Market Type of market the transaction is associated with Subscriber Name Name of the subscriber associated to the transaction Exchange Subscriber ID Unique number given to the subscriber by the exchange Status Current status of the enrollment Visit status list in Glossary to view the description of relevant status Error Code and Description Error code for the transaction hover the mouse over the code to see what error code stands for To view complete list of error codes visit FAQs Queue The reason for holding the processing 2014 hCentive Inc All Rights Reserved Page 28 Weblnsure Exchange Manager Working with Transactions
6. 1 Click Advanced Search to search for an enrollment 2 Provide From Received Date and To Received Date and File Name 3 Choose the Exchange and Market from the list From Received Date To Received Date File Name Exchange fat fat ALL Market ALL Figure 5 20 Searching Transaction Batch 4 Click Search to fetch the results You search results appear 5 Your search appears in the transaction batch list F 2014 hCentive Inc All Rights Reserved Page 25 Weblnsure Exchange Manager Working with Transactions Batch Number Unique number associated to a set of transactions Source Exchange name for the transaction batch Destination Health plan career s name for the transaction batch Type Specifies the type of transaction enrollment or payment Date and Time Date and time when transaction batch was last updated File Name EDI file name associated to the transaction batch Status Count Number of transactions in the batch with related status Hover the cursor over the number to know type of status Flow The flow of transaction Inbound or Outbound Total Transactions The number of total transactions including passed and failed in a particular transaction batch You can click the number to view details of transaction Failed Transactions The number of failed transaction in particular transaction batch Click the number to view details of failed transactions Passed Transac
7. showcase their products across multiple state exchanges This integration required insurers to conform to various PPACA and state specific guidelines such as health plan certification reporting tracking subsidies enrollments dis enrollments life status change requests billing and many others Weblnsure Exchange Manager WEM helps in adapting to this new landscape came in place with introduction of PPACA It acts as an integration point between HIX your organization and other related parties to minimize the impact on existing business services and technical infrastructures Weblnsure Exchange Manager Overview Weblnsure Exchange Manager WEM manages the connectivity data exchange compliance and transaction reconciliation for any and all public and private exchanges you are connected to Enrollment Data in Carrier Designated Format Figure 1 1 Snapshot of WEM and Exchange Connectivity mil 2014 hCentive Inc All Rights Reserved Page 5 Weblnsure Exchange Manager Introduction to Weblnsure Exchange Manager WEM provides connectivity to the state exchanges federal and third party private exchanges as desired All transactions made on these exchanges route to WEM which are then distributed back into client s back end systems WEM is designed to be adaptable to current and future market changes It is expected that the landscape of public and private health insurance exchanges will continue to evolve going into 201
8. 1 Working with Payments In this chapter Paymenis 33 e Filter the Payment List 33 e Customize the View of Payment List 33 e Advanced Search 33 Payment Details Weblnsure Exchange Manager Working with Payments Payments Enables health plans to send and receive various payment related information It allows for the management and aggregation of premium APTC and subsidy payments late payments broker commissions and more Filter the Payment List You can filter the Payment list based on exchange name and payment statuses Click M To filter the payment s list and click Apply Customize the View of Payment List 1 To customize the view of Enrollment list click EJ A list of view option appears EDI Group Control Humber EDI Transaction Set Control Number Source Destination Batch Number x Figure 6 1 Customize Option for Payment s List 2 Click the option you want to view the list in To select multiple options pres ctrl key 3 After you have selected the option s click right arrow To remove the selected option click left arrow 4 To set the priority of selected option click up and down arrow 5 Click Submit to view the customized list of enrollments Advanced Search You can use Advanced Search to search for one or more specific enrollments REA EXPORT EDI Group Control No Ti Fig
