Assumptions and Constraints

  1. OIPA will only receive consolidated family neutral records. The insurance carrier's file receiving system will be responsible for combining multiple data subset files together when applicable to create consolidated family neutral records before passing to the OIPA system.
  2. TPA/Multi-Customer files will be separated into Group Customer based files by the insurance carrier's file receiving system before passing to OIPA. Each Data Intake "File" that is sent to OIPA will consist of family neutral records which pertain to a single Group Customer.
  3. Integration will send a request to process a file, regardless of how the file is loaded into the OIPA system. OIPA will not provide a background service that monitors the database or other mechanism that checks for the arrival of new files/records to process.
  4. When the insurance carrier's file receiving system loads a file and sends a request to process to OIPA, the file is ready to be processed in the system. The File will have already gone through appropriate generic and global level validations to certify that the file is suitable for pre-processing by OIPA.
  5. The insurance carrier's file receiving system will identify individual neutral family records with errors when passed as part of a Group Customer Data Intake file which passed the applicable generic and global level validations in the aggregate.
  6. Integration between the insurance carrier's file receiving system and OIPA will be accomplished through a messaging interface. Since OIPA does not provide a native message interface, an OIPA bridge will be created by the consulting team that will receive messages from the insurance carrier's file receiving system and translate those messages onto the appropriate API calls in OIPA.

Exclusions

  1. OIPA will not receive records for files that failed completely in the aggregate in the insurance carrier's file receiving system.
  2. Determination of plan eligible class membership in conjunction with Data Intake file processing is limited to associate/employee/sponsor ("primary member") directly affiliated to Group Customer; dependent eligibility for enrollment under available benefit plans/coverages will be handled within OIPA at the Policy level based on applicable Plan/Coverage rules.
  3. This document only covers data received from automated data intake. It does not cover other methods of receiving data – these will be entered using the Enrollment screen.

 

 

 

 

 

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