Small Business Health Options Program (SHOP) FAQ
Guidance for FAQ regarding Issuer Participation Requirements and EFT/EDI Onboarding
Program Area: Small Business Health Options Program (SHOP)
Question: If an issuer participated in testing last year, does the issuer need to submit a new Electronic Data Interchange (EDI) Registration form?
Answer: The answer depends on a couple of parameters. 1. Is there any trading partner relationship change for the organization, e.g., clearinghouse change or introduction of a trading partner for the new plan year? If the answer to either of these scenarios is "Yes", then the issuer needs to submit a change form. 2. Has the issuer filed its current year plans? If no, then the issuer needs to submit a change form to fill in the current year plan information. 3. Is the issuer payee group information already filed? Or is that information changing? If the issuer has not filed this information, then a change form is required. If the information is already filed but the information is changing, then CMS also needs a change form.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 05, 2014
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