9. 4 and beyond Data models and business processes will continue to change and require insurers to continually realign their business models to adapt Another aspect of WEM is HIX integration which demands minimal changes in an organization s existing business services and technical infrastructures as it leverages existing IT investments and resources to help reduce your costs WEM Modules e Transaction Batch e Transactions e Enrollments e Group e Payment e Reconciliation FI 2014 hCentive Inc All Rights Reserved Page 6 Working with WEM In this chapter e System Reguirements 8 e Signing into WEM 8 Forgot Password aaa ctus d 4 iR eed s ipiius 8 e Editing the Profile 10 e Editing the Profile 10 e AddingaUser 11 Weblnsure Exchange Manager Working with WEM System Requirements Weblnsure Exchange Manager WEM is compatible with different browsers and is Operating System OS independent Browser platforms supported include but not limited to Internet Explorer Chrome and Safari Prior and current versions are supported with no known compatibility issues Signing into WEM On the Sign In page provide valid email address password gt Forgot your password Login powered by s hCentive Figure 2 1 WEM Sign In page Click Login to enter WEM After successful log
10. ange Overview This section contains exchange wise transactions irrespective of HOPs In a default view you can view maximum 10 rows Click Source to sort the columns in alphabetical order Click any of the other column header to sort the table in ascending or descending order IT 2014 hCentive Inc All Rights Reserved Page 13 Weblnsure Exchange Manager Working with Dashboard Enrollment re Source a Recerved 21 22 Group gt Payment gt 4 Figure 3 7 Overview Window YTD Statistics You can view year to date YTD statistics on dashboard These statistics are shown by default on the Dashboard screen It has three options Weekly Monthly and Yearly You can choose the opadtion by clicking the toggle buttons with On Off functionality YTD Statistics CU Te bh Xo uei Figure 3 8 YTD Statistics Green state represents On which will show the relevant area charts according to selected filters e Weekly W Click W to view the data for past seven days from the current day e Monthly M Click M to view the data for past 30 days from the current day e Yearly Y Click Y to view the data for past one year Selecting this option displays the data for pass 12 months if available or the month WEM started capturing the data for the first time mil 2014 hCentive Inc All Rights Reserved Page 14 Weblnsure Exchange Manager Working with Dashboard The data will adjust as per
11. cancellations and renewals You can view or search the enrollments and related details on this page Filter the Enrollment List You can filter the enrollment list based on following criteria e Exchange Filter the data based on exchanges across the States e Market Filter through two market types SHOP or individual e Status Filter the data based on the status of enrollment To filter the enrollment list based on Name Market and Exchange click vi Select the status and click Apply Customize the View of Enrollment List 1 To customize the view of Enrollment list click EJ A list of view option appears Source Exchange Subscriber ID Exchange Subscriber ID Issuer Subscriber ID Issuer Subscriber ID Market Subscriber Name Market Figure 4 12 Customize Option for Enrollment List 2 Click the option you want to view the list in To select multiple options pres ctrl key 3 After you have selected the option s click right arrow To remove the selected option click left arrow 4 To set the priority of selected option click up and down arrow 5 Click Submit to view the customized list of enrollments Advanced Search You can use Advanced Search to search for one or more specific enrollments IT 2014 hCentive Inc All Rights Reserved Page 18 Weblnsure Exchange Manager Working with Enrollments Ejus 4 TET CE a MM UT m n EXPORT v Excha yer IL Q advanced Search gt ee eee en am a Ain a f Figu
12. ce Exchange Name The exchange name where enrollment was registered Market The type of market a transaction is associated with Small Business Health Options Program SHOP or Individual Exchange Subscriber ID The identification number given by the exchange to the subscriber Issuer Subscriber ID The identification number given by the issuer to the subscriber Enrollment Status The current status of the enrollment Visit status list in Glossary to view the description of relevant status Total Premium Amount Total premium amount to be paid by the subscriber APTC Advance Premium Tax Credit A federal subsidy that will pay a portion of an subscriber s health insurance premium CSR Cost Sharing Reductions CSRs Subsidy that is applied to reduce the out of pocket costs for the subscriber who make less than 250 of the Federal Poverty Level Total Individual RES Amount The responsibility amount Member Info Click the MEMBER INFO tab to view detailed information about the selected member For some members you may find additional details which are not mentioned in the table below There may be additional fields due to extra details in the EDI files MEMBER INFO HEALTH COVERAGE Member Name Social Security Nw ka ER A Figure 4 16 Member Information Member Name The identification number given by the exchange to the subscriber Social Security Number Thie exchange name where enrollm
