Data Intake File Types

How it Works

The Data Intake file will contain an identifier for the Group Customer to easily identify the employee and related dependents for the Group Customer. The IDs are used to identify the file type from the Group Customer Data Intake Preferences (typically identified on the Group Customer Screen) and the identification of the file type being received.

OIPA Data Functions:

Types of Files

There are many different types of files incoming for the Group Customer. Each file may additionally have different record types.

The typical types of files received are:

Participation: This file contains only eligible members who have elected to participate in coverage. The Participation file contains records for both the participant and their coverage Enrollment. OIPA will simply assign the employee to a Class and enroll them in coverage without validation of eligibility. Eligibility is handled via a different type of file. For the Participation file, the following data is stored/processed:

Note: When receiving a Participation file, OIPA does not have to run plan eligibility determination for the members in the file.

 

Eligibility:This file contains only members from the Group Customer who qualify or are eligible. There are subcategories associated with this file type. For both subcategories/sub-types of files, OIPA will need to calculate the class based on the information provided. The end result being the placement of the employees into the their respective plan eligibility class. The subcategories or sub-types of files for Eligibility are:

Population: This file contains all or a subset of the employees for a Group Customer regardless of whether they are eligible or not. No eligibility determination is being made at this point by the Group Customer. This file can be considered Universal. OIPA will need to calculate eligibility as this file only places the employee in the class for the system. A new employee sited on the Population file may:

There are two different types of records that can be received on any of the above listed file types:

Changes Only: This record type contains data changes as they pertain to information that currently exists in OIPA. OIPA will not need to calculate the changes for the Family Record as the Group Customer is sending the changes only (the ending record result is the change). For example, a completely populated or complete Family Record for a brand new employee or a partially populated Family Record representing the updated information for an existing employee or participant.

Full Record: This record will contain fully populated Family Records only. OIPA must calculate changes for each Family Record in the file received. Upon validation against the database for the existence of the record, the result could be the following:

File Type Processes

The following table outlines the different file type combinations and expected processes that will occur with OIPA.

File Type Record Type Processing in OIPA
Participation Changes Only
  • Store Employee/Dependent information
  • Store Class(es)
  • Enroll in Coverage(s)
  • Update Coverage(s)
Participation Full Record
  • Calculate changes
  • Store Employee/Dependent information
  • Store Class(es)

If currently NOT enrolled:

  • Enroll in Coverage(s)
  • Update Coverage(s)
  • Cancel if record missing from file

If current enrolled:

  • Update Employee/Dependent information
  • Update Class(es)
  • Update Coverage(s)
Eligibility Changes Only
  • Calculate Eligibility in OIPA
  • Validate Eligibility changes
  • Store Employee/Dependent information
  • Store Class(es)
Eligibility Full Record
  • Calculate Changes in OIPA
  • Calculate Eligibility
  • Validate Eligibility changes
  • Store Employee/Dependent information
  • Store Class(es)
  • Cancel if record missing from file
Population Changes Only
  • Calculate Eligibility

If Eligible:

  • Validate Eligibility Changes in OIPA
  • Store Employee/Dependent information
  • Store Class(es)
Population Full Record
  • Calculate Changes in OIPA
  • Calculate Eligibility

If Eligible:

  • Validate Eligibility Changes
  • Store Employee information
  • Store Class(es)
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