After you complete a client’s application, you may receive a Data Matching Issue (DMI) notification for the client. Consumers often need to upload documents to resolve a DMI.
This article will cover everything you need to know about DMIs, including:
What are Data Matching Issues (DMIs)
A Data Matching Issue (DMI) means that the information entered on a consumer's subsidy application doesn't match what is on file with the government (or may not be available within their records) and therefore needs to be verified.
A DMI occurs in the following 3 situations:
Incorrect or missing information on the client’s application
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.
When a DMI is not resolved your client may lose their subsidy or eligibility for health coverage. Clients have 90-95 days to resolve a DMI based on the date their application was submitted (not the effective date). Consumers typically need to upload documents to resolve DMIs.
The full list of possible DMIs is available here. DMIs can happen on HealthCare.gov, HealthSherpa, and anywhere else you may complete Marketplace enrollments.
Locating DMIs within your book of business
After enrolling your client in a plan, you will see a confirmation page with a summary of your client’s next steps, including any follow-up tasks needed to satisfy DMIs.
This information will automatically populate into your Clients dashboard so you can easily upload and track follow-up documents for your client from your dashboard. Learn more about viewing DMIs here.
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, correct and resubmit the application to see if the DMI automatically resolves.
If there were no mistakes or the resubmission doesn't resolve the DMI, you will need to upload documents to resolve the DMI.
Agents and clients have the ability to upload documents directly through HealthSherpa. Learn more about uploading follow-up documents here.
Required documentation
Consumers often need to upload documents to resolve Data Matching Issues (DMIs) and SEP Verification Issues (SVIs). Getting documents uploaded on time ensures your client keeps their subsidy and/or coverage.
The list of acceptable documents to select from varies based on the type follow-up item you are resolving:
As a reminder, each verify page within HealthSherpa contains the embedded list of acceptable documents you may choose from to satisfy the specific follow-up item selected. Learn more about uploading follow-up documents here.
How to avoid DMIs
When completing an application, keep the following in mind:
Complete all possible fields in the application
The Federally Facilitated Marketplace (FFM) will only accept applications submitted by agents that include verifiable SSNs for all applicants over 90 days old. Agents assisting non-U.S. citizens who do not have an SSN but do have qualifying immigration status will be able to enter immigration document details instead. This applies to agent assisted applications submitted on all enrollment platforms. Learn more here
Consumers who do not wish to provide their SSN or immigration documentation at the time of application can submit their own application or agents can continue assisting these consumers with their enrollment by calling the Marketplace Call Center.
Ensure the client’s name exactly matches their documents
Include an SSN and appropriate immigration documentation for non-applicants in the household as often as possible
Include non-applicants income on the application; reported income should reflect the entire household's income
Double check that the information on the application is complete and there are no errors or typos
After assisting a client with their application, 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 may wish to go ahead and set expectations with your consumer to ensure they have ample time to satisfy the DMI (i.e. documentation will be required).
Frequently asked questions
What is an SVI?
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.
When an SVI is not resolved your client may lose their SEP eligibility. Clients 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. Additionally, consumers cannot make a binder payment or use their new or updated coverage until all SVIs have been satisfied.
Consumers often need to upload documents to resolve DMIs & SVIs. Getting follow-up documents uploaded on time ensures your client keeps their subsidy and/or coverage.
Additional Resources
If you are having any technical issues using HealthSherpa, please contact our Agent Support team at (888) 684-1373, at agent_support@healthsherpa.com, or via chat from within your account.