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2021-074B
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Last modified
6/22/2021 12:13:29 PM
Creation date
6/11/2021 3:23:37 PM
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Template:
Official Documents
Official Document Type
Agreement
Approved Date
05/11/2021
Control Number
2021-074B
Agenda Item Number
12.D.1.
Entity Name
Employer Direct Healthcare, LLC
Subject
Surgeryplus Services Agreement
Addition of SurgeryPlus Benefit as Optional Benefit
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DocuSign Envelope ID: 29EAB906-1936-4BAB-83BE-97C974F00293 <br />Enrollment File Feed Requirements Ei <br />(rev. June 2020) ur er Pius"' <br />Enrollment File Summary <br />Employer Direct Healthcare ("EDH") requires a weekly enrollment file feed ("Enrollment File") from all SurgeryPlusTm clients <br />(each a "Plan Sponsor"). Enrollment Files should be system -generated and only contain members eligible for the <br />SurgeryPlusTM program. Enrollment Files are securely managed by EDH's process to extract, validate, transform and load <br />eligible members into its case management system. Upon request, enrollment validation reports can be generated and <br />delivered to a Plan Sponsor's designated recipient. <br />Eligibility Criteria <br />■ Eligible Members: The Enrollment File should only include members enrolled in medical plans that are eligible to <br />receive the SurgeryPlus- benefit as of the file effective date. <br />■ Eligibility Exclusions: Please exclude all members from the Enrollment file who: <br />L are enrolled in medical plans that are ineligible to receive the SurgeryPlus- benefit; or, <br />ii. receive secondary coverage from the Pian Sponsor <br />■ Terminated Members <br />- (Preferred) Explicit Termination Date: EDH will remove terminated members from SurgeryPlus- eligible <br />member roster using an explicit termination date for the member in the Enrollment File. Member records sent <br />with an explicit date can then be removed from subsequent Enrollment Files or can remain with a termination <br />date. <br />- Termination by Omission: EDH can remove terminated members from its system based on their omission from <br />Enrollment Flies. Please note that terminated members will remain eligible for SurgeryPlus' until the date they <br />are omitted from the Enrollment File. <br />File Transfer and Specifications <br />■ File Layout: The Enrollment File feed layout is included on Page 2 herein. <br />■ Automated File Transfer: EDH hosts a file transfer server that uses Secure File Transfer Protocol (SFTP). Upon receipt <br />of an external facing IP Address, EDH will create a dedicated account and provide credentials to connect and drop <br />Enrollment Files on the server. <br />■ Test Files: Test files should be transmitted prior to submitting production files. All test files are to be sent securely via <br />EDH's SFTP and/or through encrypted email service and include the word "Test." Please name Test Files as follows: <br />- Comma -separated values: "Test Client MMDDCCYY.csv" <br />- Text: "Test_Client-MMDDCCYY.txt" <br />■ File Formats: Please prepare the Enrollment File in an electronically readable format. EDH prefers Enrollment Files in <br />comma -separated values (.csv) format and can also process EDI 834 files. Please note, EDH cannot process Zip files or <br />Microsoft Excel files. <br />■ Production Files: Please remove the "Test_" prefix from for all production Enrollment File names as follows: <br />- Comma -separated values: "Client MMDDCCYY.csv" <br />- Text: "Client_MMDDCCYY.txt" <br />■ Population Subset Files: Please denote COBRA and Retiree population file names as follows: <br />- COBRA: "Test _ClientCOBRA_MMDDCCYY" or "ClientCOBRA_MMDDCCYY" <br />- Retiree: "Test_ClientRetiree_MMDDCCYY" or "ClientRetiree MMDDCCYY" <br />Contact Information <br />Please contact SurgeryPlus regarding all Enrollment File related inquiries at E1ipibilitVData0edhc.com. <br />
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