13. e where enrollment was registered Market The type of market a transaction is associated with Small Business Health Options Program SHOP or Individual Exchange Subscriber ID Identification number given by the exchange to the subscriber Issuer Subscriber ID Identification number given by the issuer to the subscriber Enrollment Status The current status of the enrollment Visit status list in Glossary to view the description of relevant status Total Premium Amount Total premium amount to be paid by the subscriber Total Employer RES Amount The responsibility amount Member This section provides the list of member s linked to the subscriber of selected enrollment You can view detailed information of each member To view the information click Member Detail icon in the Action area MEMBER FIRST LAST MEMBER EXCHANGE ASSIGNED MEMBER ISSUER ASSIGNED MEMBER RELATIONSHIP TO STATUS GENDER ACTION NAME NAME TYPE ID ID SUBSCRIBER i Carl Lewis Subscriber Effectuation Received and 221215921 IM221215921 Male Self Figure 4 15 Member Details Member Details This page provides detailed information about the selected member Following are the details of various fields displayed on the page IT 2014 hCentive Inc All Rights Reserved Page 20 Weblnsure Exchange Manager Working with Enrollments Exchange Subscriber ID The identification number given by the exchange to the subscriber Sour
14. ed location Filter Report 1 Select the type of report you want to view follow step 1 of previous section 2 Choose the exchange from the Source option 3 Choose market type from the Market option 4 Select From and To Date to view the report for a specified time period 2014 hCentive Inc All Rights Reserved Page 15 Weblnsure Exchange Manager Working with Dashboard 5 Click Search to generate and view the report Your filtered report is populated automatically Source Arizona Exchange Market Individual Y From Date To Date ll E Figure 3 11 View Report 6 To filter the generated report follow the steps given in previous section IT 2014 hCentive Inc All Rights Reserved Page 16 Working with Enrollments In this chapter e Enrollment 18 e Filter the Enrollment List 18 e Customize the View of Enrollment List 18 e Advanced Search 18 e Enrollment Details 20 e Member 20 Weblnsure Exchange Manager Working with Enrollments Enrollment Enrollment Processing allows your existing enrollment processing system to connect to multiple exchanges without having to implement a multiple management system It enables sending and receiving all enrollment related information to and from the exchange new enrollments dis enrollment terminations
15. een updated successfully Figure 2 5 User profile updated EI 2014 hCentive Inc All Rights Reserved Page 10 Weblnsure Exchange Manager Working with WEM Managing the Users As an admin user you can view existing users list add new users to WEM and modify the existing users rights To manage the users list 1 Hover your mouse over Settings icon to get Users option 2 Click Users option to view the User page The page shows list of Active and Inactive Users SLA amp Notifications Markt Users Figure 2 4 Manage Users 3 To filter the users list based on Active or Inactive status click vi Select the status and click Apply 4 To customize the view of available users list click EJ A list of view option appears 5 Click the option you want to view the list in To select multiple options press ctrl key 6 After you have selected the option s click right arrow To remove the selected option click left arrow 7 To set the priority of selected option click up and down arrow 8 Click Submit to view the customized list Adding a User To add a User 1 On the User page click 2 Provide the following details Email Id First Name and Last Name of the user 3 Select the group you want the add the user to There are following three groups Administrator Business and EDI User 4 Select the Exchange s for the user 5 Select the Status of the user Active or Inactive 6 Click Add Use
