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 (e.g. income discrepancies)
Trusted sources do not have data for the client (e.g. citizenship/immigration discrepancies)
DMIs can happen on HealthCare.gov, HealthSherpa, and anywhere else you may complete Marketplace enrollments.
Consumers typically need to upload documents to resolve DMIs. The full list of possible DMIs is available here.
Why it is important 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 altogether.
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 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.
You may also choose to leverage the Documents Due tab or simply select a consumer's name to go to their Client's details page to view follow-ups.
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.
Agents and their clients can upload documents directly through HealthSherpa to resolve DMIs.
Agent pathway
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 that needs to be satisfied, and in some cases it may be necessary to submit multiple documents to resolve a single DMI.
To simplify this, 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. Note: You may also check the Eligibility Determination Notice to confirm what documents need to be submitted.
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). Learn more about uploading documents here.
Consumer pathway
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.
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, keep the following in mind:
Complete all possible fields in the application
As of October 2024, CMS only accepts agent-driven applications if they include a 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
Included an SSN and immigration documentation for non-applicants in the household as often as possible
Include household income on the application for non-applicants
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.
