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Consumers often need to upload documents to verify Special Enrollment Period (SEP) eligibility and resolve any Data Matching Issues (DMIs) that arise.
In this article we’ll cover:
Documentation requests
Data Matching Issues (DMIs) and Special Enrollment Period (SEP) Verification Issues (SVIs) are Marketplace follow-uprequests that can occur when a Marketplace enrollment is submitted. DMIs and SVIs can occur on any platform where a Marketplace enrollment is submitted.
Off-exchange plans may require eligibility checks and supporting documentation at the time of enrollment. When required, additional follow-up requests will be communicated by the carrier.
When required, resolving documentation requests on time helps consumers maintain eligibility and ensures coverage can take effect.
Data Matching Issues (DMIs)
A Data Matching Issue (DMI) means the information entered on a consumer’s subsidy application does not match what is on file with the government, or is not available within their records, and needs to be verified.
A DMI can occur when:
Information is incorrect or missing on the consumer’s application
The Marketplace application is inconsistent with data from trusted sources, such as Internal Revenue Service (IRS) databases
Trusted sources do not have data for the consumer
DMIs can occur during the Open Enrollment Period (OEP) and when consumers seek a Special Enrollment Period (SEP).
Deadlines
Consumers have 90 to 95 days to resolve a DMI based on the date the application was submitted, not the effective date. Consumers typically need to upload documents to resolve DMIs.
Consequences
If a DMI is not resolved, the consumer may lose their subsidy eligibility or eligibility for coverage.
SEP Verification Issues (SVIs)
A Special Enrollment Period (SEP) Verification Issue (SVI) occurs when a consumer is eligible for an SEP and is asked to verify they experienced the qualifying life event (QLE).
SVIs can occur when consumers seek SEPs.
Deadlines
Consumers have 30 days to resolve an SVI based on the date they select a plan, not the effective date. Consumers typically need to upload documents to resolve SVIs. Consumers cannot make a binder payment or use new or updated coverage until all SVIs have been satisfied.
Consequences
If an SVI is not resolved, the consumer may lose SEP eligibility.
Viewing follow-up documentation requests
Agents can view documentation request statuses in several places.
Clients page
Clients page
Agents can get an initial view of Marketplace follow-up requests from the Clients page. Use the Documents filter and Documents column to view consumers with follow-up requests.
Consumer record
Consumer record
Select the consumer’s name on the Clients page to open their consumer record. The Details tab is the default view when an agent opens a consumer record from the Clients page.
From the Follow-ups section, agents can view all unique follow-up requests.
Follow-up documentation statuses
There are several statuses an agent might see for each follow-up:
Action needed: A follow-up document needs to be uploaded
Insufficient documentation: An uploaded document was determined by HealthCare.gov to be insufficient. View the consumer’s Marketplace Notices to find out exactly why this decision was made
Processing: An uploaded document is awaiting review by HealthCare.gov
Closed: Centers for Medicare & Medicaid Services (CMS) has indicated that documents are no longer required
Expired: The deadline to get documents approved has passed
Completed: Necessary documents have been approved
Not required: The consumer did not need to provide any follow-up documentation, no action is required. This status will display in the document status column only. It does not appear within the documents filter.
Acceptable documentation
The list of acceptable documents varies based on the specific follow-up item being resolved. A DMI follow-up asks the consumer to verify a specific piece of information. An SVI follow-up asks the consumer to provide proof that their qualifying life event occurred.
The lists of acceptable documents are available here:
Review the list to see what is acceptable, then select the appropriate documentation to upload. Each Verify page within HealthSherpa also shows the acceptable documents for the selected follow-up item.
Uploading follow-up documents
Agents can upload follow-up documents on behalf of consumers, or prompt consumers to upload their own follow-up documents.
Uploading documents on behalf of consumers
Uploading documents on behalf of consumers
The Details tab is the default view when an agent opens a consumer record from the Clients page.
From the Follow-ups section, agents can view all unique follow-up requests, who they are required for, and the deadline to complete each required item.
Select Verify next to the desired follow-up item to proceed with document upload. Verify may update to View or Re-verify after documentation is submitted.