16. ent was registered Issuer Assigned Member ID Type of market a transaction is associated with Small Business Health Options Program SHOP or Individual Exchange Assigned Member ID The identification number given by the exchange to the subscriber IT 2014 hCentive Inc All Rights Reserved Page 21 Weblnsure Exchange Manager Working with Enrollments Languages Spoken The identification number given by the issuer to the subscriber Monthly Premium The current status of the enrollment Visit status list in Glossary to view the description of relevant status Employer Click EMPLOYER tab to view the employer related information for the selected member This section displays complete information about the employer of selected member Health Coverage Click HEALTH COVERAGE tab to view policy details about an selected member This section displays type and details of the plan which the selected member is covered under MEMBER INFO HEALTH COVERAGE Member Name Social Security Nw ka Ur L aaa uam Figure 4 17 Health Coverage Plan Name Name of the plan a user has subscribed to Plan Type Plan type the member is covered for QHP ID The QHP ID of the plan Issuer Group ID The identification number assigned to a group by the issuer Exchange Assigned Policy ID The identification number assigned to a policy by the exchange Issuer Assigned Policy ID The identifica
17. ership partnership hcentive com http www hcentive com 12355 Sunrise Valley Drive Suite 310 Reston VA 20191 www hcentive com Table of Contents Chapter 1 Introduction to Weblnsure Exchange Manager 3 About this Document 202 a ee eee 4 Document Overview 0 lee RR hh rns 4 TargetAudience 4 LIU es gu a aes re Sa PITT Ses ITI sa Ae te GS Fe eee ae ee Kaa aa 4 Introduction to Weblnsure Exchange Manager 5 Patient Protection and Affordable Care Act 5 Weblnsure Exchange Manager Overview 5 WEM Modules 0 cc ee eee ee eee 6 Chapter 2 Working with WEM 0 0 0 cc es 7 System RequirementS 0 0 eee ee 8 SIGUING mto WEM us us xd yews ober RAK EM pose Rue baad BKA sees EGER ES ES 8 Forgot Password 8 EditingtheProfile 10 ManagingtheUsers anunnan 11 Adding User P 11 Chapter 3 WorkingwithDashboard 12 Dashboard ico Syd ah Beek Oe ee ee ae ba bee Bee Oe AA 13 eu AAP 13 VTO SUSIC S Wa aa anchor ae AI ance a one See her esas ra Beck My este WAW Di pe dn 14 RODOS EA oe ee AA eee 15 Generate Report WIKI eee hrs 15 PING REDON
18. have multiple transactions which can be of three types Enrollment Group and Payment These transactions travel to and from known as Hop between WEM and exchanges Transactions which WEM receives from the exchanges or payer are termed as inbound transactions and the transactions which WEM sends to the exchanges or payer are termed as outbound transactions There are four Hops 1 Hop 1 This is the initial transaction coming from exchange to WEM The transactions received are in form of EDI files and can have enrollments changes or cancellations initiated by the health insurance exchange HIX This is an Inbound transaction 2 Hop 2 Transaction forwarded from WEM to the your payer s back end system This data is converted from EDI to a readable format 3 Hop 3 Transaction from your payer s back end system to WEM This Hop carries effectuation by the payer 4 Hop 4 Transaction from WEM to the exchange where WEM converts effectuation by the payer in HOP 3 and sends to HIX Filter Transaction Batch List Click M to filter the enrollment list based on Name Market and Exchange You can filter the enrollment list based on following criteria e Transaction Filter the list based on the type and flow inbound outbound of transaction e Exchange Filter the list based on exchanges e Status Filter the list based on status of transaction batch Following is the list of statuses All Filter the list based on all type of stat
19. in you will land on the Dashboard page D Your account is locked after three unsuccessful sign in tries The account gets unlocked automatically after 15 minute If you need to unlock it instantly contact your administrator Forgot Password If you have forgotten your password click Forgot your password to reset the password Following window appears Forgot Password Please enter your email address below Figure 2 2 Forgot Password window IT 2014 hCentive Inc All Rights Reserved Page 8 Weblnsure Exchange Manager Working with WEM Provide your registered email id and click Submit You will receive an email with link to set up your password Dear Prod Support Your account has been updated successfully Please follow the link below to check your account httpshealthnet hcwem com healthnet ponaltogin i Thank You Admin WEM hCentive Inc Figure 2 2 Figure 2 3 Reset password mail Click the link to reset your password 2014 hCentive Inc All Rights Reserved Page 9 Weblnsure Exchange Manager Working with WEM Editing the Profile You can edit your first and last name along with your password through Edit Profile option on the top right corner of the home page TF Welcome John Doe Edit Profile Figure 2 3 Edit Profile Update your details and click Save You will get a pop up window confirming update to the profile User Profile User profile has b
