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CMS works with insurers on inaccurate enrollment data


By Gregg Blesch
Posted: December 4, 2013 - 7:30 pm ET
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As reports suggest a surge of consumers successfully choosing health plans through HealthCare.gov, the CMS is working to calm the nerves of insurers still rattled by inaccuracies in the enrollment data they're receiving from the site.

The agency formed a team with QSSI, the contractor assigned to lead the federal website rescue effort, to work directly with insurance companies on the problems with so-called 834 files, which are necessary to transfer enrollment data from the federal insurance marketplace to the plan issuers.

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The CMS issued a joint statement Wednesday with the trade group America's Health Insurance Plans and the Blue Cross and Blue Shield Association, whose licensees are offering exchange plans in most states.

“Ensuring that all Americans who need coverage are properly enrolled is a top priority for all of us. We are working together closely to resolve back-end issues between health plans and HealthCare.gov,” they said in the statement. “We will report on our progress.”

About 29,000 consumers signed up for plans Sunday and Monday through the site, according to published reports citing internal administration figures. A CMS spokeswoman declined to confirm the number, which would exceed HHS' tally of 27,000 (PDF) for the entire month of October. The next official enrollment report is expected in mid-December.

The federal government's online portal is the primary means to offer enrollment in new subsidized plans to consumers in 36 states that did not set up their own state-run marketplaces under the Patient Protection and Affordable Care Act.

The CMS said Monday that its technicians had fixed bugs causing the bulk of the problems with 834 files. Insurers, however, continued to express concerns with the files they were receiving. An AHIP spokeswoman said insurers were still getting files that “are duplicative or include missing or inaccurate information, and in some cases they aren't receiving those enrollment files at all.”

CMS spokeswoman Julie Bataille reiterated Wednesday that the agency believes fixes put in place during the weekend resolved most of those problems, and that “insurers are now testing those changes to make sure that they agree.”

A report in the Washington Post suggested that as many as one third of the enrollment records as of early this week contained errors. The Obama administration disputed the figure but has declined to provide its own numbers. Bataille said the CMS would not provide an error rate until the records have been fully vetted.

Much of the other “back-end” work to be done on the site—Henry Chao told lawmakers in a hearing last month that 30%-40% of the site had yet to be built—involves components that allow payments from the government to insurance companies, Bataille said. The CMS, she added, is committed to making sure those payments flow beginning Jan. 1, and she emphasized that the status of that work won't stand in the way of consumers getting coverage.

The site has seen a surge of consumer visits since the Obama administration announced Monday that its team had fixed most of the glitches that prevented many consumers from completing applications for several weeks after open enrollment began Oct. 1. The CMS said the site logged nearly 950,000 visits on Tuesday.

Follow Gregg Blesch on Twitter: @MHgblesch


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