HHS: 15,000 enrollments never made it to insurers

We have wondered for more than two months about the impact of the flawed and mostly still-missing Healthcare.gov back end had on the few consumer sign-ups that actually appeared to succeed. In today’s AP/GfK poll, only 24% of the 11% of respondents who attempted to enroll through an exchange succeeded in completing their enrollment since the ObamaCare rollout — or so they think. After weeks of speculation about the bugs in the 834 reports, HHS finally admitted in a Saturday-morning document dump that 15,000 signups never got to the insurers in the first ten weeks of the program — but note the part in bold:


As the technical improvements to HealthCare.gov continue making a difference to consumers using the website, our attention remains on addressing issues with the more “back end” parts of the system, including the creation and accuracy of 834 transaction forms.  These transaction forms are processed by health plans when consumers choose a product in the Marketplace, and our priority is working to make sure that every 834 form – past and present – is accurate, and that consumers are able to successfully enroll in the coverage of their choice.

Our dedicated 834 team – led by our General Contractor QSSI and working in partnership with issuers nationwide – is laser focused on ensuring we’ve made improvements to the system for the long term, and as we move forward, addressing any issues that could potentially impact consumer coverage.  This integrated team works on reconciliation issues 24/7, and maintains a telephone hotline for issuers who have questions.

Our analysis indicates that between October 1st and December 5th, the number of consumers for whom 834s were not produced was fewer than 15,000.  But as the graph shows, since the beginning of December, missing 834s as a percentage of total enrollments has been close to zero.  These significant improvements are due to the technical fixes put in place by the end of November.


But the insurers weren’t complaining just about missing reports, but also incorrectly-formatted 834s that dumped bad data into their systems.  Even in their PR release, HHS makes the distinction between “the creation and accuracy of 834 transaction forms.” The number here, at least in terms of what HHS describes in the metric, only relates to the creation of 834s.

In fact, the Washington Post’s earlier reporting on 834s notes that HHS was dealing with three discrete issues on 834s, of which creation/transmission was only one:

About 10 percent of Obamacare enrollment files have errors. Medicare spokeswoman Julie Bataille confirmed that the agency believes about 10 percent of the health law’s enrollment files — known in insurance-speak as 834 transmissions — have some kind of error. (That figure was reported earlier Friday by Jonathan Cohn at The New Republic.)

This is a lower error rate than during the first two months of open enrollment, when the agency estimates about one in four of the transmissions had a problem.

Bataille said there are essentially three problems affecting the 834 transmissions. There are situations where HealthCare.gov doesn’t generate any transmission at all, times when it generates duplicate transmissions and situations where the transmission occurs but contains inaccurate information.

“Because there have been a number of different problems, it has made it difficult for us to quantify the total number of forms and errors over time,” Bataille said.


HHS later said that 365,000 people signed up for plans through the exchanges, and a 10% error rate — some had estimated it might be as high as a third — would mean over 36,000 failed 834s, not 15,000.  And if HHS is only now releasing the number of 834s it failed to create, it means we still don’t know how many went out with bad information, and how many are still going out with bad information.  Their Saturday news dump proclaiming that “Missing 834s are declining” to 0.38% appears to ignore the issue of existing but corrupted 834s that may still be going out to insurers.

HHS has been reluctant to part with any solid information about the 834s, for obvious reasons. They’ve hemmed and hawed about the issue almost ever since the system went on line. This press release appears to be serving that same effort of obfuscation.

Update: The Post’s Sarah Kliff also notes that this only addresses one problem with the 834s:

During the first two weeks of October, the new federal analysis estimates, nearly 10 percent of enrollments were missing an 834 transmission. That number rose to 15 percent in mid-October before steadily declining through November.

From late November into early December, CMS estimates that less than 1 percent of sign-ups failed to send a record to the health insurer, indicating that a suite of software fixes have helped address the problem.

The missing enrollment files are one of three problems with the 834 transmissions that the federal government has identified. The other two are enrollment transmissions being sent in duplicate and those that are sent with inaccurate, or missing, data.


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