20. ity amount Queues This field specifies the queue where payment is on hold Transaction Member Details The Member tab to displays members and related details associated to the transaction Field Description Source Exchange ID The exchange name where enrollment was registered Market Type of market a transaction is associated with Small Business Health Options Program SHOP or Individual Exchange Subscriber ID The identification number given by the exchange to the subscriber Issuer Subscriber ID The identification number given by the issuer to the subscriber Current status of the enrollment Visit status list in Glossary to view the description of relevant status Enrollment Status Total Premium Amount This field shows total premium amount to be paid by the subscriber IS 2014 hCentive Inc All Rights Reserved Page 30 Weblnsure Exchange Manager Working with Transactions APTC Advance Premium Tax Credit A federal subsidy that will pay a portion of an subscriber s health insurance premium CSR Cost Sharing Reductions CSRs Subsidy that is applied to reduce the out of pocket costs for the subscriber who make less than 250 of the Federal Poverty Level Total Individual RES Amount This field gives the responsibility amount Queues This field specifies the queue where payment is on hold F 2014 hCentive Inc All Rights Reserved Page 3
21. nsaction List Click vi to filter the Transaction list based on Source and Status You can filter the enrollment list based on following criteria e Source Filter the list based on the exchange from where transaction is initiated Destination Filter the list based on the exchange from where transaction is sent Market Filter the list based on the type of market e Status Filter the list based on status of transaction list Enrollment Filter the transactions based on enrollment status Queue Filter the transactions based on the queue type Click Apply to view the list of filtered transactions Customize the View of Transaction List 1 To customize the view Transaction List click EJ A list of view option appears Batch Number source Destination Type Date and Time Figure 5 21 Customize Transaction 2 Click the option you want to view the list in To select multiple options pres ctrl key 3 After you have selected the option s click right arrow To remove the selected option click left arrow 4 To set the priority of selected option click up and down arrow 5 Click Submit to view the customized list of transaction batches Advanced Search You can use Advanced Search to search for one or more specific transactions i 2014 hCentive Inc All Rights Reserved Page 27 Weblnsure Exchange Manager Working with Transactions me anced Search Adv eel t atu ET as EXPORT pr
22. ou can view Policy Payment details and Linked Enrollments IT 2014 hCentive Inc All Rights Reserved Page 35
23. pter 1 Introduction to WEM Chapter 2 Working with WEM Chapter 3 Working with Dashboard Chapter 4 Working with Enrollments Chapter 5 Working with Transactions Chapter 6 Working with Payments Target Audience The information presented in this manual is useful for the business or administrative users of WEM Limitations This manual describes about different modules seen on the user interface UI of the WEM Any technical information which is related to the implementation or back end engineering is out the scope of this manual IT 2014 hCentive Inc All Rights Reserved Page 4 Weblnsure Exchange Manager Introduction to Weblnsure Exchange Manager Introduction to Weblnsure Exchange Manager Patient Protection and Affordable Care Act The Supreme Court ruling on health reform released June 28 2012 upheld the two key elements of the PPACA Patient Protection and Affordable Care Act the individual mandate requiring individuals to obtain health coverage or pay a penalty and the massive nationwide Medicaid eligibility expansion which will extend health coverage to a broader segment of the U S population The U S Census Bureau claims that there are approximately 50 7 million uninsured Americans including 8 7 million children According to the healthcare reform states needed to have a Health Insurance Exchange HIX operational by Oct 1 2013 To comply and take advantage of the opportunity insurers needed to integrate and
24. r IT 2014 hCentive Inc All Rights Reserved Page 11 Working with Dashboard In this chapter Dashboard 13 e Overview 13 e YTD Statistics 14 REPONS us ah E d RR dicar pens LA dieci A es DAA CR 15 FilterReport 15 e Generate Report 15 Weblnsure Exchange Manager Working with Dashboard Dashboard The WEM accounting dashboard allows you to track the statistics of transaction flows both inbound and outbound to various exchanges with the ability to drill down to detailed information per transaction Dashboard is the landing page for Weblnsure Exchange Manager WEM Dashboard displays data for the exchange which you have selected To select an exchange 1 Click Manage Exchanges to view the list of state codes for respective state exchanges The exchange button acts as the exchange filter and load the exchange overview along with exchange graphs Figure 3 5 Exchange Banner 2 Click the relevant state code to view the data on the Dashboard The exchange name appears on the top right corner of the page For example in the screen shot below we can see Florida exchange name m v 2014 4 Enrollment d L A k Figure 3 6 Selected Exchange 3 Go to the Overview section to view the information about enrollment group and payment from the chosen exch
