Media Blog

CMS Kinda, Sorta Admits It’s Having Back-End Problems

Sarah Kliff over at the Washington Post’s “Wonkblog” has been doing a good job reporting on the back-end problems of One main — and outstanding — issue is regarding the “834″ reports. These are automatic reports generated by and sent to insurance companies that tells insurers who signed up and for what. The reports have been riddled with errors, meaning people who think they have insurance do not. That’s a problem.

Although CMS acknowledges this problem with the reporters, they won’t give a straight answer on how many people who signed up are affected. And reporters have asked over and over again for the details, to no avail. Here’s what Kliff posted on Tuesday:

Still no 834 error rate. This was a question that came up a few times Monday, and again today when CNBC’s Dan Magnan brought it up.

“We know there are different types of errors,” Bataille said. “We have information on the specific bugs. The statistic I don’t have [is] in terms of overall error rate. We’re making a lot of progress to punch out the issues we have diagnosed working with issuers.”

When asked about the Washington Post’s report this morning that approximately one-third of the 834s sent so far had errors, Bataille replied, “I can tell you that does not reflect an accurate picture of what is happening right now…we’ve made tremendous progress and will certainly work to fix any standing issues.”

Bataille said that her agency is looking at both the issues with 834s that have occurred in the past, and also those that are happening now, to get a sense of whether the fixes they are implementing are working. CMS has a “team of experts working with issuers and working with officials from CMS so we are having regular daily conversations in order to identify any additional issues in the system, make sure those issues we’ve made improvements to are working,” she said.

Last night, CMS sent out this release to the media, hoping to show everyone that they’re, at the very least, working on the problem. The release, however, gives no details, nor any sense of confidence that CMS knows what’s going on:

Joint Statement from CMS, AHIP & BCBSA

WASHINGTON – The Centers for Medicare & Medicaid Services (CMS), America’s Health Insurance Plans (AHIP), and the Blue Cross Blue Shield Association (BCBSA) issued the following joint statement today: 

“Ensuring that all Americans who need coverage are properly enrolled is a top priority for all of us. We are working together closely to resolve back-end issues between health plans and This is a very focused effort that is being driven by a team of experts from CMS, key outside contractors working closely with health plan representatives and overseen by CMS’s general contractor, Optum/QSSI. We will report on our progress.”

But it get worse. Kliff posted yesterday on similar back-end problems with those who have signed up for Medicaid. An excerpt:

Every week, usually on Tuesday, the Centers for Medicare & Medicaid Services sends state Medicaid departments something called a “flat file.”

These files are sort of similar to the much-discussed 834 transmissions, which the exchange sends to an insurance plan when someone signs up. Except the flat files are for the Medicaid program, and lists people that the exchange thinks — but hasn’t officially determined — will be eligible for the Medicaid program.

And, much like those 834 transmissions, Medicaid officials say, these flat files are riddled with errors and incomplete information.

“They are really incomplete with lots of data cells missing,” said Matt Salo, who runs the National Association of Medicaid Directors. “Sometimes the immigration status is missing, or their town is in a different state. A quick glance sometimes shows they’re not Medicaid eligible because they earn too much, or they’re already in the system.”

The flat file was not initially meant to be an enrollment document. It was meant, instead, to give states a sense of enrollment volume, so they could beef up their staffing, if necessary. A separate account transfer function was supposed to be the actual enrollment vehicle.

Medicaid expansion is the part of Obamacare that the left likes to say is working the best. Maybe not. 



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