The ABCs of Connecting Electronically to Your Insurance Carriers
By Dwight Matheny, Ascentis Vice President and General Manager
So you’re tired of the paper mess around open enrollment and you’re thinking in the age of the Web there must be a better way, right? There is definitely a better way, but actually doing it on your own is not for the faint of heart. Many people don’t know the process and complexities involved, and many vendors have little experience in this area. That’s why it’s so important to partner with an HRIS or HR software vendor that has years of experience in this process. If you choose to do it yourself, you’ll have greatest success if you follow these critical steps:
Step 1: Negotiate –
Will your carrier be interested in allowing connectivity from your company to their systems? How are your skills in negotiating with an insurance carrier? If your company is in the 100-1,000 employee range, will carriers be interested in dealing with you or will they only want to deal with larger groups where there is a greater return for them?
Step 2: Review the Carrier’s Companion Guide –
What’s a companion guide? Isn’t there a federally mandated standard format? Well, yes … but carriers generally have a long list of enhancements, interpretations, and additions to the standard, and so they put those into a Companion Guide. Here’s a few examples from EyeMed, Independence Blue Cross, and AmeriHealth. These are all fun documents you can read in your spare time.
Step 3: Get the right technology –
Get the right technology to securely communicate with the carrier. The carrier will let you know what’s required, and, by the way, each carrier is different. Be prepared to learn about encryption, secure transfer methods and other fun topics. And don’t forget to make sure you comply with the federal privacy and security regulations.
Step 4: Get to know 834 and start coding
– Be prepared to write some code to get your enrollment data into the federally mandated ANSI X12N 834 file format. Make sure to follow the federal regulations (check out page 50,358… it’s my favorite). You can purchase the documentation on the 834 file format from WPC (only a few hundred pages of fun reading).
Step 5: Testing, testing, 123 –
If you’ve made it through steps 1-4, you’re ready to test with your carrier. Could be a slight problem here… many carriers don’t do testing in November or December, and can only test for a couple of clients at a time, so be prepared to wait your turn. We’ve seen anywhere between five and 40 steps in a carrier’s testing processes, so be prepared to be actively involved in the process. You will have to arrange to respond to any errors in your data or programming, fix the errors, and get the new, improved file back to the carrier and then re-test (after getting back into line!). Oh, and did you think about your open enrollment date prior to this?
Step 6: Deploy! –
Having passed steps 1-5, you’re ready to start the electronic feeds, and then you’re ready to do this again with your other five carriers!
Step 7: The “Are you kidding me?” step –
Your CFO decides that it’s time to change carriers. Have a few margaritas, tell your family you’ll see them next year, and start over at Step 1!
Step 8: There’s a better way! –
Ascentis specializes in connecting small to mid-sized companies to their carriers electronically through their flagship HRIS product, Ascentis HR. Using the Ascentis Carrier Connect Service, you can transmit data directly to your carriers, and eliminate billing errors and overpayments. If your company also deploys Ascentis Employee Self-Service, Carrier Connect virtually eliminates data errors and offers a truly paperless open enrollment environment. Download the free white paper: Web-based Online Enrollment: How a Paperless Process Saves Time, Eliminates Errors, and Increases Employee Satisfaction. Visit Ascentis for more details, or call 1.800.229.2713.