Carrier Implementation Planning

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Samantha Haynes
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1 Carrier Implementation Planning Overview of Key Activities January 15, 2013 A service of Maryland Health Benefit Exchange

2 IT/Integration Approach Update 2

3 Documentation Update Document Original Delivery Comments Due To be Finalized Carrier Integration Package 834 Companion Guide 820 Companion Guide Carrier Integration and Test Plan 2/20/13 3/11/13 3/21/13 2/20/13 3/11/13 3/21/13 3/7/13 3/21/13 3/28/13 3/14/13 3/28/13 4/4/13 3

4 Carrier Integration Overview MHBE will have multiple integration points with carriers to support QHP sales, enrollment, and ongoing administration through to renewal or termination both for the Individual and SHOP Exchanges QHP Set-up Product (rate and benefit information) Provider Network Information End-to-End Customer Life-Cycle Management Enrollment Initial Premium Collection (Individual and SHOP) Ongoing Billing and Premium Collection (SHOP) Eligibility Management / Change of Circumstance Renewals and Terminations Administration and Support Call Center / Customer Support Integration Enrollment and Financial Reporting and Reconciliation

5 MHBE to Carrier Integration Points

6 Technical Architecture 6

7 Testing Objectives Objective 1 Ensure secure connectivity between Carrier Systems and the MD HIX 2 Ensure the Carrier Systems and the MD HIX meet the requirements set forth in the Interface Control Document 3 Ensure end-to-end functionality of the Carrier to MD HIX interface for nominal scenarios 4 Ensure end-to-end functionality of the Carrier to MD HIX interface for error scenarios 5 Ensure processing Carrier data and interface throughput meet performance requirements Rationale The basis of any interface is ensuring consistent, predictable connectivity. Often times this is non-trivial, as it may require modifications to firewalls, routing rules, virtual IPs, certificate exchange, and other configuration changes that must be approved by appropriate control boards and security personnel. The Interface Specification defines the standard for exchange of data, content, and error handling. It is critical to test the interfaces and manually verify that the data being passed complies with the Interface Specification. This will identify early issues with the interfaces without the complexity of trying to debug data through multiple systems and services. The team must verify that the interfaces support the business processes required by both the MD HIX and the Carriers. The best way to perform this is to run end-to-end scenario tests and ensure that data travels back and forth through the systems seamlessly. Despite the best planning and architectures, there will most certainly be circumstances in production where networks are down, data arrives in an improper format, or other errors occur. To ensure operations are not interrupted, it is critical to test these scenarios and verify that the interfaces and applications recover gracefully. The nature of the data for plan updates, enrollment, dis-enrollment, and financial transactions requires timely processing. Once it has been established that both sides of the interface transmit and process data correctly, that they can also handle the anticipated volume of data with acceptable performance parameters. 7

8 Environment Set Up The Noridian Team is currently working to set up the test environment to support testing, and will have a detailed schedule for testing by objective to present at the next EAIC meeting. 8

9 Carrier Administration Portal Workflow Diagrams 9

10 Carrier Administration Portal 10

11 State Review Carriers 11

12 Carrier Import Plans 12

13 Carrier Plan Submission 13

14 State Review Plans 14

15 State Activate Plans 15

16 State QHP Recertification 16

17 Carrier Recertifies Plans 17

18 State Unauthorizes Carrier 18

19 State Decertifies Plan 19

Plan Management Stakeholder Committee April 6, 2017

Plan Management Stakeholder Committee April 6, 2017 Welcome and Introductions Standing Agenda Meeting Minutes Approval Feedback From the Field Essential Community Providers Write-in Process MHBE will allow