25. re 4 13 1 Advanced Search 1 Click Advanced Search to search for an enrollment 2 Provide the Subscriber Member information First Name Middle Name Last Name Issuer Subscriber ID Exchange Member ID Issuer Member ID Last Updated From Date Last Updated To Date BS Subscriber s Date of Birth Member s Date of Birth Case Number Figure 4 14 Advanced Search Option 3 Click Search to fetch the results You search results appear Source The exchange name of the enrollment Exchange Subscriber ID Unique identification number of the enrollment given by the exchange to the subscriber Issuer Subscriber ID Subscriber identification number assigned by the issuer to the subscriber Subscriber Name Name of the subscriber Market The market type of the enrollment this can be of two types SHOP or Individual Enrollment Status The current status of the enrollment Last Update Date The date when the status was updated last Actions You can view Enrollment Detail Linked Payments and Transaction IT 2014 hCentive Inc All Rights Reserved Page 19 Weblnsure Exchange Manager Working with Enrollments Enrollment Details This page provides detailed information about the selected enrollment Following are the details of various fields displayed on the page Exchange Subscriber ID The identification number given by the exchange to the subscriber Source Exchange Name Exchange nam
26. the filters selected for the graph For example if you select M it reflects the overview data only for the current month Reports You can view consolidated reports and download in CSV Excel or PDF format Generate Report To generate a report 1 Select the report type from the Reports section by clicking scroll down arrow Reports Reports Change Enrollments Initiated By Exchange M Client Exchange Timeplays Enrollment Batches Initiated By Exchange Enrollment Transactions Received from Carrier Enrollment by Status Exchange Client Timeplays To Date Members Waiting for Effectuation New Enrollments Initiated by Exchange New Enrollments by HIPAA Validations Payment Released b p Payment Txn for which Hop1 Enrollment Not Received MARKET Payments Cancelled via UI g Subscribers Eligible For Subsidy SHOP Total Members by Status Market o TO NE yment Amo ollectei o Total N et Payment Amo unt Collected Individual Total Subsidies Collected 1 J Transactions waiting for Payer s response o ET c a dab g a e CESP M Individual 8 27 14 12 00 AM Arizona Exchange SHOP S n 19 00 eo i UU BRL gp ce Figure 3 9 Select Type of Report 2 After you select the type of report the report populates automatically 3 Click Export to download the selected report in CSV Excel or PDF format Figure 3 10 Export a Report 4 Choose from the give formats and save the report at desir
27. tion number assigned to a policy by the issuer Actual Effective Start Date Actual start date of the coverage Actual Effective End Date Actual end date of the coverage Status Current status of health coverage plan Broker This section displays the Broker name and identification number of the broker associated with the selected enrollment Transaction Refer to the transactions section for details IT 2014 hCentive Inc All Rights Reserved Page 22 Working with Transactions In this chapter In this chapter Transaction Batch 24 e Filter Transaction Batch List 24 e Customize the View of Transaction Batch List 25 e Advanced Search 27 Transactions 27 e Filter Transaction List 27 e Customize the View of Transaction List 27 e Advanced Search 27 Transaction Details e Transaction Member Details 30 Weblnsure Exchange Manager Working with Transactions Transaction Batch This module captures all the files flowing in and out of system pertaining to modules like enrollment payment group and custom files except reconciliation files It supports file level tracking with file status counts links to download files and view associated transactions You can view the transaction batch details on this page One transaction batch can
