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 FF-SHOP issuer has an approved 2015 Electronic Data Interchange (EDI) Registration form on file for the Individual Marketplace that notates 'SHOP,' what must issuers update on the onboarding form?
Answer: EDI Registration forms filed in a previous year may not contain an issuer's Qualified Health Plan's (QHP's) certified for the current plan year. Also, EDI Registration forms may not have the Payee group information setup. These changes are required for the Centers for Medicare & Medicaid Services (CMS) to deliver Group XML, 834, and 820 files properly to issuers.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 05, 2014
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