Benefit Strategies | Employee Benefits Third Party ...



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|SPM Import / Change Specification |

|(Retiree and Direct Bill Participants) |

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|Eligibility not handled by BSL (no dependent details being passed) |

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|DEFINES IMPORT VERSION 2.0 |

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|Revised July 2020 | Benefit Strategies, LLC |

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Table of Contents

1 Introduction 3

2 Definition of Terms 3

2.1 SPM – Special Plan Member 3

2.2 CSV – Comma Separated Values file 3

2.3 Import Version 3

2.4 Line Identifier 4

3 Import File Process 4

4 Import Line Identifiers (Record Definitions) 4

4.1 [VERSION] 4

4.2 [SPMINSERT] 5

4.3 [SPMPLANINSERT] 6

4.4 [SPMPLANMEMBERSPECIFICRATEINSERT] 7

4.5 [SPMSUBSIDYSCHEDULEINSERT] 8

4.6 [SPMUPDATE] 8

4.7 [SPMPLANUPDATE] 10

4.8 [SPMCLIENTDIVISIONUPDATE] 10

4.9 [SPMPLANDROP] 11

5 Data Types 12

6 Import File Layout 13

7 Sample Sets of Import Records 15

Introduction

This specification will explain the format and function of the import file used to systematically load both new SPMs as well as make changes to existing SPMs in the COBRApoint system.

Possible reasons to pass changes for existing SPMs:

- Demographic changes such as last name, address, and phone number.

- Annual Open Enrollment changes such as plan adds, plan drops, coverage level changes, and member specific rate changes.

- Marriage or birth of a child.

Definition of Terms

This document uses various terms that may have different meanings to different audiences. Section 2 will help to explain these terms in the context of this document.

1 SPM – Special Plan Member

A SPM is an individual who is considered either a retiree or a direct bill participant.

2 CSV – Comma Separated Values file

A CSV file is a text file that contains values on each row that are separated by commas.

3 Import Version

Each file should include the [VERSION] being used at the top of the file. An example of what this should look like is provided below. If no [VERSION] exists in the import file, then an error will be generated.

[VERSION],2.0

4 Line Identifier

Each text line that is imported must have as its first field a “Line Identifier” (see section 4 below). The line identifier defines what fields come next on the text line.

Import File Process

A CSV import file should be created that matches the specifications defined in this document and be encoded in ANSI format. Please note, you should NOT use Excel to edit or save these files as Excel will alter the format of large numeric columns (such as SSN) and make them unreadable to COBRApoint. This import file might be built with a simple text editor (such as Notepad) or might be generated from an export program written for an existing database.

This file should be set up as new changes only. No duplicate data from previous files should be passed. The same would be true for Annual Enrollment changes. For example, if the SPM is being billed for 5 plans currently and only 1 of the plans has a rate change, then, only the plan with the change should be passed.

Import Line Identifiers (Record Definitions)

• Special Column Legend

( Required Field

? Optionally required

* Field does not need to be included in update, however it cannot be set to NULL or blank

S Requires Scheduling

1 [VERSION]

|Field Name |Data Type |Special |Accepted Values |

|Version |Integer |( |Use “2.0” for this import specification |

2 [SPMINSERT]

In the event that an SPM exists with the same Client Division, SSN, Billing Start Date, Billing Type, and Billing Frequency, an Error message will be returned stating "Error: There already exists within this Client an SPM with the same SSN, Billing Start Date, Billing Frequency, and Billing Type.”

|Field Name |Data Type |Special |Accepted Values |

|ClientName |Text-100 |( |The unique Client Name assigned in COBRApoint. |

|ClientDivisionName |Text-50 |( |The unique Client Division Name assigned in COBRApoint. If no |

