Inconsistency Terminations, EPOG 9/2014

Inconsistency Terminations
EPOG 9/2014
Inconsistency Terminations
• Inconsistency termination 834s were generated and
distributed to Issuers last week.
• In situations where multiple people in the family had
an expiring inconsistency, unexpected 834
transactions were received.
Inconsistency Terminations
Example: 3 Person Enrollment Group
John – Subscriber
Jane – Spouse
Child – Dependent
John & Jane BOTH have an expiring inconsistency.
Inconsistency Terminations
Process Flow of the 834 Transactions:
1) FFM Expired Inconsistency for John
a. Produced an 834 terminating John, Jane, Child (Term NLE)
b. Produced additional 834 Enrolling Jane & Child (CiC)
2) FFM Expired Inconsistency for Jane
a. Produced an 834 Cancelling Jane & Child* (Cancel NLE)
b. Produced additional 834 Enrolling Child as the new Subscriber
In this example, four (4) 834 transactions were created instead of
the expected two (2) to complete the termination process
*Plans with future effective dates are cancelled
Inconsistency Terminations
Member Count
834 Maintenance
Transaction Description
John, Jane, Child
Term NLE
Terminated entire group due to Inconsistency
Jane and Child
New Plan created with Jane as subscriber with 1
Jane and Child
Cancel NLE
Cancelled plan due to Inconsistency on Jane
Child Only
New plan created, with Child as Subscriber
Additional Information
New Issue Identified:
• Proactive QA on 834s has identified a unique scenario were a
consumer may not be terminated when they should.
• Occurs when there are multiple consumers on an enrollment group
and all have expired inconsistencies.
Next Steps:
Root Cause Analysis at an advantaged stage.
Currently validating findings.
Apply defect fix
Provide resolution
Distribute additional 834 transactions if necessary.