28. tions The number of passed transaction in particular transaction batch Click the number to view details of passed transactions Sender TPID TPID of the sender Acknowledgment Files EDI Acknowledgment files flowing as a response to last transaction These can be of two types 999 and TA1 click the file to view information Status Current status of the transaction batch Ack Transfter Status Current status of the acknowledgement file transfer Market Type of market for the transaction batch Actions Click to view all transactions to the transaction batch Click Ke download 834 EDI file Click to view validated and passed EDI files for the transaction batch IS 2014 hCentive Inc All Rights Reserved Page 26 Weblnsure Exchange Manager Working with Transactions Transactions Transaction is the routing or exchange of data between the exchanges WEM and payers The transactions route in EDI format which are HIPAA compliant A transaction can include processing of an enrollment or a payment Each transaction will have a Transaction Batch number assigned which links it to other related transactions This is the inside view of a file which is referred transactions A file comprises of set of transactions and are displayed on this page A member can have multiple transaction like new request followed by change instruction termination etc You can view the list of transactions on this page Filter Tra
29. ure 6 2 1 Advanced Search 1 Click Advanced Search to search for a payment IT 2014 hCentive Inc All Rights Reserved Page 33 Weblnsure Exchange Manager Working with Payments 2 Provide the EDI Transaction Set Control Number and Processing Dates EDI Transaction Set Control Number From Processing Date To Processing Date Figure 6 3 Advanced Search Option 3 Click Search to fetch the results You search results appear Field Description EDI Group Control Number This is the EDI Group Control Number to identify the source group segment of the enrollment group EDI Transaction Control Number This is the EDI Transaction Set Group Control Number to identify the source group segment of the enrollment group Source Health plan career s name for the transaction batch Destination The exchange name from where payment is made Batch Number Transaction batch number associated with the payment click the number to view the related transaction Processing Date The date when payment was processed Payment Method This field shows whether the payment carries financial information or not ACH Financial information account bank details available NON Financial information account bank details not available Actions You can view Payment Detail and Linked enrollments to the payments Click to view additional payment details related to the policy Click to view linked enrollment to the payment Pa
30. uses Accepted Filter the list based on accepted transactions only File Received Filter the list based on received transactions batches only File Sent Filter the list based on sent transactions batches only Partially Accepted Filter the list based on sent partially accepted transaction batches only Rejected Filter the list based on sent partially rejected transaction batches only Replayed Filter the list based on transaction files which were not processed earlier and now have been replayed by WEM Select the desired option and click Apply IS 2014 hCentive Inc All Rights Reserved Page 24 Weblnsure Exchange Manager Working with Transactions Customize the View of Transaction Batch List 1 To customize the view of the list of Transaction Batches click EJ A list of view option appears From Received Date To Received Date File Name Exchange ALL v Market ALL c03 r3 Figure 5 18 Customize Transaction Batch 2 Click the option you want to view the list in To select multiple options pres ctrl key 3 After you have selected the option s click right arrow To remove the selected option click left arrow 4 To set the priority of selected option click up and down arrow 5 Click Submit to view the customized list of transaction batches Advanced Search You can use Advanced Search to search for one or more specific transaction batches EXPORT Figure 5 19 Advanced Search
31. yment Details Transaction Reference Number Unique transaction number for the payment Payer Name The name of the payer mi 2014 hCentive Inc All Rights Reserved Page 34 Weblnsure Exchange Manager Working with Payments Payer ID The identification number of the payer Payer Name The name of the payee Payee ID The indentification number of the payee Credit Debit Type of payment Payment Effective Date The effective date of the paymet Payment Process Date The date processing date of the payment Payment Delivery Date The delivery date of the payment Sender Account Number Account number of the sender Receiver Account Number Account number of the receiver Total Amount Total amount of the payment Field Description Payment Level The level of the payment Policy of Program Sub Level The sub level of the paymet Individual or Organization Payment Type Type of the payment Market Type of the market Exchange Subscriber ID Unique identification number given by the exchange to the subscriber Exchange Group ID Unique identification number given by the excahage to the group Employer TIN The Tax Identification Number TIN of the employer in the payments for the group enrollment Plan ID Identification number of the health insurance plan for which pyamet is made Payment Processing Date The date when payment was processed Amount Amount of the payment Action Y
Download Pdf Manuals
Related Search