Open Enrollment - EDI File Rollover - Step by Step Guide

File Rollover Procedures

** It is a good practice to save after updating each tab of the export and exit the export and come back to ensure the changes were applied. This is particularly important on the Benefits and Formatting tabs.**

CREATING YOUR OE FILE

  1. From within the HRIS system Data > Exports > Manage, create new categories – click on Categories
    • OE Files, e.g., 2016 OE Files (follow naming convention of previous years if applicable)
    • Carrier Files, e.g, 2016 Carrier Files (follow naming convention of previous years if applicable)
  2. Select the current year file that is to be duplicated and click Duplicate Selected exports.
    • Copied export will have “-copy” appended to the current name.
    • Click on the newly copied export to make updates.

Properties Tab

  1. Update export Name to reflect new plan year (follow naming convention on current file).
  2. Assign to appropriate newly created OE Category.
  3. Confirm correct Carrier is assigned in the Carrier dropdown box.
  4. Update Output Filename if required by carrier. (would be in OE file email response from carrier).
    • If a test file is going to be sent, update to test file name if required by carrier.
    • If a test file will be sent, update (S)FTP if required by carrier.
      • May also need to update the User ID and Password for (S)FTP (if specified by carrier).
  5. Full file vs Change file. Most EDI files are full files and therefore most OE files are Full files. If a Change file is requested for the OE file, it is not as simple as selecting the Change File radio button. This is due to how the system populates the benefit change log when the benefits for the new year are created. Regardless of the election in the previous package all employees are placed into the benefit change log with the export reason on Coverage Initiated. If a change file is needed, please contact EDI for assistance.
  6. Confirm the checkbox: Include Terminated Dependents from Change Log (Export Reason = 'Coverage Terminated.') is NOT checked. **This applies to OE files ONLY**
    • This will cause dependents that were dropped by the employee during OE to be sent in the file as covered and will create issues with the file.
  7. Review email addresses in the Notification Addresses text box. An email will be sent indicating the export success or failure to these email addresses.
    • Update if necessary.
    • There should always be at least one email listed, the client admin, broker or Infinity AM are the best options.
  8. Update Effective Date to start of new package, e.g., 1/1/2017.
    • If the benefits in the file are off-cycle from the benefit package, this date should be the effective date at the benefit level.

Benefits Tab

  1. Select new package
  2. Keep current package selected (for now) (It helps if Group by Codes are used Step 13)
    • Current package will need to be included if file will send explicit terms (Steps 14-16)
  3. Check Group by Codes on current benefits – add to new benefits (easier when current package included)
    • Look for a benefit that is duplicated in the current package. This is done to have the file populate data correctly. For example, Life & AD&D – there one combined benefit in the system but the file needs to send separately with different group by codes, so they need to be duplicated in the export.
    • To duplicate a benefit:
      • First check to include it and Save.
      • Then click the link Duplicate in Export
    • Add Group by Code values to new package benefits based on current benefit values.
    • Make sure all benefits to be included are checked.
    • Click Save Benefits.
      • Now is a good place to exit the export and come back to make sure updates were saved.

STOP! If EXPLICIT TERMS are required for OE file then complete Steps 14, 15 &16 (If not - Skip to Final Checks to Confirm Prior to Sending (after Step 16)

  1. Confirm both benefit years (e.g. 2016, 2017) and the benefits (incl. Group by Codes) for both years are included so that the terms from the previous year can be included in the file.

Formatting tab

  1. Employee Record
    • Check Mapping on the Benefit – Expiration Date field
    • 834 files - Add the year of the new package and mapping:
      • Benefit – Expiration Date = Benefit – Package Expiration Date THEN Do not include field
    • Fixed Length or Delimited file – map to blank (select top option and leave text box blank).
    • Repeat for Dependent Record.

EDI_Rollover_-_00.png

  1. Run Utility – It is important that this utility be run AFTER the open enrollment window is closed and all employee elections have been completed. **Best practice is to run this utility just prior to sending the OE file, keeping in mind the utility does not run on demand, but as a system process. So allow for the time necessary for the utility to complete.** Peak times are November and December and extra time may be needed for the utility to complete.
    • Go to Settings >Benefits Management
    • Go to New Package
    • Go to Default Mapping – make sure it is set to rollover mapping used to create (rollover) the benefit records for this package.
      • Make sure Rollover mapping includes the benefits that need Explicit terms
        • Go to Rollover Mappings
        • ** use the Print link to view the Rollover Mapping**
      • SAVE Package Details if added Rollover Mapping
    • Go to Plan Utilities
    • Select “Add previous year’s terms to Benefit Change Log”
    • Enter new package start date as Effective Date
    • Save and Continue
    • Select new package and any benefit that needs to be sent as explicit terms – select the ones you need
    • System will run the utility as a system process
    • Check back to Step 3 tab for status
    • Once utility has completed review change log(s)
    • An explicit term will be in the change log with an end date of the new plan year start date
      • Explicit terms will be in the file with their actual start/end dates
      • You can go one step further and review file for Explicit terms
      • Look for the correct end dates for explicit terms
      • Also confirm that no other employees have an end date in the file

