Orphaned records…split families…reconciliation-mageddon (Originally Posted 1/10/2014)

The entire transaction life cycle just hasn’t been well thought out. It’s as if there was nobody within the carrier community that was even consulted by the powers that are over at various alphabet agencies.

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Processing enrollment transactions is a lot more difficult that it appears from 30,000 feet. And with the Federal Exchange reportedly unable to process life events very well…as well as the constantly changing grace periods and due dates, this becomes a reconciliation and remediation nightmare…which is further compounded by the fact folks are still trying to get as many people out the doors to the carriers as is humanly possible. It will easily be the end of the first quarter before many of these exchanges truly are able to comprehend the volume of transactions (correct and incorrect) that were pushed out. The mechanism for fixing a lot of this is a “change” transaction – and yep, that’s probably part of most systems’ “life events” processes.

It is coming as a shock that carriers “do stuff” and actually validate the 834 transactions via strict sets of business rules after saying “it looks ok structure-wise” via a 999 document. The EDI community has been doing this stuff for decades. If competent resources were deployed to manage the transaction life cycle, this really should have been the “easy part” since receiving 834s and reconciling them against the membership within an adjudication system is one of the things that payors do every single day.

Anyhow…Breitbart has a link to an AP report here: http://www.breitbart.com/Big-Government/2014/01/09/Some-find-health-insurers-have-no-record-of-them