Enrollment numbers may be stuck in computer limbo, health IT consultant says

Federal officials are tight-lipped on enrollment numbers from the troubled HealthCare.gov website.

That's probably because applications are caught in a limbo of computer-generated inaccuracies, according to a health IT consultant who worked on two of the insurance exchanges not run by HHS.

“The definition of enrollment in my mind is someone who has actually been set up in the health plan and they've confirmed that back to the exchange,” said Stuart Beaton, a Nashville-based consultant. “Once that confirmation has been received by the exchange, that's when you're enrolled. And the federal exchange and some of the states are having trouble with that round-trip exchange.”

In testimony before Congress earlier this week, HHS Secretary Kathleen Sebelius and CMS Administrator Marilyn Tavenner both deflected repeated requests by House members to release data about applicants enrolled in health insurance coverage through HealthCare.gov, launched Oct. 1 as part of the Patient Protection and Affordable Care Act.

Sebelius said during her testimony to the House Energy and Commerce Committee that the “system isn't functioning, so we are not getting that reliable data.” But the problem goes beyond data.

And last week, in grilling an executive from HealthCare.gov's prime contractor, CGI Federal, Rep. Adam Kinzinger (R.-Ill.) asked about one health plan alleging it had received an electronic enrollment message from the exchange for an enrollee with three spouses and others with the enrollees' children listed as spouses.

That's because HealthCare.gov “has not been able to correctly put the members in the enrollment file in the right way,” Beaton said. “And until those corrected fields are sent back to the insurance company, they're not enrolled. So, I think there are number of people in that limbo state, and their corrected information has not been sent back to they exchange.”

The considerable complexity of family relationships and a lack of adequate testing of the system before its launch are roots of the problem, according to Beaton.

“The logic was confused, and the (ASC X12) 834 (enrollment transaction) just reflected what (data) was passed to it,” Beaton said. “The example of the person with three spouses was, obviously, they were unable to associate each of the family members correctly. If you have a husband and wife and three kids, it wants to know the relationship of each of the children to the primary subscriber who set up the account and then to the spouse, and then they wanted to know the relationships of the children to each other. If there are stepchildren involved, there may be someone else who is financially responsible for those kids, a third party who is supposed to making premium payments for those kids.”

That means even when HHS gets the website fixed, insurers may still be sorting through garbage data transmitted in flawed enrollment transactions.

“They may have a lot of people in November still stuck in (the) process,” Beaton said.

Follow Joseph Conn on Twitter: @MHJConn