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.
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.
For Plan Year 2026 coverage and beyond, 820 files for APTC payments will only be sent to issuers from CMS following the standard monthly.
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.
BeWell will continue to report state subsidies monthly. We are evaluating whether the format — i.e., an 820 — will change. We will provide additional information to the carriers for consideration and feedback.
Yes, it will change to the GetInsured layout. The final date is TBD.
GetInsured does not have a gifted member indicator. These members will be sent to the carrier as a passive renewal. We will notify you if you are receiving passive renewals from another carrier.
We will not be providing a document showing RCNI changes. We provided the sample RCNI file on 2/10 via email.
The Sender ID will be NM0 (NM+ numerical zero).
The dependent relationship code will be what the enrollee selects on the application. It can be Ward if they select that, but it will not always be Ward.
Yes, carriers should use the 348 date as the policy’s effective date.
Yes, the DTP349 will only be sent on term/cancel transactions, as well as any change transactions generated after a future dated term is processed.
Yes, plan changes will be sent as a term/add pair. The INS03 will be 021 for the add. The INS04 will be dependent on the event that generated the plan change.
Coverage effective date changes are generated by the Admin. BeWell provided carriers with an EDI Processing Guide that provided carriers with options for how to receive an effective date change file. Carriers can either receive (1) Change file (001) with new effective date or (2) Cancel/Add pair with new effective. Carriers should use the 348 date to determine the policy’s effective. The INS04 value may vary on the change file.
