Washington Health Benefit Exchange S CENARIOS : SHOP E NROLLMENTS February 14, :00-3:00 PM

Agenda TopicFacilitatorDuration Welcome Introductions Purpose of the Meeting Brad 10 Min Update on Action Items Randy5 Min SHOP Timelines Initial enrollment timeline Ongoing enrollment timeline Randy5 Min SHOP Enrollment Scenarios General SHOP technical conventions SHOP Enrollment Scenarios 1,4,7 Cheryl Don 60 Min Questions, Wrap up, and Next Steps Brad10 Min

WA HBE Technical Meeting Schedule 3 DateAgendaComment Period February 14 th Enrollment Scenarios I (Initial Enrollment) Comments due by 2/19 February 20 th SHOP Enrollment Scenarios II (Changes & Terms) Comments due by 2/26 February 21 st I&F Payment Scenarios (820) Comments due by 3/5 February 28 th SHOP Payment Scenarios (820) ) Comments due by 3/5

SHOP Initial Enrollment Timeline 4

SHOP Ongoing Enrollment Timeline 5

General SHOP 834 Guidelines ▪ Initial enrollment – 834 changes sent after cutoff along with 834 audit ▪ Ongoing enrollment – 834 changes sent daily, 834 audit sent monthly ▪ Each Issuer will have separate folders, within this there will be a Test and Prod folder ▪ Inbound - Used to drop the inbound files that need to be submitted to the Exchange (820 if Issuer receives payment directly) ▪ Ack - Trading partner should look for acknowledgements to the files submitted in this folder. 999 and custom error reports will be available for all the files submitted by the Trading Partner ▪ Outbound – outbound transactions generated by the Exchange will be available in this folder (834 and 820 files) ▪ Error – Any inbound file that is not ASC X12 compliant or is not recognized by the Exchange will be moved to this folder 6

Folder Structure 7 CarrierTestInboundAckOutboundErrorProdInboundAckOutboundError

General SHOP 834 Guidelines ▪ The files are named such that the Individual Market and the SHOP Market are separate files and thus don’t need separate folders. ▪..... ▪ Example of file name: I M.O ▪ When acknowledgements are produced, append an “A” on the end of the file so we know which file was acknowledged ▪ It has been suggested that if we do not have data that we produce an empty file so Issuers know our process ran 8

General SHOP 834 Guidelines ▪ Enrollment is sent at QHP/Plan level ▪ Within each enrollment, we send employer, employee, dependent information ▪ ISA ▪ GS for QHP ▪ ST for each enrollment ▪ 1000A – Sponsor Name (Employer Name) ▪ 1000B – Payer (Issuer Name) ▪ 2000 – Member Level Detail (For each employee and dependents) ▪ 2100A – Member Name ▪ 2100C – Member Mailing Address ▪ 2100D – Member Employer ▪ 2300 – Health Coverage ▪ 2700/2750 – Reporting Categories ▪ SE ▪ GE ▪ IEA 9

REMINDER: Carrier Workshops Washington Health Benefit Exchange will be hosting Individual Carrier Workshops. ▪ The purpose of these Workshops is to provide continued support of Exchange implementation for Carriers by providing a setting to discuss impacts and changes specific to each carrier. SCHEDULE: Workshops will be held every Monday from 12:00pm – 2:00pm WHERE: HBE Olympia- 521 Capitol Way S Olympia, WA or Webinar hosted. HOW TO SCHEDULE A WORKSHOP: Please Brad Finnegan at with a preferred date and a list of expected attendees. 10

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