Final Checks to Confirm Prior to Sending:

Review the remaining schedule dates for the current production file. We want to avoid the following scenarios; (1) Sending the OE file while a current year file is processing (this can be done by confirming with carrier before sending the OE file), (2) and/or sending a current year file after the OE file has been sent (this is addressed by deleting remaining schedule dates for the current file after the OE file has been sent).

Properties tab

  • Export is out of Test Mode
  • Export is not configured to send to export history only. Typically, should be FTP or SFTP
    • If other than SFTP- make sure there is pgp encryption
  • Confirm the checkbox: Include Terminated Dependents from Change Log (Export Reason = 'Coverage Terminated.') is not checked.
  • Export Effective Date is set to the new package effective date (unless benefits are off cycle)
  • Current year file is not currently processing with carrier
  • Current year pending file schedule dates has been removed

Benefits tab

  • Correct benefits are selected - Note especially the Carriers for the benefits selected
  • Confirm Group By Codes are entered if needed (Benefits tab section above)
  • Only if Explicit Terms are required:
    • Are the current benefits also included?
    • If Explicit Terms being sent – Did you run the utility? **Best practice is to run this utility just prior to sending the OE file, keeping in mind the utility does not run on demand, but as a system process.
    • Check an example in both the Employee and Dependent records if possible to confirm data sent correctly.

Formatting tab

  • Check the mapping for hard coded dates
    • Hard coded dates are needed for explicit terms
    • Hard coded dates are typically not needed otherwise
    • Check the Employee Record.
    • Check the Dependent Record.

Well done! Notify carrier and send OE file.

DELETE EXPORT SCHEDULE FOR CURRENT-YEAR PRODUCTION FILE

Once the OE file has been processed most carriers cannot receive files for the current year. To prevent this from happening, you will want to delete the remaining, pending schedules from the current production export.

Schedule tab

  • Select the remaining Pending schedule records by checking box on far right of screen
  • Click Delete Selected Records

CREATE YOUR NEW PLAN YEAR PRODUCTION FILE

Now that the OE file has been updated, copy this file for the file to be the ongoing Production file for the current year.

  1. Copy OE file to configure scheduled Production file.
    • Update export Name – remove reference to OE (if one was added). Follow naming convention from current Production file.
    • Confirm Output filename is correct for Production file.
    • If test file or OE file naming convention is different than ongoing scheduled file
    • Confirm (S)FTP address, User Name and Password are correct for the Production file.

If Explicit Terms were sent in the OE file they need to be removed from this new Production File

On the Benefits tab

  • Remove the current package and Save.
  • On the Formatting tab, Employee and Dependent Records
  • Check Mapping on the Benefit – Expiration Date field.
  • Remove references to specific dates. Mapping should be generic: Not include a reference to a specific date (likely the current year’s package end date)
  • Example: Benefit – Expiration Date = Benefit – Package Expiration Date THEN Do not include field
  • In the screen shot below, remove the AND record from the mapping
  • Complete on both Employee AND Dependent records
  • Confirm the checkbox: Include Terminated Dependents from Change Log (Export Reason = 'Coverage Terminated.'). is checked

EDI_Rollover_-_00.png

CREATE EXPORT SCHEDULE FOR NEW PLAN YEAR

Once the OE file has been received and processed, go ahead and schedule the Production file for the new package year.

**The first scheduled file must be on or after the new package start date.**

**Note any schedule dependencies from the current files and apply when creating the new schedule.**

**COBRA files often have schedule dependencies**

Final Checks to Confirm Before Leaving the Production file to confirm that it is 100% ready for the upcoming year:

Properties tab

  • Export is out of Test Mode
  • Export is not configured to send to export history only. Typically, should be FTP or SFTP
    • If other than SFTP- make sure there is pgp encryption
  • Confirm the checkbox: Include Terminated Dependents from Change Log (Export Reason = 'Coverage Terminated.') is checked
  • Export Effective Date is set to the new package effective date (unless benefits are off cycle)

Benefits tab

  • Correct Package/Benefits are selected. *Note especially the Carriers for the benefits selected.
  • Validate Group by Codes

Formatting tab

  • Check the mapping for hard coded dates
    • Hard coded dates are typically not needed
      • Exception are some FSA files
      • You can always reference the current file or reach out to EDI if in doubt
    • Check the Employee Record
    • Check the Dependent Record

Process is complete.

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