User Guide for Employers Version 1.0 Resolution Interface

Transcription

1 Welcome to the User Guide for Employers Version 1.0 Resolution Interface

2 Contents Chapter Introduction to HPHConnect s Resolution Interface Overview HPHConnect Support Shared Expectations Accessing HPHConnect Accessing the Resolution Interface Notification... 5 Chapter Review and Correct Errors via the Resolution Interface Notification Process View Errors Correct Errors... 9 Chapter Reporting EDI Error Reports HPHConnect Questions? Call

3 Chapter 1 Introduction to HPHConnect s Resolution Interface 1.1 Overview Welcome to HPHConnect s Resolution Interface! Harvard Pilgrim Health Care is making great health care easier to manage. Through the Resolution Interface, employers and brokers have access to electronic tools that empower them to manage EDI transactions in a simpler, faster and more accurate way. Resolution Interface for Employers The Resolution Interface gives you flexible options for correcting and re-submitting enrollment information to Harvard Pilgrim. This User Guide for Employers describes the transactions you can perform with HPHConnect s Resolution Interface and gives instructions on how to use it. You can also find this guide online at Go to the Employers page and select HPHConnect. Customer Service We want you to feel at ease using the Resolution Interface. If you have questions, call HPHConnect Customer Service at Our team of experts will be happy to help. 1.2 HPHConnect Support Your feedback is important as we work to enhance and improve the Resolution Interface. If you have any questions or comments, please call HPHConnect Customer Service at Note: HPHConnect Customer Service provides user support for HPHConnect features. If you experience a problem with your web connection or hardware, please call your IT department. 1.3 Shared Expectations The following guidelines will help ensure a smooth EDI submission and error correction process. Harvard Pilgrim will: Process your file within one business day of the date received or notify you of our inability to use the file as submitted. Note: File must be received prior to 5 p.m. Monday Thursday and Saturday, and prior to 4 p.m. on Friday in order to be processed on the day the file is transmitted. Identify and mark errors to be resolved by the employer in HPHConnect s Resolution Interface within three business days from the date the file is processed. In return, we ask Employers to: Submit files accurately and according to the agreed-upon submission schedule. Retrieve and review both a file Acknowledgement and a file Summary receipt to ensure that your files are received and processed by Harvard Pilgrim. Correct actionable errors within two business days from the date the errors are viewable and communicate the resolution to Harvard Pilgrim via HPHConnect s Resolution Interface. Update your HRIS (Human Resource Information System) system prior to the next scheduled file submission. Submit any file specification changes to Harvard Pilgrim for approval before implementing any changes. 2 HPHConnect Questions? Call

4 1.4 Accessing HPHConnect Go to and select Employers from the left-hand navigation bar. For initial access to your HPHConnect account, use the Harvard Pilgrim-assigned username and password. Upon your initial login, you will be required to create your own unique password for continued access to your account. Your password can be changed at anytime by selecting Change Password from the left-hand navigation bar. Note: To ensure a secure internet connection, you will need a web browser that supports 128-bit encryption. If you don t have one, HPHConnect will direct you to a web page where you can get a free browser update. For optimum performance, we recommend using Internet Explorer v5.0 or Netscape v4.7 or greater. HPHConnect Questions? Call

5 Accessing HPHConnect If you need to update your browser, choose the appropriate browser and follow the on-screen instructions. You may need to restart your computer after downloading and installing the new browser. 4 HPHConnect Questions? Call

6 1.5 Accessing the Resolution Interface To view transactions that Harvard Pilgrim has identified as unable to be processed select View EDI Errors from the left-hand navigation bar Notification This easy reminder helps you stay up-to-date with transactions that require your attention. Choose Logo/ Update on the left-hand navigation bar and enter your address as instructed. You can enter multiple addresses, separated by semicolons, to which the notification message will be sent. HPHConnect Questions? Call

7 Chapter 2 Review and Correct Errors via the Resolution Interface 2.1 Notification Process If Harvard Pilgrim cannot process a transaction due to a discrepancy, we will notify you via (therefore an address is required to be on file for all EDI transactions). This message will provide a link to the HPHConnect web-based Resolution Interface, where you can view and correct the errors online. File Discrepancies Made Available with Web Link Received: from mail pickup service by ntweb013 with Microsoft SMTPSVC; Sat, 13 Oct :22: From: <HPHConnect_Feedback@HPHC.org> To: <callahanp@abc.org> Subject: Transaction errors that require action Date: Sat, 13 Oct :21: X-MimeOLE: Produced By Microsoft MimeOLE V Message-ID: < da1NTWEB013@ntweb013> Thank you for using the HPHConnect EDI Enrollment Process. As of 10/13/2001, you have transaction errors that require action before they can be processed by Harvard Pilgrim. Click here to log on to HPHConnect and view these transactions. Please contact the HPHConnect Customer Service Center at if you have any questions. Note: To ensure that our processes stay in synch, it is critically important that you resolve all actionable errors displayed through HPHConnect s Resolution Interface within two business days from the date you are notified of the errors. Within the notification message, choose the link to HPHConnect to go to Harvard Pilgrim s web site. Then, select HPHConnect for Employers to login to HPHConnect. 2.2 View Errors On the left-hand side of the page, select View EDI Errors to see all subscriber contracts that currently have an error assigned to you by Harvard Pilgrim. To view or fix an error, click on the name of the subscriber from the EDI Error Information screen. This will take you to the Contract Errors screen for that subscriber. 6 HPHConnect Questions? Call

