EDI Implementation Process

Setting up an EDI connection? You can find all the information you need on a new EDI implementation here.


Getting Started

When you or your Advisor request to have a new EDI connection between Maxwell and your carrier, our EDI team will review your request and make sure we have all the information needed to set that up for you.

If you’re interested in setting up a new EDI connection for one of your benefits, you’ll need to complete an EDI request so we can review and start gathering the information needed to set this up with your carrier.

>> Request a new EDI Connection here

The typical information needed for a new EDI connection includes:

  • A Submitted EDI Request Form
  • Policy Number
  • Carrier information and Carrier Contact
  • Data Discrepancy Contact

Next Steps after requesting an EDI connection

Once we’ve received and reviewed your request, we’ll begin the work with your carrier. It’s also important to ensure that whoever is listed as the Data Discrepancy Contact for your EDI connection is reviewing emails sent from our EDI team and your carrier once we begin implementing the new file feed.

>> Looking for more? Be sure to Check out the Frequently Asked Questions below.


Status of your EDI Connection

Below is an overview of the steps to set up a new EDI Connection:

Status   Definition of Steps   Estimated Time in Each Status*
         

Step 1: Gathering Requirements

 

 

In this step, we receive your request to set up an EDI feed, assign an EDI Analyst to review and reach out to your carrier for requirements.

 

Depends on you and your carrier’s response time to ensure all information is complete.

Step 2: Carrier Testing

 

 

In this step, we review the carrier’s file specifications, build your EDI file to send from Maxwell, and test it with the carrier.

  ~ 5 weeks
Step 3: Preparing to Go Live  

In this step, we ensure our team is prepared to support the ongoing success of your EDI feed as we finalize your EDI setup, go-live date, and feed schedule.

  ~ 1 week
Requires Attention: Pending Client Action  

Information is needed from the client to continue EDI setup. The Data Discrepancy contact for the client should check for an email that includes more detail.

  Depends on client response time.
Connected  

The EDI feed is live and will automatically send employee enrollment information from Maxwell based on the feed schedule.

  Congrats! Your connection is live!

*Please note: the “Time in Each Status” are estimates only. Definitive times generally depend on how quickly carriers respond and how promptly brokers and employers are able to clarify issues as they arise throughout the process.

 


Frequently Asked Questions

I want to set up a new EDI connection. How can I start that and what information is required?

If you’re interested in setting up a new EDI connection for one of your benefits, you’ll need to complete an EDI request so we can review and start gathering the information needed to set this up with your carrier.

>> Request a new EDI Connection here

The typical information needed for a new EDI connection includes:

  • A Submitted EDI Request Form
  • Policy Number
  • Carrier information and Carrier Contact
  • Data Discrepancy Contact

How long does it take to set up a new EDI connection?

Maxwell strives to offer a best in class experience across our platform, including streamlining the process for setting up EDI connections and integrations with carriers and partners. As consistent with industry standards and work required with your carrier, EDI connections can typically take about 60-90 days to get up and running. Our team is dedicated to get your connection up and running as soon as possible through the work done on gathering requirements, testing with carriers and supporting your success to go live.

  • Please note: For clients on the Sun Life + Maxwell experience, once your portal is released to you, even though a Live EDI connection may not appear in your portal, we will automatically take care of getting your employee’s latest enrollment information over to Sun Life. The 60-90 day timeline will apply for medical plan EDI connections and all non-Sun Life benefit EDI connections.

>> You can learn more here about working with Sunlife + Maxwell and EDI.

 

What is my role during implementation?

Maxwell is here to help streamline the process for setting up EDI connections with your benefit carriers and will do most of the work directly with your carrier. But you may be able to help!

In the case there are clarifications between the data in your carrier’s system and the information we have in the Maxwell portal, the designated “Data Discrepancy Contact” will be contacted to review these discrepancies and will receive any discrepancy reports. Ensuring the data accuracy will create a smoother testing process during your EDI connection setup.

 

Why might my EDI connection take longer than expected to set up and go live?

If you’re requesting a new EDI connection towards the end of the year, it’s helpful to keep in mind that this is a peak time for your insurance carriers, especially when it comes to managing renewals and setting up new EDI connections. During this time, you may see a longer timeline for setting up new feed implementations since testing can take additional time and is still a crucial step in a successful connection.

 

What is a data discrepancy contact?

When setting up and managing an EDI connection, data accuracy between Maxwell and your insurance carrier is especially important. In case there are clarifications between the data in your carrier’s system and the information we have in the Maxwell portal, the designated “Data Discrepancy Contact” will be contacted to review these discrepancies and will receive any discrepancy reports.

  • Note: Discrepancies for live feeds are rare but often result from manual updates made in the carrier system and not in Maxwell. We encourage clients to review weekly reports from your carriers and conduct routine audits of your carrier bill.

How frequently is the EDI Status showing in my portal updated?

You can view the status of your Live and In progress feeds from the EDI & Integrations tab under Settings in your portal. This status is updated on a daily basis. If you have additional questions, you can reach out support@maxwellhealth.com.

 

How will I know when my EDI connection is ready to go live?

You will be notified by email from the Maxwell EDI team prior to any EDI connection going live. We’ll make sure to notify you so that once your connection is live, you know you can stop caring for portal updates with carriers manually.

When the connection is live, you will also see an updated status of “Connected” in the Settings > EDI and Integrations area of your Maxwell portal. This is also where you can view the feed schedule and the last sync date if applicable.

 

My requested EDI connection is not yet live, how should I handle new enrollments and changes with the carrier?

If your EDI connection is not yet live, you should ensure that you are updating carriers directly with your new enrollment data once it is updated in Maxwell. This includes following your open enrollment as well as any ongoing updates until the EDI connection is live.

Maxwell’s reporting capabilities make it easy to pull this information from the portal.

>> Check out the About Reports article which outlines which report will suit your specific needs best.

 

I’ve requested a COBRA file but I don’t see this on the Current EDI Feeds dashboard?

The Current EDI Feeds tab will only show EDI connections with your benefit carriers, it does not include COBRA file connections. If you’ve requested a direct connection with a vendor for your COBRA file, you’ll see that listed under the Current Integrations tab.

  • Reminder: Maxwell does not act as a COBRA administrator, but you can use Maxwell to manage qualifying events that result in an active employee becoming eligible for COBRA coverage. Learn more about Managing COBRA Events in Maxwell.

 

My file is already live and it’s about to renew, will I see anything different on the Current EDI Feeds dashboard?

Each year when your benefits are renewing in Maxwell, any live EDI connections for those products must also be renewed. This EDI renewal process is essential to making sure that renewal elections are sent electronically to carriers in a timely and accurate manner.

The status for your existing live EDI connections will not change in the Current EDI Feeds dashboard, but you may want to learn more about the renewal process.

>> Check out more detail on the EDI Renewal Process here

 

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