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A Rush To Reconcile Health Enrollment Data, By Hand

Posted: December 12, 2013

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Problems persist on the back end of HealthCare.gov, which must process accurate enrollment information so insurers can receive premium payments and start coverage for consumers. Reconciliation of the data just started this week, as time to fix problems is running out.

Affordable Care Act navigator Nini Hadwen helps Floridians shop for health insurance in October.

Affordable Care Act navigator Nini Hadwen helps Floridians shop for health insurance in October. Joe Raedle

With just a few weeks left before a deadline to get health coverage, lingering bugs lurk in the part of HealthCare.gov that you can't see. And since time is running out to get things right, health officials on Thursday urged insurance companies to cover some enrollees even if their premium checks haven't come in.

Under the law's guidelines, consumers have to sign up for a health insurance exchange — and pay their first month's premium — by the end of December if they want coverage in January.

"The short time period presents a number of challenges," says Robert Zirkelbach, a spokesman for America's Health Insurance Plans, an industry trade group.

The 834 forms — electronic files sent from HealthCare.gov's back end to insurance companies — must have accurate and complete data in order for a consumer to be considered fully enrolled.

The White House projected confidence this week: "We have a team of experts working both through technological fixes but also through some elbow grease, going through and confirming that that information is conveyed accurately and completely, to confirm that they'll be signed up for health care and eligible to get covered on Jan. 1," White House Deputy Press Secretary Josh Earnest said Wednesday.

But the Obama administration estimates that 1 in 10 forms is still problematic, an improvement from 1 in 4 bad forms in October and November. And late Thursday, health officials pressed insurance companies to grant consumers a little more leeway.

Since health plans weren't supposed to start coverage until they're paid, anyone mailing in a check will have to get it in quickly. So the Department of Health and Human Services issued new guidelines, encouraging insurers to go ahead and cover people in January even if their payments don't come in until later in the month.

"So far, the health plans I have spoken to have seen only about 20% of their enrollees pay their premium," health industry consultant Bob Laszewski wrote in his blog Thursday.

"The situation everyone wants to avoid is a situation in which consumers think they're enrolled when they're not. Or the situation where they find out that they're not enrolled when they try to schedule an appointment to see a doctor," Zirkelbach says.

Then, there's the work of reconciling the government enrollment records with the data received by insurance companies.

"I don't think you can be confident that everyone who is enrolled will have a plan until we can do a reconciliation between the government records and the insurance company records," Laszewski told NPR.

The work of reconciling files just got started Wednesday, when health officials sent spreadsheets of their latest enrollment data to insurers to cross-check records. Zirkelbach says it's a significant step.

"It will for the first time give us the size and scope of the technical challenges that exist," he says. For all the focus on technology in recent weeks, Health and Human Services Secretary Kathleen Sebelius says that reconciliation work is getting done manually.

"We are in the process of actually hand-matching individuals with insurance companies," she told lawmakers in a Wednesday hearing.

With the deadlines getting closer and December enrollments surging ahead of the deadline, whatever remaining challenges exist will need to be resolved in a hurry.

"You should probably call your insurance plan, the one you believe you've enrolled in. Just verify that you've in fact enrolled," Laszewski says.

Copyright 2014 NPR. To see more, visit http://www.npr.org/.

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