ELIGIBILITY GUIDELINES FOR VISION OPEN ENROLLMENT 2015

Transcription

1 This guide outlines the requirements when submitting 2015 open enrollment data. Also the document highlights the significant system change in place as of Q (April). Timelines ELIGIBILITY GUIDELINES FOR VISION OPEN ENROLLMENT 2015 UnitedHealthcare Vision

2 Table of Contents 2015 Open Enrollment Overview...2 Important Dates...2 Manual Eligibility...2 Important Note:...2 EDI Eligibility With Timelines...3 *** It is highly advisable to send new effective dates for all of your active subscribers...3 Examples:...3 This is an example of a subscriber moving from family coverage to employee only coverage...3 This is an example of a subscriber moving from employee coverage to family coverage. 3 Examples Continued:...4 This is an example of a subscriber moving from employee+1 coverage to family coverage...4 Questions?...4 EDI Eligibility Files...5 File Name...5 Pre File Processing Deadlines...5 Post File Processing Deadlines...5 Vision Eligibility Contact Information...6 Electronic (EDI) Eligibility Analysts FTP & transmissions...6 Escalated Eligibility Issues...6 1

3 2015 Open Enrollment Overview Please review the following guidelines when submitting eligibility for the 2015 benefit year ****Our business has gone through a major system change in Q2 of 2014 (April). We moved off of our AS400 system and moved all aspects of our business to our new system VAS. In the past (AS400) we had several limitations as to how we were able to process data as far as timelines. We couldn t load future dated data until the actual date. In the past we would hold your OE file(s), load your file(s) on 12/31. We also ask you to send the current year data for the remainder of the year, and begin sending your future data after the 1st of the year. With the change to our new system we will be able to receive and load future changes in the current year, which will make things easier for you. EDI Changes are outlined on pages 3-4. You can transmit your file with the original or new effective plan year dates for all records (both changed and unchanged records). If a member changes to a new plan you should submit new effective dates for those records i.e. 1/1/15. Eligibility Type Manual EDI (electronic files) Important Dates Eligibility Submission Deadline Close of Business December 19, 2014 Close of Business December 19, 2014 *Online eligibility via myuhcspecialtybenefits.com must be submitted by the close of business on December 30, Manual Eligibility The submission for manual eligibility will remain unchanged from previous years. All 2015 manual enrollment forms must be received by the Eligibility Department no later than the close of business on Friday, December 19, 2014 in order to be guaranteed for January 1, All manual enrollment forms received after December 19, 2014 will be processed based on first-in/ first-out priority. Due to the high processing demand during this time, our standard service level of 4 business days will not be supported during the last week of December through the first week of January. Important Note: Please do not submit enrollment forms for existing members with no changes, as this can significantly delay processing. Please forward all manual enrollment forms to the following address: Eligibility Operations Dept. UnitedHealthcare Vision 6220 Old Dobbin Lane Liberty 6, Suite 200 Columbia, MD FAX: (888)

4 EDI Eligibility With Timelines As mentioned above, our new system will be able to handle future timelines correctly and more efficiently. We won t need a special open enrollment file as we requested in the past. With our new improved system/changes you can pass your open enrollment changes as they take place and the future open enrollment data should be sent along with the current unchanged year data. Once the open enrollment data is sent on your file they should remain on your file for the remainder of the year along with the current unchanged data. We will be unable to process open enrollment term by omission records. Records that should remain active or term on a specific date must be transmitted with the specific date (i.e. 12/31/14). *** Members can be sent with their original or new plan year effective date (1/1/15) Examples: 1. This is an example of a subscriber moving from family coverage to employee only coverage. In this example you will see the pre-open enrollment data sent just like it has been throughout In the post-enrollment data you will notice the subscriber is passed with his original or new effective date but the dependents are being transmitted with 12/31/14 term dates. When you send the post-open enrollment data you should continue to send the post-enrollment data until On 1/1 John Doe s dependents will term and he will switch to employee only coverage. Starting 1/1/15 you should drop the termed records from the ongoing file. Pre-Open Enrollment Data (data sent ongoing in 2014) Subscriber John Doe 1/1/2014 Dependent Jane Doe 1/1/2014 Dependent Joe Doe 1/1/2014 Post-Open Enrollment Data (data sent after the 2015 elections, but sent in the 2014 calendar year) Subscriber John Doe 1/1/2014 or Dependent Jane Doe 1/1/ /31/14 Dependent Joe Doe 1/1/ /31/14 **Notice the original or new effective date that should appear on the file 2. This is an example of a subscriber moving from employee coverage to family coverage. In this example you will see the pre-open enrollment data sent just like it has been throughout In the post-enrollment data you will notice the subscriber is passed with his original or new effective date but the dependents are transmitted with 1/1/15 effective dates. Once you send the post-open enrollment data you should continue to send the post-enrollment data ongoing. On 1/1 John Doe s dependents will be active and he will switch to family coverage. Pre-Open Enrollment Data (data sent ongoing in 2014) Subscriber Joe Smith 1/1/2013 Post-Open Enrollment Data (data sent after the 2014 elections, but sent in the 2013 calendar year) Subscriber Joe Smith 1/1/2013 or Dependent Mary Smith Dependent Mike Smith **Notice the original or new effective date that should appear on the file Examples continued on the page 4 (next page) 3

