Navigator organizations follow this process to receive an enrollment report providing details on the enrollments for which MNsure is paying a per enrollee payment. The enrollment report enables navigator organizations to identify any discrepancies between their enrollment records and MNsure's per enrollment payments.
Procedures for Privacy and Security Policies Questionnaire
The questionnaire confirms that an organization has in place the privacy and security policies and procedures that are included in Section 6.0 of the MNsure Grant Services Contract Navigator/In-Person Assistance Attachment A. Failure to have a particular policy or procedure in place does not necessarily mean the questionnaire will be denied, but an organization should provide an explanation and may be contacted for further information.
The completed questionnaire should be faxed or emailed to the ARC.
MNsure will review the questionnaire for completeness and evaluate the organization’s compliance with privacy and security requirements.
If the questionnaire is incomplete, MNsure will notify the sender and request that a complete questionnaire be submitted.
If the questionnaire is not submitted by the information privacy and security responsible party on record, MNsure will request that the questionnaire be resubmitted, or that an authorized individual update the agency’s contacts online using the Agency Management Program (AMP)
If there are any questions regarding answers to the questionnaire, MNsure will contact the information privacy and security responsible party for clarification.
If the questionnaire is approved, MNsure will notify the information privacy and security responsible party and proceed with processing any available enrollment reports.
If the questionnaire is denied, MNsure will notify the information privacy and security responsible party. After being notified of a denial, an organization has 30 days to appeal the decision. An organization that is denied may submit a new questionnaire in the next fiscal year.
Procedures for Sending Enrollment Reports
After the navigator per enrollee payments have been finalized for a quarter (generally 60 days after the close of the quarter), MNsure will begin processing requested enrollment reports for the quarter. Anticipated dates for state fiscal year 2019:
3rd Quarter 2018 available after December 1, 2018
4th Quarter 2018 available after March 1, 2019
1st Quarter 2019 available after June 1, 2019
2nd Quarter 2019 available after September 1, 2019
The enrollment report will be securely emailed to the navigator organization's designated payment coordinator. The email will come from email@example.com. The navigator organization is responsible for notifying MNsure immediately if there is any change to the designated payment coordinator by having an authorized individual update the agency’s contacts online using the Agency Management Program (AMP).
The navigator organization should submit questions regarding the enrollment report to the ARC.
Procedures for Reporting Potential Discrepancies
After a navigator organization has reviewed their enrollment report, they may report any potential discrepancies between MNsure's enrollment records and their own. To report potential discrepancies, the navigator organization must send an Excel file with a list of any cases for which they believe they should receive a payment. The file should include:
Consumer's first and last name (required)
Consumer's date of birth (required)
The date the application was submitted or the enrollment was completed (required)
If known, the consumer's address
If known, the method of application (online vs. paper)
MNsure will process reports of potential discrepancies in the order received as resources are available, but not any earlier than the following:
Discrepancies from 3rd quarter 2018 will not be reviewed until after April 30, 2018.
Discrepancies from 4th quarter 2018 will not be reviewed until after August 30, 2018.
Discrepancies from 1st quarter 2019 will not be reviewed until after November 30, 2019.
Discrepancies from 2nd quarter 2019 will not be reviewed until after January 30, 2019.
MNsure will review all reported potential discrepancies to determine whether the case meets payment requirements (see MNsure's Navigator Payment Policy). Once MNsure has completed reviewing the file, the navigator organization will receive a file from MNsure which indicates whether the case was determined eligible for payment, ineligible for payment, or more information is required.
If eligible for payment, a payment will be issued.
If ineligible for payment, the reason will be included.
If more information is required, MNsure will continue to review the case until a final determination can be made.
Terms and Definitions
Enrollment report: Quarterly spreadsheet listing individual enrollments by a contracted navigator organization based on MNsure’s accounting of enrollment payments. Data elements of the enrollment report are first name and last name of consumer, city, date of birth, Assister ID, organization name, program into which consumer was enrolled.
Per enrollee payment statements: Quarterly statements sent by MNsure to a navigator organization’s payment coordinator that summarize the organization’s per enrollee payments by navigator ID and program determination.
Information privacy and security responsible party: The individual designated in Section 4.2 of the MNsure Grant Services Contract that is responsible for complying with data privacy and security for the agreement.