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HealthSherpa provides tools to help agents & agencies proactively identify enrollments where agent of record (AOR) status may be at risk.

In this article we'll cover:

The agent of record (AOR) is the agent currently associated with a consumer’s Marketplace policy.

The AOR may change when a Marketplace enrollment is submitted or updated. If a different agent completes an enrollment submission or application update, that agent may become the AOR for the policy.

HealthSherpa receives AOR information from the Centers for Medicare & Medicaid Services (CMS) after syncing through Enhanced Direct Enrollment (EDE) data sync.

The Details tab is the default view when an agent opens a consumer record from the Clients page.

From the Plans section, agents can view the AOR associated with each policy.

If the consumer has multiple active policies, review the AOR listed for each policy. Select View Plan History to review how the AOR may have changed throughout the year.

From the Application section, agents who have been granted full book or shared book access by an agency administrator may also see an Original agent value.

The original agent is the agent who originally created the application or used search & claim functionality on an existing Marketplace application.

The original agent value may or may not match the AOR displayed.

HealthSherpa offers reporting tools to help agents & agencies proactively identify current plan year enrollments where AOR status may be at risk.

To view applications where AOR status may be at risk, agents can go to the AOR at risk tab within the Clients page.

The AOR at risk tab is sorted with the most recent entry first. HealthSherpa also displays alert indicators that provide counts of new records in this tab since the agent last visited the list.

Agents & agency administrators can also export AOR at risk clients.

HealthSherpa provides functionality to help agents identify consumers deemed high risk. Consumers identified as high risk may have had enrollments submitted by other agents within the current plan year.

When an agent uses search & claim functionality, HealthSherpa uses an algorithm to determine whether the consumer may have had an enrollment submitted by another agent. If the consumer is identified as high risk, HealthSherpa displays a banner.

Agents should confirm consent is documented before proceeding.

The agent of record (AOR) is the agent currently associated with a consumer's Marketplace policy. The AOR can change over the course of a plan year if a consumer's application is updated by a different agent.

The National Producer Number (NPN) is the unique identifier assigned to a licensed agent. Carriers and Marketplaces use the NPN to connect Marketplace activity back to the agent.

No. The high risk banner does not always mean a consumer has been fraudulently enrolled.

There are certain cases where it may be appropriate for a consumer to appear to be working with multiple agents, such as:

These cases are rare. Agents should check with the consumer directly to confirm why the consumer is being flagged.

A consumer may be identified as high risk when their information is associated with activity that suggests another agent may have submitted, updated, or attempted to submit an enrollment for the same consumer.

This can happen when lead vendors obtain consumer information through online forms, web scraping, data harvesting, social media solicitations, or advertisements that offer monetary rewards for providing consent. These forms of consent are generally not considered sufficient for enrolling a consumer in health coverage. Some lead vendors may also resell the same consumer’s information to multiple agents or agencies.

Agents should be diligent about lead sources, speak with the consumer directly if they believe the consumer’s information may have ended up on a lead list, and personally confirm and document consent before submitting an enrollment or making an application change. HealthSherpa offers active consent tools to help agents document consent and confirm the consumer has reviewed and verified the accuracy of their application information.

The agent should first contact the consumer to confirm the consumer wants the agent to assist with their application.

If the banner is related to unexpected duplicate applications, the agent should help the consumer contact the Marketplace to cancel or terminate the duplicate coverage. The Marketplace Support team may be able to retroactively terminate duplicate coverage and help minimize repercussions to the consumer.

If the duplicate applications are expected, such as due to a dependent aging out, a move, or another legitimate reason, no action is needed.

HealthSherpa can take action within HealthSherpa when fraudulent activity is identified, but this may not prevent an agent from accessing the application through the Marketplace or another Enhanced Direct Enrollment (EDE) partner.

Agents should report suspected fraudulent activity. To prevent continued unauthorized access or application changes, action may be required at the Marketplace level. The Centers for Medicare & Medicaid Services (CMS) manages access for the Federally Facilitated Marketplace (FFM).

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.