6:31am

Sat November 30, 2013
Health Care

A New Worry Looms Online For The Affordable Care Act

Originally published on Sat November 30, 2013 2:13 pm

Saturday is the day the Obama administration promised it would have HealthCare.gov working smoothly for the majority of people who need to sign up for health insurance.

As the Obama administration scrambles to fix the glitch-plagued site, experts are beginning to worry about another problem that may further impair the rollout of the Affordable Care Act.

Health insurance companies say they're seeing numerous errors in a form that plays a vital part in the enrollment process. The problems are manageable so far, but many worry about what will happen if enrollment surges in the weeks to come.

The 834

It's safe to say that the vast majority of consumers have never heard of an 834 EDI transmission form, despite its crucial role in the process of signing up for health insurance. It's a kind of digital resume that tells an insurance company's computer everything it needs to know about an applicant, says Bob Laszewski, a health policy consultant.

"It contains all of the person's enrollment information, all the information that [an] insurance company needs to get this person entered as a policy holder," Laszewski says.

The 834 has been around for a long time. The architects of the Affordable Care Act intended for it to play a central role in the sign-up process, says Tim Jost, a professor of law at Washington and Lee University.

"The 834 information is information the insurers have to have to get people enrolled in coverage, which of course is the point of going through the marketplace," Jost says.

Multiple Mistakes Make Insurers' Jobs Harder

But health insurance companies say the 834s they are receiving from applicants on the federal and state exchanges have sometimes been riddled with errors, Laszewski says.

"Duplicate enrollments, people enrolling and unenrolling, inaccurate data about who's a child and who's a spouse, files just not being readable," he says.

Highmark Blue Cross Blue Shield of West Virginia has been steadily processing new customers ever since the launch of Obamacare this fall. But Highmark President Fred Earley says mistakes in the 834s are making the job harder.

"We've had some situations where the records don't track, or we've seen duplicates," Earley says. "We've had situations where we'll get a record to show that someone canceled coverage when we've never had a record to show they enrolled in the first place."

Earley says his firm has been dealing with the problems by calling up state and federal officials and correcting the mistakes. The exact cause of the problems is unclear. The Obama administration has been slowly making fixes, and officials say they're making progress. But Laszewski says the fixes are not fast enough.

"The error rates have been falling," he says. "HealthCare.gov has been making progress, but we're not to the point yet where people can trust that high-volume enrollment can occur and we won't have serious customer service problems."

Laszewski says the test will come over the next few weeks. People who want coverage to begin on Jan. 1 have until just before Christmas to sign up, and there's likely to be a surge of new applicants in the weeks to come.

"What happens if we start getting hundreds of thousands or millions of people signing up by the Dec. 23 deadline, and the insurance industry is receiving hundreds or thousands of these a day?" he says. "That's what everyone's worried about."

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

Transcript

SCOTT SIMON, HOST:

And one of the problems that healthcare.gov has had specifically affects insurance companies. They say they're seeing a lot of errors in a particular form that they need to complete enrollment. The problems have so far been manageable but what will happen if enrollment surges in the coming weeks before the December 23rd deadline? NPR's Jim Zarroli reports.

JIM ZARROLI, BYLINE: It's safe to say that the vast majority of consumers have never heard of an 834 EDI transmission form, but it plays a crucial role in the process of signing up for health insurance. It's a kind of digital resume that tells an insurance company's computer everything it needs to know about an applicant. Bob Laszewski is a health policy consultant.

BOB LASZEWSKI: It contains all of the person's enrollment information, all the information that insurance company needs to get this person entered as a policy holder.

ZARROLI: The 834 has been around for a long time. And the architects of the Affordable Care Act intended for it to play a central role in the sign-up process. Tim Jost is a professor of law at Washington and Lee University.

TIM JOST: The 834 information is information the insurers have to have to get people enrolled in coverage, which of course is the point of going through the marketplace.

ZARROLI: But health insurance companies say the 834s they're receiving from applicants on the insurance exchanges have sometimes been riddled with errors. Again, Bob Laszewski.

LASZEWSKI: Duplicate enrollments, people enrolling and un-enrolling, inaccurate data about who's a child and who's a spouse, files just not being readable.

ZARROLI: Highmark Blue Cross Blue Shield of West Virginia has been steadily processing new customers ever since the launch of Obamacare this fall. But the company's president, Fred Earley, says mistakes are making the job harder.

FRED EARLEY: I mean, we've had some situations where the records don't track, or we've seen duplicates. We've had situations where we'll get a record of somebody canceling coverage when we've never had a record to come across to show they enrolled in the first place.

ZARROLI: Earley says his firm has been dealing with the problem by calling up state and federal officials and correcting the mistakes. Just why so many errors are coming in is unclear. The Obama administration has been slowly making fixes and officials say they've made progress. But insurance industry Bob Laszewski says it's not clear they're going fast enough.

LASZEWSKI: The error rates have been falling. Healthcare.gov has been making progress, but we're not to the point yet where people can trust that high-volume enrollment can occur and we won't have serious customer service problems.

ZARROLI: Laszewski says the test will come over the next few weeks. People who want coverage to begin on January 1st have until just before Christmas to sign up, and there's likely to be a surge of new applicants in the weeks to come.

LASZEWSKI: What happens if we start getting hundreds of thousands or millions of people signing up before the December 23rd deadline, and the insurance company's receiving hundreds or thousands of these a day? That's what everyone's worried about.

ZARROLI: For health insurance companies, the worst-case scenario is that they'll be overwhelmed by errors and won't be able to fix them. And come January, all those new customers for health insurance will discover they're not getting what they signed up and paid for. Jim Zarroli, NPR News, New York. Transcript provided by NPR, Copyright NPR.