Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 09, 2014

Program Area: Small Business Health Options Program (SHOP)

Question: In the 820 Companion Guide, scenario 3 for SHOP shows non-sufficient funds (NSF) for January, but also a February payment. Why would the Federally-facilitated Small Business Health Options Program (FF-SHOP) apply the February payment if January was NSF? Issuers have to apply payments in order.

Answer: Scenario 3 is an example where Company 1 has an NSF, but (new) Company 2 paid a premium. The FF-SHOP takes back the negative amount from the issuer and the FF-SHOP uses the payment from Company 2 to offset the amount. The payments are not from the same Employer Group.

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