Consumers often need to upload documents to resolve Data Matching Issues (DMIs) and SEP Verification Issues (SVIs). Getting follow-up documents uploaded on time ensures your client keeps their subsidy and/or coverage.
You can upload and track follow-up documents for your client from your HealthSherpa for Agents dashboard.
In this article we will cover:
DMIs & SVIs
A Data Matching Issue (DMI) occurs in the following 3 situations:
Incorrect or missing information on the client’s application (e.g. SSN missing)
An inconsistency between the client’s Marketplace application and existing information from trusted sources, like IRS databases.
Trusted sources do not have data for the client.
Special Enrollment Periods (SEPs) are certain timeframes outside of the annual Open Enrollment Period (OEP) when a consumer can can enroll in ACA coverage or change ACA plans.
An SEP Verification Issue (SVI) occurs when a Consumer is eligible for an SEP due to a Qualifying Life Event (QLE), such as losing coverage, and is asked to verify they have experienced the QLE.
DMIs & SVIs can happen on HealthCare.gov, HealthSherpa, and anywhere else you may complete Marketplace enrollments.
Consumers typically need to upload documents to resolve DMIs and SVIs.
Viewing document statuses
You can get an initial view of document statuses by looking at your Clients List. You may also use the Documents filter to see all clients with a particular Document status.
You may also choose to leverage the Documents Due tab. Located on the Clients page, the Documents Due tab features a list of clients with DMIs and SVIs. Learn more about the documents due tab here.
Uploading follow-up documents
From your Clients page, select a consumers name to view their Clients details page. Here, you may access a full list of the consumer's follow-up items, who they're required for, and the deadline to complete each required follow-up item. Select the 'Verify' button to proceed with document upload. Note: the 'Verify' button may update to say 'View' once documentation has been submitted.
The documents required will vary depending on the type of DMI or SVI that needs to be satisfied, and in some cases it may be necessary to submit multiple documents to resolve a single DMI or SVI.
Each verify page contains a list of acceptable documents you may choose from to satisfy the specific follow-up item in question. Select the document type, find the file on your computer, and upload.
You may repeat this process as many times as needed (e.g. multiple documents need to be uploaded, documents need to be resubmitted, revised/additional documentation is required).
Viewing upload history
You may view follow-up upload history from the Verify page associated with each respective follow-up.
Document statuses
There are several statuses you 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 your client's Marketplace Notices to find out exactly why this decision was made
Processing: An uploaded document is awaiting review by HealthCare.gov
Closed: CMS has indicated that documents are no longer required
Expired: The deadline to get documents approved has passed
Completed: Necessary documents have been approved. Congratulations!
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.
Consumers can also upload their own documentation!
Your clients can log into their own HealthSherpa Consumer Dashboard to view their follow-ups and upload documents independently. Learn more about the Consumer Dashboard here.
Consumers also receive reminder emails from HealthSherpa prompting them easily upload follow-up documents. Learn more about follow-up document reminder emails here.