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. 2 Inconsistency Terminations Example: 3 Person Enrollment Group John – Subscriber Jane – Spouse Child – Dependent John & Jane BOTH have an expiring inconsistency. 3 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 (CiC) 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 4 Inconsistency Terminations Member Count 834 Maintenance Transaction Description John, Jane, Child Term NLE Terminated entire group due to Inconsistency Jane and Child CiC New Plan created with Jane as subscriber with 1 Dependent Jane and Child Cancel NLE Cancelled plan due to Inconsistency on Jane Child Only CiC New plan created, with Child as Subscriber 5 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. 6