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Insurers warn 'back-end' problems persist with HealthCare.gov


By Paul Demko
Posted: December 3, 2013 - 6:45 pm ET
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By all accounts, the shopping experience on HealthCare.gov has improved significantly. That means customers can routinely access information about what health plans and subsidies are available and select the product of their choice.

But many questions remain about the accuracy of the information that's submitted to insurance companies. Ever since the Oct. 1 opening of the federal and state online marketplaces, there have been problems with so-called 834 enrollment files that provide detailed information to insurers about new subscribers.

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CMS officials asserted this week that the bulk of the problems have been fixed, attributing 80% of those glitches to a now-resolved bug that caused inaccurate reporting of Social Security numbers. Problems with accurately identifying the relationship between family members (e.g. a child reported as a parent) were also fixed, the CMS said.

The Obama administration has been less forthcoming about what problems remain or how many inaccurate forms have already been submitted.

A spokeswoman for the trade group America's Health Insurance Plans, however, said in an e-mail Tuesday that insurers are still seeing problems with the 834 transmissions. “Plans are seeing some enrollment files that are duplicative or include missing or inaccurate information, and in some cases they aren't receiving those enrollment files at all,” she said.

That description is consistent with Aetna's recent experience. “Although there have been improvements, the website is still a work in progress and we are working closely with the marketplace technical team and other carriers to help identify, prioritize and test additional issues,” spokeswoman Cynthia Michener said in an e-mail.

CMS spokeswoman Julie Bataille declined to provide an error rate when asked Tuesday about the continuing problems with 834s. In response to a question about a report in the Washington Post suggesting that such errors have affected roughly one third of individuals who have signed up for coverage through HealthCare.gov, Bataille said only that significant progress has been made.

“I can tell you that that does not reflect an accurate picture of what is happening right now,” she said. “We have made tremendous progress and huge improvements in 834 forms and will certainly work to fix any outstanding issues.”

Some insurers say they are seeing more accurate information in the files.

Kristin Ash, a spokeswoman for Pittsburgh-based Highmark, which operates in Pennsylvania, West Virginia and Delaware, said that the company is receiving a higher volume of 834 forms from the federal government in recent days and that the accuracy of the information has indeed improved.

“Ultimately, it's important for us that the data coming from the federal government is correct and timely so people can have no delay in their coverage come Jan. 1, 2014,” she said.

McLaren Health Plan, which is selling products in 28 counties in Michigan, has seen fewer than 200 enrollments so far through the federal exchange. But Kathy Kendall, president and CEO of the Flint-based firm, says enrollment has picked up by 50% in the last week. “The majority of them didn't have any issues,” Kendall said. The low number of enrollees, she added, is more of a concern for McLaren.

Insurance consultant John Gorman said that even though the CMS successfully made hundreds of fixes in components that consumers see when they visit the site, significant questions remain about the back-end system. “It's much less clear where the geek squad is on that punch list,” Gorman said. “We have seen a lot of improvement. The problem is that it remains wildly inconsistent.”

Gorman said the biggest fear for insurers, particularly those just entering the marketplace, is that problems with inaccurate information will persist through Jan. 1 when plans go into effect and, as a result, they won't immediately receive federal subsidies to pay for the plans. “The folks that are in the greatest jeopardy if this scenario develops are without question the CO-OPS (Consumer Operated and Oriented Plans) and a handful of other startups,” Gorman said. “For these little guys that are barely embryonic, that's a very dangerous scenario.”

Follow Paul Demko on Twitter: @MHpdemko


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