Carriers Q&A

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.

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.

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).

Based on the Evolve-2026-Carrier-Onboarding-Kickoff document mentions that dedicated agents in the CEC will provide health plan support, wanted to clarify do these dedicated agents have to be located within New Mexico?

To clarify, the CEC staff will connect members to health plans for questions about their coverage (claims, cost sharing specifics, etc.). CEC primarily will support application and enrollment questions.

The CEC will be staffed with agents that are trained to support carriers specifically (i.e. inquiries from carriers). BeWell and GI are committed to hiring New Mexico agents whenever possible, but some agents may be located outside of New Mexico.

Can Carriers make updates to member's mailing address, email address, or phone numbers? Will NM SBE take these updates from the Carriers?

Demographic changes must be made in the BeWell system, and the carriers should refer those changes/members to BeWell for updates.

Will enrollment policy ID starting 2026 be the same as the policy ID that will be on the PBP?

Carriers will receive a new Policy ID for the Plan Year 2026 enrollment; this will be a different Policy ID than the 2025 enrollment. When the first PBP is generated in for Plan Year 2026, the PBP will have the Policy ID that corresponds to the Plan Year 2026 enrollment. However, this will not be the same Policy ID that is on the current PBP as the current PBP is for Plan Year 2025.

What is the grace period for binder payment and subsequent payments? Also, what past due notifications are currently sent?

We do not have a grace period for binder payment. Subsequent payments are standard CMS grace periods of 30 days without APTC or 90 days with APTC. Check the carrier resource for samples of current notifications.

Will there be any new letters, or changes to existing letter templates? Also, which letters will be handled through the exchange, and which are expected to come from Issuers starting PY2026?

Other than the transition of the premium billing functionality, there will not be any change in the management of notifications (exchange v carrier). We have posted samples of the current premium billing notices on the carrier resource page.

Medicaid Transition Subsidy - NM HIX is not deducting the subsidy from the total responsibility amount on the 834. Should we expect the 820 D along with the enrollment to auto effectuate the case?

There will be an indicator on the 834 that lets the carrier know there is MTPR eligibility and that the enrollment should be auto effectuated. Separate reporting will replace the 820D.

As there will not be a grace period for binder payment, does this mean that if payment is not received before the effective date, that the policy will be cancelled for non-pay, or would issuers follow FFM rules?

For FFM, if there is a retro add transaction, the binder payment expected is up to the current month.
Example: Current date is 2/1/2026 and a new enrollment comes in with a retro effective date 1/1/2026 , binder payment collected for FFM = January+February payment.
Is this expected, or would Jan Payment satisfy binder for effectuation?

BeWell currently requires binder payment by the due date, which is the last day of the month before the coverage effective date, or at least seven days from the date enrollment ia submitted. For example, enrollment submitted on the 31st, binder payment would be accepted through the 7th of the next month. While grace periods are not allowed for binder payments, we recognize binder payment due dates may vary, and we are open to the FFM approach.

For the retro add transaction, Payment would be required for both the retroactive and current months. However, if a member enrolls for the current or future month, submits payment for that month, and subsequently adjusts the effective date to a prior month, they will be considered late since they were effectuated and would not be canceled. A grace period would then be triggered.

When will BeWell and GetInsured provide the mapping file that has the consumer’s *existing* Exchange-Assigned Member ID and *new* Exchange-Assigned Member ID, post-transition?

The mapping document will be provided after we complete our first data migration. The timing is not final but will be provided as soon as it is ready.

If there is another policy ID effective after a termination date, and the case was reinstated, how would we put the subsequent policy ID back on the case?

The new policy ID would need to be cancelled and the old policy ID reinstated. This would be taken care of via ticketing since Carriers are unable to send terminations or cancellations unless they are for non payment.

Will the SOPA template continue to be used? If it will not be used, how will issuers provide the plan data for the SOPA CSRs? In preparation for the May testing, will issuers need to create a different document in order to validate the SOPA CSRs?

There will be a new SOPA template that we anticipate will be very similar. More details will be shared very soon.

If we receive a retro transaction, and the first month is 100% covered by MTPR, does the next month need to be paid as well for effectuation?

No, carriers should auto effectuate any enrollment received with MTPR flagged.

If a case does not have APTC subsidy, but has State Subsidy, what should their grace period be? 30 - 90 days, and what would the effective termination date be?

90 days

For NON-APTC cases what would be the grace period timeline. 30 or 31 days?

30 days/End of month

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Evolve 2026

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