| | | |divisions are set up, client name should be listed. |

|Salutation |Text-35 | |MR, MRS, MS, MISS, DR |

|FirstName |Text-50 |( | |

|MiddleInitial |Text - 1 | | |

|LastName |Text-50 |( | |

|SSN |SSN |( | |

|IndividualIdentifier |Text - 20 | | |

|Email |Email | | |

|Phone |Phone | | |

|Phone2 |Phone | | |

|Address1 |Text-50 |( | |

|Address2 |Text-50 | | |

|City |Text-50 |( | |

|StateOrProvince |Text-50 |( | |

|PostalCode |Text-35 |( | |

|Country |Text-50 | |Leave blank if the SPM resides in the USA |

|Sex |Sex |( |F, M, U |

|DOB |Date |( |Date of Birth |

|TobaccoUse |Text-35 |( |YES, NO, UNKNOWN |

|EmployeeType |Text-35 |( |FTE, PTE, UNKNOWN |

|EmployeePayrollType |Text-35 |( |EXEMPT, NONEXEMPT, UNKNOWN, SALARY, HOURLY, EXECUTIVE |

|YearsOfService |Integer | | |

|PremiumCouponType |Text-35 |( |PREMIUMNOTICE, COUPONBOOK |

| | | | |

| | | |Note: COUPONBOOK should be used if billing is set up on a payroll |

| | | |schedule. If not on a payroll schedule, please use PREMIUMNOTICE.|

|IsCOBRAEligible |Boolean | | |

|IsCOBRAEligibleAtTermination |Boolean | | |

|BillingStartDate |Date |( |The date that Benefit Strategies should start billing the |

| | | |participant. Note: Cannot change after welcome letter sent. |

|BillingEndDate |Date | |Do not use (always leave blank) |

|BillingFrequency |Text-35 |( |MONTHLY, WEEKLY, BIWEEKLY, QUARTERLY, YEARLY, SEMIMONTHLY |

|BillingType |Text-35 |( |RETIREE, PREMIUMPAY, FMLA, LEAVEOFABSENCE, STDPREMIUM, LTDPREMIUM,|

| | | |DISABILITYPREMIUM, CUSTOM |

|IsLegacy |Boolean | | |

|EnrollmentDate |Date |( |Original enrollment date of the SPM on active coverage. If |

| | | |unknown, default to 1/1/2000. |

|SPMSubsequentGracePeriodOptionType |Text-45 |( |CLIENTDEFAULT, IGNORE, CUSTOM |

|SubsequentGracePeriodNrOfDays |Integer |? |Required if SPMSubsequentGracePeriodOptionType is set to Custom |

|AllowMemberSSO |Boolean | |Leave blank |

|BenefitGroup |Text-50 | |Can be used for reporting purposes. |

|AccountStructure |Text-50 | |Can be used for reporting purposes. |

|ClientCustomData |Text-50 | |Can be used for reporting purposes. |

|QueueHIPAACertification |Boolean | | |

|QueueWelcomeLetter |Boolean | | |

|InitialGracePeriodDate |Date | |Date the SPM’s Initial Grace Period will start. |

|SPMInitialGracePeriodOptionType |Text-35 | |Initial Grace Period option – “CUSTOM” or “CLIENT DEFAULT” or |

| | | |“IGNORE”. If not specified, will default to “CLIENT DEFAULT”. |

|InitialGracePeriodDays |Integer |? |Required if SPMInitialGracePeriodOptionType is set to “CUSTOM”. |

3 [SPMPLANINSERT]

|Field Name |Data Type |Special |Accepted Values |

|ClientName |Text-100 |( |The unique Client Name assigned in COBRApoint. |

|oSSN |SSN |( | |

|oBillingStartDate |Date |( |For new a SPM, list the date that Benefit Strategies should start billing the |

| | | |participant. |

| | | | |

| | | |For adding a plan to an existing SPM, list the date that Benefit Strategies |

| | | |originally began billing for this participant. |

|oBillingType |Text-35 |( |RETIREE, PREMIUMPAY, FMLA, LEAVEOFABSENCE, STDPREMIUM, LTDPREMIUM, |

| | | |DISABILITYPREMIUM, CUSTOM |

|oBillingFrequency |Text-35 |( |MONTHLY, WEEKLY, BIWEEKLY, QUARTERLY, YEARLY, SEMIMONTHLY |

|PlanName |Text-50 |( | |

|StartDate |Date |( |The start date that the SPM will begin coverage on this plan. |

|EndDate |Date | |Optional, the end date the SPM will cease coverage on this plan. |

