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:
- Each contains key values that need to be processed.
- The key values contained on each record can be details relevant to the member.
- Each record will have an identifier such as a Tax ID number or special / unique ID assigned to them as an employee identifier.
- The key values contained on each record can be details relevant to the member.
- An expected number of records will be provided for each file that defines the number of / quantity of records expected to be on the actual file received.
- Once the last record on the file is delivered, the calling system will indicate the entire file is ready.
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:
- Member information stored (client / address)
- Employment information stored (salary, placement/position in the company)
- Employee's dependents stored (client/address)
- Employee and dependents are enrolled in selected coverage(s) (policy, segments)
- Employee's placement in the applicable Class (legacy structure, billing, etc...)
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:
- Eligibility with the Class specified. The Group Customer is informing the Carrier what class the employee is eligible for and the file will contain both employee information and the intended eligibility class.
- Eligibility without Class specified. For this purpose, the file only contains the employee information for which class determination will be based.
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:
- Member information may be stored (client/address)
- Employment information may be stored (salary, grade/position)
- Employee placement into a class (union, non-union, management, non-management)
There are two different types of records that can be received on any of the above listed file types:
- Changes only
- Full Record
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:
- A new record for the employee must be added to OIPA
- An employee record exists, but the record must be updated
- An employee records exists in OIPA but not on the file received and therefore, should be removed (canceled) from OIPA (subject to Group Customer preferences).
File Type Processes
The following table outlines the different file type combinations and expected processes that will occur with OIPA.
- Employee information includes client data, address information, relationship (to the Group Customer), and dependent changes/updates/additions including client and address information.
- Eligibility can result in additions to the Class Membership.
- Participation can include updates/additions to coverage or specifically, Segments.
File Type | Record Type | Processing in OIPA |
---|---|---|
Participation | Changes Only |
|
Participation | Full Record |
If currently NOT enrolled:
If current enrolled:
|
Eligibility | Changes Only |
|
Eligibility | Full Record |
|
Population | Changes Only |
If Eligible:
|
Population | Full Record |
If Eligible:
|