5 Examples Continued: 3. This is an example of a subscriber moving from employee+1 coverage to family coverage. In this example you will see the pre-open enrollment data sent just like it has been throughout In the post-enrollment data you will notice the subscriber is passed with his original or new effective date and the existing dependent is passed with her original or new effective date. The new dependent is transmitted with 1/1/15 effective dates. When you send the post-open enrollment data you should continue to send the postenrollment data ongoing. On 1/1 John Doe s new dependent will be active and he will switch to family coverage. Pre-Open Enrollment Data (data sent ongoing in 2014) Subscriber Brady Anderson 1/1/2014 Dependent Angie Anderson 1/1/2014 Post-Open Enrollment Data (data sent after the 2015 elections, but sent in the 2014 calendar year) Subscriber Brady Anderson 1/1/2014 or Dependent Angie Anderson 1/1/2014 or Dependent Mark Anderson **Notice the original or new effective date that should appear on the file Questions? Please contact your account eligibility analyst for further information. We will be happy to discuss the process with you. Eligibility analyst contact information is located on page 6. 4

6 EDI Eligibility Files File Name Since we will load your open enrollment changes on your ongoing files, you ll have no need to change your existing file name. You should continue sending the same file format and use the same file naming convention as you have throughout Files should be placed in the same directory as your current FTP eligibility files. There have been no file or data format changes made by UnitedHealthcare Vision that require file testing. Pre File Processing Deadlines FTP eligibility files received by the close of business on December 19, 2014 will be loaded no later than December 31, 2014 (your file will load on your normally scheduled day as it has throughout 2014). All open enrollment files received after December 20, 2014 will be processed based on first-in/ first-out priority. **If you submit your Open Enrollment data as described on pages 3-4 as part of your normally scheduled files, there will be no delay as the files will process on as they have throughout Due to the high processing demand during open enrollment, our standard service level of two business days will not be supported during the last week of December through the first week of January. There have been no file or data format changes made by UnitedHealthcare Vision that require file testing. Files should be placed into the same directory as your current FTP eligibility files. Post File Processing Deadlines Existing clients are asked to use the online eligibility feature for any 2014 changes that need to be processed after your last 2014 calendar file is loaded, if needed. This will ensure that changes are updated instantaneously in our system. Contact if you would like to register for online eligibility access through the website. The following address can also be used as an alternative method for submitting 2014 eligibility changes to be made manually. Please note, however, that the standard processing time of four business days cannot be guaranteed during the last week of December through the first week of January. 5

7 Vision Eligibility Contact Information Electronic (EDI) Eligibility Analysts FTP & transmissions George Follmer Michelle Lodrick Sabrina Dyett Tamara W illiams tamara_b_williams@uhc.com Escalated Eligibility Issues Electronic (EDI) Eligibility Mike Stanson Vision EDI (Electronic) Manager mstanson@uhc.com Manual Eligibility Navnit Chitalia Manual Eligibility Manager navnit_d_chitalia@uhc.com Jodi Neelin Manager Electronic Eligibility jodi_neelin@uhc.com John Miklausich Director Enrollment and Billing john_e_miklausich@uhc.com