|CoverageLevel |Text-35 |( |EE, EE+SPOUSE, EE+CHILDREN, EE+FAMILY, EE+1, SPOUSEONLY, SPOUSE+CHILDREN, |

| | | |CHILDRENONLY |

| | | | |

| | | |There are other coverage level options available in the system, but the above |

| | | |is what’s used most often. |

| | | | |

|FirstDayOf |Date | | |

|LastDayOf |Date | | |

|NumberOfUnits |Decimal |? |Required if the plan is Units Based (e.g. Life) |

|PlanBundleName |Text-50 |? |Conditionally required for plans that are part of a bundle. |

|QueuePlanLetterChange |Boolean | |Default is true. Set to false to stop the plan change letter from being sent. |

4 [SPMPLANMEMBERSPECIFICRATEINSERT]

|Field Name |Data Type |Special |Accepted Values |

|ClientName |Text-100 |( |The unique Client Name assigned in COBRApoint. |

|oSSN |SSN |( | |

|oBillingStartDate |Date |( |For new a SPM, list the date that Benefit Strategies should start billing the |

| | | |participant. |

| | | | |

| | | |For updating a rate of an existing SPM, list the date that Benefit Strategies |

| | | |originally began billing for this participant. |

|oBillingType |Text-35 |( |RETIREE, PREMIUMPAY, FMLA, LEAVEOFABSENCE, STDPREMIUM, LTDPREMIUM, DISABILITYPREMIUM, |

| | | |CUSTOM |

|oBillingFrequency |Text-35 |( |MONTHLY, WEEKLY, BIWEEKLY, QUARTERLY, YEARLY, SEMIMONTHLY |

|PlanName |Text-50 |( | |

|StartDate |Date |( |Plan start date. |

| | | | |

| | | |For a new SPM, this would be the date that Benefit Strategies should start billing the |

| | | |participant. |

| | | | |

| | | |For an existing SPM experiencing both a member specific rate and coverage level change,|

| | | |this field should list the same date that’s listed in the EffectiveDate field on the |

| | | |[SPMPLANUPDATE] line. |

| | | | |

| | | |If only the rate is changing for an existing SPM and there is no change in the coverage|

| | | |level, this field should list the date that corresponds with the start of the most |

| | | |current coverage level. |

| | | | |

|RateStartDate |Date |( |The start date of the member specific rate on the plan. |

| | | | |

| | | |For a new SPM, this would be the date that Benefit Strategies should start billing the |

| | | |participant. |

| | | | |

| | | |For an existing SPM, this would be the date that the rate change should take effect. |

| | | | |

|RateEndDate |Date | |End Date of the member specific rate (if applicable) |

|Rate |Decimal |( |The amount of the member specific rate |

5 [SPMSUBSIDYSCHEDULEINSERT]

|Field Name |Data Type |Special |Accepted Values |

|ClientName |Text-100 |( |The unique Client Name assigned in COBRApoint. |

|oSSN |SSN |( | |

|oBillingStartDate |Date |( |For new a SPM, list the date that Benefit Strategies should start billing the |

| | | |participant. |

| | | | |

| | | |For adding a subsidy to an existing SPM, list the date that Benefit Strategies |

| | | |originally began billing for this participant. |

|oBillingType |Text-35 |( |RETIREE, PREMIUMPAY, FMLA, LEAVEOFABSENCE, STDPREMIUM, LTDPREMIUM, |

| | | |DISABILITYPREMIUM, CUSTOM |

|oBillingFrequency |Text-35 |( |MONTHLY, WEEKLY, BIWEEKLY, QUARTERLY, YEARLY, SEMIMONTHLY |

|InsuranceType |Text-35 |( |MEDICAL, DENTAL, VISION, PHARMACY, FSA, HCRA, EAP, GAP, 401k, LIFE, NULIFE,MSA, |

