It seems like I can’t open my email without seeing something about the Affordable Care Act and how it’s going to affect checking patient eligibility. We really hoped that the larger payers that were going to participate as healthcare exchange plans would be on top of things but that hasn’t been the reality.
What we’ve seen so far :
1. Some health plans did not have ACA members loaded as timely as we had hoped. Some are loading the bare minimum with the intentions of loading benefits later.
2. ACA members aren’t being clearly identified in the EDI eligibility responses by some insurance companies.
3. We still aren’t getting a clear picture of how the 90 day grace period is going to be represented in eligibility responses. A couple of payers have implemented very clear messages indicating that the person is within their 90 period but most have not.
The good news is that most payers are still making changes to accomodate the ACA membershship and we expect to see some improvements in February and March. I’ve already seen notifications from at least two large plans that they will be making changes in February to help clarify where the member is in relation to their grace period. I’ll post these changes as I get them.