Carriers Q&A - EDI - BeWell Carriers

With regards to recon the current process with NFP is a daily recon process and GetInsured utilizes and RCNI like approach is there an expectation we would have to have a dual process sending daily reconciliation files to NFP and monthly RCNI to GetInsured?

Issuers will begin sending monthly RCNI files for PY 2026 to GetInsured in December of 2025. Issuers will maintain the current recon process with NFP through Q1 2026.

With the premium billing move back to the carriers, what would the process be in members are sending payments to the state for PY26 instead of the carriers?

The specifics are being determined and details will be provided in early 2025. BeWell will submit the payment to the carrier.

Will BeWellNM provide advance notice to carriers of communications to members, copy of letters that members will receive etc? I think its important to that we have awareness around the timing of these communications and copies of what is being sent so our call teams are aware.

There is a full communication plan for this project that includes regular communications to all stakeholders, including issuers, which we will be sharing soon. The plan includes communications to members with advanced notice to carriers.

Will the user fee process change or the current process managed by OSI still stay in place?

BeWell issues a broader market assessment rather than a user fee. We don’t anticipate a change in this process due to the transition.

Will all members that are migrated going to be effectuated in the GetInsured system or are effectuation files required?

All members who are auto-renewed will be auto-effectuated during the auto-renewal process. Issuers are not required to send effectuation files for auto-renewals.

If a member is renewed into a different issuer’s plan, binder payment would be required and issuers would be required to send an effectuation for these enrollments.

Would the exchange assigned ID change with migration to GetInsured similar to what we see with FFM to SBE migrations?

Yes, the Exchange Assigned Member ID will be changed to new values similar to the process with FFM to SBE migrations. BeWell and GetInsured will provide a mapping file that has the consumer’s existing Exchange-Assigned Member ID and new Exchange-Assigned Member ID post-transition.

This ID change is only for Exchange-Assigned Member IDs; the Issuer-Assigned Member IDs do not need to change.

What is the impact to the 820 file process with this migration? While it’s obvious that we would receive the premium payment since that would move to paying the carriers directly but that is only 1 of the many we receive. What about format, timing, naming conventions, companion guide etc.

For Plan Year 2026 coverage and beyond, 820 files for APTC payments will only be sent to issuers from CMS following the standard monthly.

What about the 820 files that NFP would send for state subsidy payments? Who would be sending those in future state?

BeWell, Health Care Authority and GetInsured are reviewing the current process for the state subsidies. We expect changes and will provide more information as those changes are finalized.

If members are in grace period during renewal time with the states current premium process will those members be passively renewed? If the members are passively renewed how will non payment terminations work if they term for non payment of 2025 premiums?

Yes, members who are actively enrolled at the time of renewal will continue to be renewed, even if they have outstanding payments due and/or are in a grace period. If members are passively renewed, and subsequently termed for non payment, you will receive a non payment term for the applicable month in PY2025. You will not receive a cancel transaction for the PY2026 passive renewal.

Are we expected to see retro enrollment in 2026 for 2025? If so, who would be handling retro enrollment?

There will be two urls/portals until the full data migration date (est to be March 2026). Until that date, all PY2025 transactions will be handled in the current Optum platform. Following that date, the GetInsured platform would be the single system for prior year (2025) and current year (2026) transactions. All 2026 application and enrollment transactions will be in the GetInsured platform, beginning with renewals for PY2026 (October 2025).

Since Getinsured will be operating for plan year 2026, they will likely have their own portal that is built and running for members to go to. How will it work for existing members to make changes and or enroll for PY25 (for whatever reason). Will there be two url's/portals?

There will be two urls/portals until the full data migration date (est to be March 2026). Until that date, all PY2025 transactions will handled in the current Optum platform. Following that date, the GetInsured platform would be the single system for prior year (2025) and current year (2026) transactions. All 2026 application and enrollment transactions will be in the GetInsured platform, beginning with renewals for PY2026 (October 2025).

Carriers Q&A – EDI

Category

Evolve 2026

Resources

Helpful Links