| | | |PBA, HSA, NUOTHER1, NUOTHER2, GRPLIFE, NUGRPLIFE, VOLLIFE, NUVOLLIFE, CANCER, |

| | | |MERP, DEPLIFE1, DEPLIFE2, DEPLIFE3, NUDEPLIFE1, NUDEPLIFE2, NUDEPLIFE3, |

| | | |MEDSTURIDER1, MEDSTURIDER2, MEDSTURIDER3, LTD, AD&D, CHIROPRACTIC, VEBA, |

| | | |CUSTOMBILLING, LTDNONUNITBASED, LTDUNITBASED, STDNONUNITBASED, STDUNITBASED, |

| | | |CRITICALILLNESS, ACCIDENTNONUNITBASED, |

| | | |ACCIDENTUNITBASED, VOLUNTARYOTHER, UOTHER1, UOTHER2, UOTHER3 |

|SubsidyType |Text-35 |( |EMPLOYER |

|SubsidyAmountType |Text-35 |( |FLAT, PERCENTAGE |

|StartDate |Date |( |Must be less than End date. |

|EndDate |Date |( |Must be greater then Start Date. |

|Amount |Money |( |Amount if FLAT or Percentage if PERCENTAGE of the subsidy. For example, use “50” |

| | | |if it is a 50% subsidy and the SubsidyAmountType is set to PERCENTAGE. Must be |

| | | |greater than zero. |

6 [SPMUPDATE]

|Field Name |Data Type |Special |Accepted Values |

|ClientName |Text-100 |( |The unique Client Name assigned in COBRApoint. |

|oSSN |SSN |( | |

|oBillingStartDate |Date |( |List the date that Benefit Strategies originally began billing |

| | | |for this participant. |

|oBillingType |Text-35 |( |RETIREE, PREMIUMPAY, FMLA, LEAVEOFABSENCE, STDPREMIUM, |

| | | |LTDPREMIUM, DISABILITYPREMIUM, CUSTOM |

|oBillingFrequency |Text-35 |( |MONTHLY, WEEKLY, BIWEEKLY, QUARTERLY, YEARLY, SEMIMONTHLY |

|Salutation |Text-35 | |MR, MRS, MS, MISS, DR |

|FirstName |Text-50 |* | |

|MiddleInitial |Text - 1 | | |

|LastName |Text-50 |* | |

|SSN |SSN |* | |

|IndividualIdentifier |Text - 20 | | |

|Email |Email | | |

|Phone |Phone | | |

|Phone2 |Phone | | |

|Address1 |Text-50 |* | |

|Address2 |Text-50 | | |

|City |Text-50 |* | |

|StateOrProvince |Text-50 |* | |

|PostalCode |Text-35 |* | |

|Country |Text-50 | |Leave blank if the SPM resides in the USA |

|Sex |Sex | |F, M, U |

|DOB |Date |* |Date of Birth |

|TobaccoUse |Text-35 |* |YES, NO, UNKNOWN |

|EmployeeType |Text-35 |* |FTE, PTE, UNKNOWN |

|EmployeePayrollType |Text-35 |* |EXEMPT, NONEXEMPT, UNKNOWN, SALARY, HOURLY, EXECUTIVE |

|YearsOfService |Integer | | |

|PremiumCouponType |Text-35 |* |PREMIUMNOTICE, COUPONBOOK |

| | | | |

| | | |Note: COUPONBOOK should be used if billing is set up on a payroll|

| | | |schedule. If not on a payroll schedule, please use |

| | | |PREMIUMNOTICE. |

|IsCOBRAEligible |Boolean | | |

|IsCOBRAEligibleAtTermination |Boolean | | |

|BillingStartDate |Date |* |List the date that Benefit Strategies originally began billing |

| | | |for this participant. |

| | | |Note: Cannot change after welcome letter sent. |

|BillingEndDate |Date | |Do not use (always leave blank) |

|BillingFrequency |Text-35 |* |MONTHLY, WEEKLY, BIWEEKLY, QUARTERLY, YEARLY, SEMIMONTHLY |

|BillingType |Text-35 |* |RETIREE, PREMIUMPAY, FMLA, LEAVEOFABSENCE, STDPREMIUM, |

| | | |LTDPREMIUM, DISABILITYPREMIUM, CUSTOM |

|IsLegacy |Boolean | | |

|EnrollmentDate |Date | | |

|SPMSubsequentGracePeriodOptionType |Text-45 |* |CLIENTDEFAULT, IGNORE, CUSTOM |

|SubsequentGracePeriodNrOfDays |Integer |* |Required if SPMSubsequentGracePeriodOptionType is set to Custom |

