EDI Renewal Process

Each year when an employer’s products are renewing in Maxwell, any live EDI files 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.

Below are the steps that must be completed to ensure that the EDI renewal process happens without gaps in service.

  1. About 90 days prior to your renewal effective date, Maxwell Health will work with your Advisor to let them know you have an upcoming EDI renewal.

  2. Your Advisor will submit a form via our Tempo tool about your renewal including the necessary information for the Maxwell Health EDI team to initiate planning for sending renewal data via EDI.

  3. If no form is submitted, it is assumed that the Advisor desires to renew all carrier EDI feeds as-is.

  4. Depending on the information provided, the EDI team will either reach out to the carrier for an updated structure or move forward with renewing the file, if there are no changes in the plan or file structure.

    • If the information submitted indicates a change to plans, eligibility groups, or custom fields, it’s likely that an updated account structure is required from the carrier.
    • It’s imperative that necessary amendments to the structure are submitted and processed in a timely manner. Please work with your carrier to ensure this is the case.
  5. If this information is not received within 20 days prior to your renewal effective date, the Maxwell Health EDI team will notify your Advisor that there may be a delay in the renewal of the EDI file.

    • This means that if no action is taken, there may be a period of time in which the EDI file may be shut down and that you and/or your Advisor will be responsible for sending any enrollment updates to the carrier directly.

    • Also, your Advisor will need to ensure amended/updated account structures are available within 20 days of the plan year start date. If it’s not available, there may also be a period of time in which the EDI file may be shut down and that the you and/or your Advisor will be responsible for sending any enrollment updates to the carrier directly.

  6. The EDI renewal file will then be built and QAed by Maxwell Health prior to sending to the carrier.

  7. EDI renewal files are typically transmitted on the scheduled carrier production day following when an Open Enrollment has been processed. 

  8. Once the first EDI file is sent for the new plan year, the EDI team will notify the contact who currently receives production discrepancy reporting for your company’s carrier feed.
    • Please note: After the new plan year file is sent, all changes for the previous plan year will need to be managed by you and/or your Advisor as EDI will only send the new plan year’s information on the file.

As always, we highly recommend that you and/or your Advisor consistently review and act on EDI discrepancy reports, as well as audit bills, to ensure the right employees are covered at all times.

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