By: Michael Volpe
“The wonderful thing about standards is that there are so many of them to choose from.” - Rear Admiral (Ret) Grace Hopper
In the SS&C eBriefing titled “Building a digital enrollment ecosystem,” we discussed the workgroup formed by LIMRA to address non-healthcare related employee benefits data interchange. Health enrollment data has been standardized by federal law to use the HIPAA 834 enrollment specification format; no such standards exist for the other employee/ancillary benefits (e.g. life, disability, critical illness, etc.).
ACORD, a global, nonprofit organization that develops electronic standards for the insurance and related industries, created the ACORD Member Enrollment Standard. This effort was initiated through the acceptance by ACORD of a data file format for ancillary benefits contributed by BenefitFocus. The file format was established more than 10 years ago and is used by more than ten life and ancillary carriers.
The HR Open Standards Consortium (HROS), a global standards community with more than 9,000 members in 93 countries, promises “an open, transparent, and trusted approach to HR data standards development.” One of the eight active projects underway is the Benefits Enrollment specification. This workgroup, comprised of insurers and providers of HR and employee benefits solutions, has been focused on the same ancillary benefit types as the initial LIMRA project. It is interesting to note that the HROS specification is intended to address both “batch” file feeds and real-time system interactions.
Based on publicly available information, it seems clear that at least several of the top carriers are hedging their bets by participating in all three initiatives. With three separate, respected standards bodies addressing the same transactions, industry adoption will ultimately determine which will prevail. Until such a time, partners in the EDI transactions will try to simplify the existing feeds as much as possible.
Since 2004, the SS&C BenefiX™ carrier data exchange service has been used by many enrollment platform vendors to simplify EDI tasks. With SS&C BenefiX, vendors can create a single, standard enrollment file format to send into the service. It then transforms, translates, and transmits the enrollment data to the respective carriers in their preferred formats. With more than 300 carrier file formats supported, there are very few enrollment transactions we have not transmitted. To learn how we can help you, contact Diane Edwards or download our brochure.