|AllowMemberSSO |Boolean | | |

|BenefitGroup |Text-50 | | |

|AccountStructure |Text-50 | | |

|ClientCustomData |Text-50 | | |

|QueueHIPAACertification |Boolean | | |

|QueueWelcomeLetter |Boolean | | |

|InitialGracePeriodDate |Date | |Date the SPM’s Initial Grace Period will start. |

|SPMInitialGracePeriodOptionType |Text-35 | |Initial Grace Period option – “CUSTOM” or “CLIENT DEFAULT” or |

| | | |“IGNORE”. If not specified, will default to “CLIENT DEFAULT”. |

|InitialGracePeriodDays |Integer |? |Required if SPMInitialGracePeriodOptionType is set to “CUSTOM”. |

7 [SPMPLANUPDATE]

|Field Name |Data Type |Special |Accepted Values |

|ClientName |Text-100 |( |The unique Client Name assigned in COBRApoint. |

|oSSN |SSN |( | |

|oBillingStartDate |Date |( |List the date that Benefit Strategies originally began billing for this participant. |

|oBillingType |Text-35 |( |RETIREE, PREMIUMPAY, FMLA, LEAVEOFABSENCE, STDPREMIUM, LTDPREMIUM, DISABILITYPREMIUM, |

| | | |CUSTOM |

|oBillingFrequency |Text-35 |( |MONTHLY, WEEKLY, BIWEEKLY, QUARTERLY, YEARLY, SEMIMONTHLY |

|PlanName |Text-50 |( | |

|StartDate |Date |( |This field should list the SPM’s plan start date for the existing / current coverage |

| | | |(tier) level. The start date for the new coverage level will be listed in the |

| | | |EffectiveDate field below. |

|CoverageLevel |Text-35 |( |EE, EE+SPOUSE, EE+CHILDREN, EE+FAMILY, EE+1, SPOUSEONLY, SPOUSE+CHILDREN, CHILDRENONLY |

| | | | |

| | | | |

| | | |There are other coverage level options available in the system, but the above is what’s|

| | | |used most often. |

| | | | |

|EffectiveDate |Date |( |Must fall between Plan start date and plan end date. Enter the date that the change |

| | | |should take effect. For example, if a SPM had EE+1 coverage for the 2016 plan year and|

| | | |is changing to EE only for the 2017 plan year (based on January renewal), the correct |

| | | |date to enter would be 01/01/2017. |

8 [SPMCLIENTDIVISIONUPDATE]

|Field Name |Data Type |Special |Accepted Values |

|ClientName |Text-100 |( |The unique Client Name assigned in COBRApoint. |

|oSSN |SSN |( | |

|oBillingStartDate |Date |( |List the date that Benefit Strategies originally began billing for this |

| | | |participant. |

|oBillingType |Text-35 |( |RETIREE, PREMIUMPAY, FMLA, LEAVEOFABSENCE, STDPREMIUM, LTDPREMIUM, |

| | | |DISABILITYPREMIUM, CUSTOM |

|oBillingFrequency |Text-35 |( |MONTHLY, WEEKLY, BIWEEKLY, QUARTERLY, YEARLY, SEMIMONTHLY |

|ClientDivisionName |Text-50 |( | |

|EffectiveDate |Date | |≥ Today if sent |

9 [SPMPLANDROP]

|Field Name |Data Type |Special |Accepted Values |

|ClientName |Text-100 |( |The unique Client Name assigned in COBRApoint. |

|oSSN |SSN |( | |

|oBillingStartDate |Date |( |List the date that Benefit Strategies originally began billing for this |

| | | |participant. |

|oBillingType |Text-35 |( |RETIREE, PREMIUMPAY, FMLA, LEAVEOFABSENCE, STDPREMIUM, LTDPREMIUM, |

| | | |DISABILITYPREMIUM, CUSTOM |

|oBillingFrequency |Text-35 |( |MONTHLY, WEEKLY, BIWEEKLY, QUARTERLY, YEARLY, SEMIMONTHLY |

|PlanName |Text-50 |( | |

|StartDate |Date |( |This field should list the date that corresponds with the start of the most |

| | | |current coverage level. |

|EffectiveDate |Date |( |Must be greater than plan start date. Enter the last day of coverage on the plan.|

| | | |For example, if a SPM had dental coverage for the 2016 plan and doesn’t want to |

| | | |continue it for the 2017 plan year (based on January renewal), the correct date to|

| | | |enter would be 12/31/2016. |

Data Types

The data types that used in the various import sections are defined below. Please note, the fields in the import file are all text fields (since it is a CSV file) and that the definitions below explain the formatting of the text in that field.