8 If you wish to search for a subscriber, press the Search button on the EDI Error Information screen. This will take you to the Search for Subscribers screen where you can search for a subscriber using one of the following search criteria: First Name 1. Last Name 2. SS# 3. Error Status HPHConnect Questions? Call

9 The results of the search will display all errors associated with each subscriber that satisfies the search criteria. You can also choose to search based on error status where the error statuses are described as follows: a) All Errors b) HPHC Employer Actionable are errors that you need to correct before Harvard Pilgrim can process the transaction. c) Actionable/Employer Read Only shows errors that Harvard Pilgrim has to correct; you can only view these errors. After you arrive at the Contract Errors screen you will see a summary of Member transactions that belong to the same subscriber contract. 8 HPHConnect Questions? Call

10 2.2 Correct Errors There are two options for correcting errors, as follows: 1. Directly in HPHConnect and resubmit the transaction to Harvard Pilgrim through the Resolution Interface by selecting the Update button from the Contract Errors screen. Please note that if you correct an error using the HPHConnect Resolution Interface, it is imperative that you also correct the information in your HRIS prior to your next file submission. 2. Clear the error using the HPHConnect Resolution Interface and correct it in your next file submission. Choose this option by checking the applicable box in the lower left corner of the Contract Errors screen. HPHConnect Questions? Call

11 To view or update a particular member s information, click on his/her link on the Contract Errors screen (i.e., on the text Member 1 Information ). When you are ready to view and fix the next error associated with the contract you are viewing, select Return to Contract from the Update Member Record screen. If you would like to view another contract in your group, select Search instead. Repeat these steps until you have taken action on all errors. In certain circumstances you will be able to correct the error from the Contract Error screen, while other errors will require action at the member level after clicking on Member 1 Information and making updates on the Update Member Record screen. If the Transaction Type is consistent across all member errors, the Contract Errors screen will display the Transaction Type along with the Maintenance Effective Date and/or Termination Date field(s), depending on the type of transaction. If the dates submitted via your file are consistent among the member errors, the applicable dates will also display on the Contract Errors screen, otherwise the date fields will be empty but editable. If the Transaction Type is not consistent across all member errors, the Transaction Type, Maintenance Effective Date and Termination Date fields will not be displayed on the Contract Errors screen. These errors are more appropriately corrected at the member level. In addition, certain fields are only available at the member level, whereby corrections to those fields need to be done from the Update Member Record screen. 10 HPHConnect Questions? Call

12 When correcting errors at the contract level, you have two different status options available. The Fix this error in entire contract option will allow you to submit corrected information on all like errors. After completing the necessary fields, simply choose this disposition on any member displaying the error to be corrected. The other status disposition, Fix this member s error only, allows you to update the status of a specific member s error. This may be done from either the Contract Errors or Update Member Record screen after the necessary fields have been corrected. After choosing the appropriate status disposition select Update to resubmit the transaction to Harvard Pilgrim. Note: All errors must be corrected within two business days from the date the errors are presented to you. Don t forget that the information must also be corrected in your HRIS prior to your next file submission. If Harvard Pilgrim has assigned an error with a Read Only status, you will be able to view contract and member-level errors, but you may not edit them. These errors are provided for your information only Harvard Pilgrim is responsible for correcting the error. Once electronic enrollment setup is complete, it is important to design and maintain the ongoing processes that will enable you to submit enrollment transactions to Harvard Pilgrim. There are five steps necessary for ensuring successful EDI enrollments: Scheduling the transmission of Enrollment files with Harvard Pilgrim Verifying that Harvard Pilgrim received the file Reviewing any errors and transactions that Harvard Pilgrim could not process Resolving errors via HPHConnect s Resolution Interface Updating your system to prevent discrepancies between your system and Harvard Pilgrim s enrollment system prior to submitting your next file HPHConnect Questions? Call

13 Chapter 3 Reporting 3.1 EDI Error Reports Two types of reports are available to help you analyze the different types of errors presented for your correction through HPHConnect s Resolution Interface. This information will enhance our ability to effectively work together to identify trends and opportunities to reduce errors on future files. Select EDI Error Reports from the left-hand navigation bar to view the report options. Then, select one of the report links to go to a screen that will allow you to indicate the specific date range and division criteria to use to run the selected report. Up to 12 months of error history is available. You may view these reports online or download them into a spreadsheet for further analysis. 12 HPHConnect Questions? Call

14 1. The Audit Report shows the current status of each error, including the impacted subscribers and members, a date stamp reflecting when the errors were corrected and subsequently processed by Harvard Pilgrim, and the user who submitted the corrected error. The error statuses include: New: Errors reported but not yet acted upon. Pending: Errors resubmitted to Harvard Pilgrim with corrected information. Fixed: Errors successfully reprocessed by Harvard Pilgrim. Cleared: Records that were cleared from the HPHConnect Resolution Interface. HPHConnect Questions? Call

15 2. The Error Totals Report shows a summary of errors, organized by frequency and type of error. This information enhances our ability to effectively identify trends and opportunities to reduce errors on future files. 14 HPHConnect Questions? Call

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