On the Verify page, review the list of acceptable documents for that follow-up item. Required documents vary based on the type of DMI or SVI.
Select documents from the device to upload, or choose documents already saved on HealthSherpa, then submit.
In some cases, multiple documents are needed to resolve a single DMI or SVI. Agents can repeat this process as needed.
A success indicator displays when files have been successfully submitted to CMS for review.
Prompting consumers to upload their own follow-up documents
Prompting consumers to upload their own follow-up documents
For documents with a status of Action needed or Insufficient documentation, agents can manually prompt consumers to submit follow-up documents by sending a unique Documents due link. The link can be sent from the Clients page or the consumer record.
Clients page
Clients page
To send a unique Documents due link from the Clients page, find the consumer’s name. In the Actions column, select the View dropdown menu, then choose Collect documents.
Consumer record
Consumer record
Select the consumer’s name from the Clients page to open their consumer record. The Details tab is the default view when an agent opens a consumer record from the Clients page.
From the Follow-ups section, agents can send a unique Documents due link by selecting Collect documents.
No matter where the unique Documents due link is generated, a pop-up window opens with a preview of the email.
From the Preview email pop-up, manually type the consumer’s email address to send the email directly from HealthSherpa, or select the Copy the link tab to share it another way.
Consumer experience when a Documents due link is shared
Consumer experience when a Documents due link is shared
When the unique upload link is shared (either sent from HealthSherpa or copied and shared another way), the consumer receives a follow-up document reminder email.
Collecting documents early
Collecting documents early
Agents can request documents from consumers before DMIs and SVIs are generated.
To prompt a consumer to upload documents early, send a unique intake form.
Consumers can view and upload their own follow-up documents using their HealthSherpa Consumer Dashboard.
Viewing upload and submission history
Documents uploaded or submitted by consumers and agents can be accessed at any time from the Verify page for each follow-up.
Follow-up document upload notifications
HealthSherpa sends an email from no_reply@healthsherpa.com notifying agents when documents are submitted by a consumer.
Frequently asked questions
How can agents reduce the risk of Data Matching Issues (DMIs)?
Agents can reduce the risk of DMIs by entering complete, accurate information and reviewing the eligibility determination notice after the application is submitted.
When completing an application:
Complete as many application fields as possible.
Enter the consumer’s name exactly as it appears on official documents.
Include an SSN or immigration document details for non-applicants in the household when possible.
Include non-applicants’ income on the application when possible. Reported income should reflect the household’s total income.
Double check the application for missing information, typos, and other errors.
What happens if an agent tries to send a unique upload link via email directly from HealthSherpa, but the consumer does not have an email address associated with their application?
The agent can select the send email option, but an error message displays and the email will not send.
The agent can copy the link to share it another way, or go to the consumer record and manually type the consumer’s email address from the Preview email pathway.
What does it look like when the upload link is successfully sent or copied?
When the link is successfully sent or copied, success alerts such as these display:
Can consumers upload documents using a mobile device?
Yes. Consumers can upload documents using a computer or a mobile device.
What happens if consumers miss the deadline to submit documents?
When a DMI is not resolved, consumers may lose subsidy eligibility or eligibility for coverage. When an SVI is not resolved, the consumer may lose SEP eligibility.
If consumers miss the deadline to submit documents, they should:
Call the Marketplace right away at 1-800-318-2596 to explain the situation and ask if the deadline can be extended. In some cases, the Marketplace can give extra time.
Gather documents required to satisfy the DMI or SVI.
Submit the documents as soon as possible.
Don’t wait until the last minute. Marketplace review can take 5 to 30 business days depending on the type of document. Uploading early helps avoid gaps in coverage.
If coverage was already canceled, the consumer will need to be SEP eligible in order to reapply.
Can agents customize the email signature within notifications consumers receive?
Agents are able to set up custom branding within the marketing link included with their HealthSherpa for Agents account. Any customizations made will apply to the email notification consumers receive.
Agency administrators can also control email customizations at the agency level.
Additional resources
For help using HealthSherpa or for other assistance, contact Agent Support. Agent Support is available by phone at (888) 684-1373, by email at Agent_Support@HealthSherpa.com, or by chat directly from your account.
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