|Data Type |Definition |

|Text |Can be any text value up to the number of characters specified. If the text contains a comma, then the entire field should be enclosed |

| |in double quotes (“). |

| | |

| |Examples |

| | |

| |Client Name: “Benefit Strategies, LLC” |

| |Last Name: “Doe, Jr.” |

|Integer |Can be any number from 0 to 32,767. No punctuation |

|Date |Entered as MM/DD/YYYY, where MM is the month, DD is the day and YYYY is the year. You can use a single digit or two digit leading zero |

| |for the month and day. The year should always be entered as 4 digits. |

|Boolean |True = "1", "Y", "YES", "T" or "TRUE" |

| |False="0", "N", "NO", "F" or "FALSE" |

|Money |Format as number with one period, no commas and always have at least one digit to the left of the period and 2 digits to the right of |

| |the period. IE: 12 cents would be entered 0.12 |

|SSN |Format as 9 digits – can also include the dashes. Note that leading zeros are required if the SSN begins with zeros |

|Sex |Single character where M = Male, F = Female, U = Undisclosed. |

|Phone |Format as 10 digits |

|Email |Text-100, with at least one “@” and at least one “.” After the @ |

|Decimal |Format as number with one period, no commas and have at least one digit to the left of the period and up to 4 digits after the period. |

| |Example. 0.1234 |

Import File Layout

Depending on whether you are trying to load a new SPM or make changes to an existing SPM, there are certain line types that are required as well as a specific line type order that must be followed.

Below are some scenario layout examples for SPMs with member specific rated plans. Please see section 4 for the field names for each line identifier as well as the field definitions.

|Scenario |Expected Line Types & Line Order |

|New SPM |[SPMINSERT] |

| |[SPMPLANINSERT] |

| |[SPMPLANMEMBERSPECIFICRATEINSERT] |

|Existing SPM with a demographic change (phone number, |[SPMUPDATE] |

|address, etc.) | |

|Return to work from LOA / end billing  |[SPMPLANDROP] |

|Going on a new leave |[SPMINSERT] |

| |[SPMPLANINSERT] |

| |[SPMPLANMEMBERSPECIFICRATEINSERT] |

|Experiencing a rate change (no change in coverage level) |[SPMPLANMEMBERSPECIFICRATEINSERT] |

|Experiencing both a rate change and coverage level change |[SPMPLANUPDATE] |

|for a plan |[SPMPLANMEMBERSPECIFICRATEINSERT] |

|Switching plans during annual enrollment (example: |[SPMPLANDROP] – existing plan |

|switching medical from PPO to HMO)  |[SPMPLANINSERT] – new plan |

| |[SPMPLANMEMBERSPECIFICRATEINSERT] – new plan |

|Existing SPM adding a plan during annual enrollment that |[SPMPLANINSERT] – new plan |

|the SPM wasn’t previously enrolled on (example: enrolled on|[SPMPLANMEMBERSPECIFICRATEINSERT] – new plan |

|medical in 2018 and now for 2019 continuing with medical | |

|with no changes / same coverage level and rate, but adding | |

|dental) | |

|Switching billing types |[SPMPLANDROP] – plan under existing billing type |

| |[SPMINSERT] – new billing type and new billing start date |

| |[SPMPLANINSERT] – plan under new billing type and new billing start date |

| |[SPMPLANMEMBERSPECIFICRATEINSERT] – plan under new billing type and new billing start date |

| | |

| |                         |

Notes:

If a billing start and stop for the same plan is being sent on the same file, the [SPMPLANINSERT] and [SPMPLANMEMBERSPECIFICRATEINSERT] lines must be listed above the [SPMPLANDROP] line. 

