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HealthSherpa offers tools that help agents track follow-ups & stay organized. Resolving follow-ups on time helps consumers maintain eligibility & ensures coverage can take effect.
In this article we’ll cover:
Follow-up management tools are not visible to HealthSherpa Enrollee Assistance Full-Service account types.
Viewing all client follow-ups
The Clients page shows consumers connected to the HealthSherpa account who have successfully submitted an enrollment. The Client follow-ups tab shows all follow-ups for those consumers in one central place.
Follow-ups are categorized by risk to help agents prioritize next steps.
Overview
Overview
Agents can only service an application and view the most up-to-date application information when they have an active Enhanced Direct Enrollment (EDE) sync to the application.
The Client follow-ups tab shows all follow-ups for all consumers in one central place.
Follow-ups are categorized by risk, helping agents prioritize which consumers to focus on first.
Callouts at the top of the tab show the number of consumers in each follow-up status. Select a callout to filter the list to only consumers with that status.
Use the dropdown filters and search bar to review specific data. The search bar supports searches by first or last name.
The list is sorted by follow-up status severity, then by the next deadline.
Columns & statuses
Columns & statuses
Client: The primary applicant’s name. At this time, the Client follow-ups tab does not include enrollments with multiple enrollment groups.
Follow-up status: The status of the consumer’s follow-ups for the selected plan year. Follow-up statuses include:
Coverage at risk: If the consumer takes no action, they may lose coverage for the upcoming plan year.
Subsidy at risk: If the consumer takes no action, they may lose all or part of their subsidy for the upcoming plan year.
Commission at risk: The Agent of Record (AOR) selected during enrollment submission may no longer be associated with the consumer's application.
Submission blocked: The consumer’s enrollment has not been submitted due to a CMS Invalid Action error. The consumer needs to take action to complete their submission.
Unknown: It remains unclear if the consumer may need to submit a payment.
Application missing: The application is not in the Client page for the plan year. Follow-ups and policy status may not be up to date until the application is searched & claimed.
Follow-ups: The specific follow-ups tied to the Follow-up status. Follow-up categories include:
AOR change
Documents due
Invalid Action
Marketplace notices
Payment due
Search & claim
Next deadline: The soonest deadline across the consumer's follow-ups.
Policy status: The consumer’s policy status as returned by the Centers for Medicare & Medicaid Services (CMS). HealthSherpa automatically hides applications that have canceled, terminated, or been archived. To view them, remove the automatic filters from the Policy status section.
Action: Options to view documents already uploaded, collect new documents, or hide or unhide the consumer from view.
Viewing follow-ups specific to document requests
Agents can view follow-ups specific to documentation requests from several places within the HealthSherpa account.
Email reminders & notifications
HealthSherpa sends reminders and notifications to agents and consumers from no_reply@healthsherpa.com to help manage follow-ups.
Follow-up document reminders
Follow-up document reminders
Sends consumers reminders before follow-up document deadlines when action is still needed.
The Follow-up document reminder email lists follow-up tasks currently in Action needed or Insufficient documentation status. The email generates 15, 5, and 1 days before a follow-up deadline when:
The application is active (not canceled or terminated), and
The consumer has 1 or more follow-up documents in one of these statuses: Action needed or Insufficient documentation.
Binder reminders
Binder reminders
Sends consumers reminders when a binder payment may be unpaid. An initial payment is the first premium payment a consumer makes to their carrier after an enrollment submission. It’s also called a binder payment or first month’s premium.
When available, the Binder reminder email includes the carrier's payment portal and contact information. The email generates 10, 5, and 1 days before an initial payment deadline.
Carriers may take a few days to update the Centers for Medicare & Medicaid Services (CMS) after receiving a payment. As a result, a binder reminder email may send even if the consumer has already paid.
Follow-up document status changes
Follow-up document status changes
Sends agents a daily summary of follow-up document status changes from the last 24 hours.
The email sends daily at 1:00 AM Eastern Time. If one consumer needs multiple documents, the table includes a separate row for each follow-up.
Disabling email notifications
Disabling email notifications
To disable specific follow-up notifications, go to the Gear icon in the top right corner of the HealthSherpa dashboard, then select Account settings.
Select the Emails tab within the Settings page, then clear the checkbox in the desired notification.
Frequently asked questions
What is an Enhanced Direct Enrollment (EDE) sync?
The Centers for Medicare & Medicaid Services (CMS) grants Enhanced Direct Enrollment (EDE) permission to agents for their enrollment submissions. This permission enables data syncs between the Marketplace and HealthSherpa.
When an application has an EDE data sync, the HealthSherpa dashboard shows the most up-to-date application information and the application can be serviced.
Can agents customize the email signature within notifications consumers receive?
Agents are able to set up custom branding within the marketing link included with their HealthSherpa for Agents account. Any customizations made will apply to the email notification consumers receive.
Agency administrators can also control email customizations at the agency level.
Additional resources
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.