After you complete a client’s application, you may receive a Data Matching Issue (DMI) notification for the client. This article will cover everything you need to know about DMIs, including:
What are DMIs
A 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.
These issues can happen on HealthCare.gov, HealthSherpa, and anywhere else you may complete Marketplace enrollments.
Why you need to resolve DMIs
Clients with a DMI will have 90-95 days to resolve it. If your client misses this deadline, they can lose their financial help (e.g. premium tax credits and cost-sharing reductions) and in some cases their Marketplace coverage.
Where you’ll see DMIs in your HealthSherpa account
Through the HealthSherpa Agent Account
After enrolling your client in a plan, you will see a confirmation page with a summary of your client’s next steps, including any DMIs.
This information will automatically populate in your Clients tab similar to the example below.
From this table, you can see which clients require follow-up documents. The table can be filtered to see a specific document status or sorted to see the closest deadlines.
To view a specific client’s document details, go to their Client Profile page (by clicking on their name or on the View button). Any follow-ups will be listed similar to the image below.
Through the Marketplace
After assisting a client with their application, you will need to read the eligibility determination notice from the Exchange to see if there is a DMI under the Next Steps section. If there is a DMI, you will see the statement ‘Important: You must submit documents’ similar to the image below:
Clients can also see whether they have a DMI by checking the Application Details sections of their Marketplace accounts for a list of all unresolved inconsistencies.
Through this route, agents will need to keep track of follow-ups and statuses on their own.
How to resolve DMIs
After an agent identifies that their client has a DMI, they should first review the application for any typos. If the agent does find mistakes, resubmit the application and see if the client still has a DMI.
If there were no mistakes or the resubmit didn’t solve the DMI, agents or their clients need to submit documents to resolve the DMI.
The documents required will depend on the type of DMI, and in some cases it may be necessary to submit multiple documents to resolve one DMI.
Common DMI types include the following:
Annual Income
Citizenship/Immigration
Non-Employer Sponsored Minimum Essential Coverage
Click here to see a full list of DMI types and acceptable documents. CMS also has templates clients can use for income DMIs and confirming the client is not incarcerated or does not have Medicare,TRICARE, or Peace Corps coverage.
Also, agents should be aware that Healthcare.gov’s eligibility support workers may call consumers who have not yet submitted documents in the weeks leading up to submission deadlines.
During these phone calls, consumers may be able to provide information to resolve open issues over the phone, particularly income issues. Agents should advise their clients that they should answer calls coming from HealthCare.gov to take advantage of this assistance. Calls coming from Healthcare.gov should be identified as such via caller ID, so consumers can feel confident these calls are legitimate.
Read the following sections for directions on how to send documents through the HealthSherpa agent account or straight to the Marketplace.
Through the HealthSherpa Agent Account
Agents and their clients can upload documents directly through HealthSherpa to resolve DMIs.
Through your HealthSherpa account, you can see the DMI verification documents needed for all your clients, view a list of acceptable documents, upload documents, and see whether documents have been approved. Find more directions on uploading follow-up documents here.
As an example, if you needed to verify income for a hypothetical client, you would see this in their Client Profile:
After clicking the ‘Verify’ button, you would be taken to a page where you can upload the appropriate documentation for the client.
This page also includes information about what documents satisfy the ‘Verify income’ requirement.
If you have follow-up document notification emails turned on in your agent account, you will receive an email when your client’s follow-up status changes. Agents will also see the status change in the ‘Documents’ column of their Client table (see list of all possible statuses).
Through the Marketplace
Agents will need to check the Eligibility Determination Notice to confirm what documents need to be submitted. You will need to cross-reference the DMI type with this help article to see a list of documents that will satisfy the specific DMI.
After determining the acceptable documents, you can assist your client in submitting the documents. Find specific directions on submitting documents to the Marketplace here.
If your client does submit documents directly through the Marketplace, here are some tips you should share:
Uploading documents online is the fastest and easiest option. If it’s successful, the client should see submitted under Application Details immediately.
When uploading documents, some acceptable documents may be missing from the Document Types drop-down menu. In this situation, clients should choose “Other” and proceed with the upload.
If a client chooses to mail in their documents, they should only send copies (not originals). They should also include the barcode from their Eligibility Notice and include their name, state, and application ID on any documentation they are submitting.
How to avoid DMIs
When completing an application on HealthSherpa, keep the following in mind:
Complete all possible fields in the application.
Ensure the client’s name exactly matches their documents.
Included an SSN for non-applicants in the household as often as possible.
Double check that the information on the application is complete and there are no errors or typos.
We strongly recommend that agents review the summary on HealthSherpa before submitting on HealthSherpa.
Recent changes to DMIs
For plan year 2022, there has been a change to the DMI threshold for annual household income:
Previously: A DMI is created if the applicant attests to a household income on their application that is lower than the information from a trusted data source by 25% or $6,000 (whichever is greater), or if no household income data is available from those sources.
Now: A DMI is created if the household income listed in the application is lower than the information from a trusted data source by 50% or $12,000 (whichever is greater). A DMI will still be generated if no data is available from trusted data sources.
This change only applies for applications on the Federally-facilitated Marketplace (FFM) and State-based Marketplaces on the Federal Platform (SBM-FPs). State-based Marketplaces (SBMs) may have different thresholds. Find more information from CMS here.
Summary
DMIs can happen wherever you complete Marketplace applications for your clients. As an agent, it’s important to help your clients resolve them when they arise, or else the client may lose their tax credits, cost-sharing reductions, and their coverage entirely.
HealthSherpa streamlines the DMI resolution process for agents. Instead of checking every eligibility notice and cross-referencing help articles, agents using HealthSherpa can quickly see which clients have DMIs, when they’re due, what they are, and see which documents satisfy that DMI all from one place.