Values listed in the StartDate field for plan changes to existing SPMs.

• [SPMPLANDROP] – The value in the StartDate field should list the date that corresponds with the start of the most current coverage level.

• [SPMPLANUPDATE] – The value in the StartDate field should list the date that corresponds with the start of the existing coverage level.  The EffectiveDate field would contain the date that the new coverage level starts.

• [SPMPLANMEMBERSPECIFICRATEINSERT] – If the SPM is having both a coverage level and rate change, the StartDate field on the [SPMPLANMEMBERSPECIFICRATEINSERT] line should list the date that’s listed in the EffectiveDate field on the [SPMPLANUPDATE] line.  If the coverage level is not changing and only the rate is, then the StartDate field should list the date that corresponds with the start of the most current coverage level, not the start date of the current plan year.

Sample Sets of Import Records

The following is a complete set of records for a new SPM enrolled in a coverage level based dental plan and a member specific rate medical plan:

[SPMINSERT],ClientName=1 Premium Billing Solutions Test,ClientDivisionName=PBS Leave of Absence,Salutation=,FirstName=Joey,MiddleInitial=,LastName=Tribianni,SSN=999994444,IndividualIdentifier=002,Email=,Phone=9176666666,Phone2=,Address1=1 Test St,Address2=Apt #547,City=New York City,StateOrProvince=NY,PostalCode=10001,Country=,Sex=M,DOB=12/08/1971,TobaccoUse=Unknown,EmployeeType=Unknown,EmployeePayrollType=Unknown,YearsOfService=,PremiumCouponType=PREMIUMNOTICE,IsCOBRAEligible=False,IsCOBRAEligibleAtTermination=False,BillingStartDate=02/05/2017,BillingEndDate=,BillingFrequency=Monthly,BillingType=LEAVEOFABSENCE,IsLegacy=False,EnrollmentDate=01/01/2015,SPMGracePeriodOptionType=CLIENTDEFAULT,GracePeriodNrOfDays=,AllowMemberSSO=,BenefitGroup=,AccountStructure=,ClientCustomData=,QueueHIPAACertification=,QueueWelcomeLetter=

[SPMPLANINSERT],ClientName=1 Premium Billing Solutions Test,oSSN=999994444,oBillingStartDate=02/05/2017,oBillingType=LEAVEOFABSENCE,oBillingFrequency=MONTHLY,PlanName=Medical Special,StartDate=02/05/2017,EndDate=,CoverageLevel=EE,FirstDayOf=,LastDayOf=,NumberOfUnits=,PlanBundleName=,QueuePlanLetterChange=TRUE

[SPMPLANMEMBERSPECIFICRATEINSERT],ClientName=1 Premium Billing Solutions Test,oSSN=999994444,oBillingStartDate=02/05/2017,oBillingType=LEAVEOFABSENCE,oBillingFrequency=MONTHLY,PlanName=Medical Special,StartDate=02/05/2017,RateStartDate=02/05/2017,RateEndDate=,Rate=800.00

[SPMPLANINSERT],ClientName=1 Premium Billing Solutions Test,oSSN=999994444,oBillingStartDate=02/05/2017,oBillingType=LEAVEOFABSENCE,oBillingFrequency=MONTHLY,PlanName=Dental Special,StartDate=02/05/2017,EndDate=,CoverageLevel=EE,FirstDayOf=,LastDayOf=,NumberOfUnits=,PlanBundleName=,QueuePlanLetterChange=TRUE

The following is a complete set of records for switching plans at open enrollment for the person above (after the initial set of SPM records is loaded):

[SPMPLANDROP],ClientName=1 Premium Billing Solutions Test,oSSN=999994444,oBillingStartDate=02/05/2017,oBillingType=LEAVEOFABSENCE,oBillingFrequency=MONTHLY,PlanName=Medical Special,StartDate=02/05/2017,EffectiveDate=12/31/2017

[SPMPLANINSERT],ClientName=1 Premium Billing Solutions Test,oSSN=999994444,oBillingStartDate=02/05/2017,oBillingType=LEAVEOFABSENCE,oBillingFrequency=MONTHLY,PlanName=MSR Medical,StartDate=01/01/2018,EndDate=,CoverageLevel=EE,FirstDayOf=,LastDayOf=,NumberOfUnits=,PlanBundleName=,QueuePlanLetterChange=TRUE

[SPMPLANMEMBERSPECIFICRATEINSERT],ClientName=1 Premium Billing Solutions Test,oSSN=999994444,oBillingStartDate=02/05/2017,oBillingType=LEAVEOFABSENCE,oBillingFrequency=MONTHLY,PlanName=MSR Medical,StartDate=01/01/2018,RateStartDate=01/01/2018,RateEndDate=,Rate=700.00

The following is a complete set of records for adding a new SPM, enrolled in a coverage level based dental plan and a member specific rate medical plan with subsidies:

[SPMINSERT],ClientName=1 Premium Billing Solutions Test,ClientDivisionName=PBS Leave of Absence,Salutation=,FirstName=Ross,MiddleInitial=,LastName=Gellar,SSN=999995555,IndividualIdentifier=003,Email=,Phone=9174444444,Phone2=,Address1=4 Test St,Address2=Apt #301,City=New York City,StateOrProvince=NY,PostalCode=10001,Country=,Sex=M,DOB=04/10/1971,TobaccoUse=Unknown,EmployeeType=Unknown,EmployeePayrollType=Unknown,YearsOfService=,PremiumCouponType=PREMIUMNOTICE,IsCOBRAEligible=False,IsCOBRAEligibleAtTermination=False,BillingStartDate=01/02/2017,BillingEndDate=,BillingFrequency=Monthly,BillingType=LEAVEOFABSENCE,IsLegacy=False,EnrollmentDate=01/01/2013,SPMGracePeriodOptionType=CLIENTDEFAULT,GracePeriodNrOfDays=,AllowMemberSSO=,BenefitGroup=,AccountStructure=,ClientCustomData=,QueueHIPAACertification=,QueueWelcomeLetter=

[SPMPLANINSERT],ClientName=1 Premium Billing Solutions Test,oSSN=999995555,oBillingStartDate=01/02/2017,oBillingType=LEAVEOFABSENCE,oBillingFrequency=MONTHLY,PlanName=Medical Special,StartDate=01/02/2017,EndDate=,CoverageLevel=EE+1,FirstDayOf=,LastDayOf=,NumberOfUnits=,PlanBundleName=,QueuePlanLetterChange=TRUE

[SPMPLANMEMBERSPECIFICRATEINSERT],ClientName=1 Premium Billing Solutions Test,oSSN=999995555,oBillingStartDate=01/02/2017,oBillingType=LEAVEOFABSENCE,oBillingFrequency=MONTHLY,PlanName=Medical Special,StartDate=01/02/2017,RateStartDate=01/02/2017,RateEndDate=,Rate=900.00

[SPMSUBSIDYSCHEDULEINSERT],ClientName=1 Premium Billing Solutions Test,oSSN=999995555,oBillingStartDate=01/02/2017,oBillingType=LEAVEOFABSENCE,oBillingFrequency=MONTHLY,InsuranceType=MEDICAL,SubsidyType=EMPLOYER,SubsidyAmountType=PERCENTAGE,StartDate=01/02/2017,EndDate=02/28/2017,Amount=100

[SPMPLANINSERT],ClientName=1 Premium Billing Solutions Test,oSSN=999995555,oBillingStartDate=01/02/2017,oBillingType=LEAVEOFABSENCE,oBillingFrequency=MONTHLY,PlanName=Dental Special,StartDate=01/02/2017,EndDate=,CoverageLevel=EE+1,FirstDayOf=,LastDayOf=,NumberOfUnits=,PlanBundleName=,QueuePlanLetterChange=TRUE

[SPMSUBSIDYSCHEDULEINSERT],ClientName=1 Premium Billing Solutions Test,oSSN=999995555,oBillingStartDate=01/02/2017,oBillingType=LEAVEOFABSENCE,oBillingFrequency=MONTHLY,InsuranceType=DENTAL,SubsidyType=EMPLOYER,SubsidyAmountType=PERCENTAGE,StartDate=01/02/2017,EndDate=02/28/2017,Amount=100

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