This policy applies to navigator organizations.
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.
Questionnaire: Form titled Enrollment Report: FY 2017 Privacy and Security Policies Questionnaire that navigator organizations must submit to be approved to be eligible to receive an enrollment report.
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.
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
- A navigator organization initiates the process for requesting an enrollment report by submitting a completed and signed Enrollment Report: FY 2017 Privacy and Security Policies Questionnaire to the Assister Resource Center (ARC) by fax or email.
- 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 Questionnaire must be completed by the information privacy and security responsible party designated by the navigator organization in Section 4.2 of the MNsure Grant Services Contract Navigator/In-Person Assistance Attachment A. If the information privacy and security responsible party has changed since the contract was finalized, the organization’s authorized representative or the individual with signature authority must complete and submit a Request to Update Authorized Contacts form to the ARC.
- 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 the navigator organization’s information privacy and security responsible party be updated using the Request to Update Authorized Contacts form.
- 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 2017:
- 3rd Quarter 2016 available after December 1, 2016.
- 4th Quarter 2016 available after March 1, 2017.
- 1st Quarter 2017 available after June 1, 2017.
- 2nd Quarter 2017 available after September 1, 2017.
- The enrollment report will be securely emailed to the navigator organization's designated payment coordinator. The email will come from firstname.lastname@example.org. The navigator organization is responsible for notifying MNsure immediately if there is any change to the designated payment coordinator by submitting a Request to Update Authorized Contacts form to the ARC.
- 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)
- The file must be sent by secure email to the ARC at email@example.com.
- 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 2016 will not be reviewed until after March 1, 2017
- Discrepancies from 4th quarter 2016 will not be reviewed until after June 1, 2017
- Discrepancies from 1st quarter 2017 will not be reviewed until after September 1, 2017
- Discrepancies from 2nd quarter 2017 will not be reviewed until after December 1, 2017
- 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.Procedures for Reporting Potential Discrepancies
Reference and Related Documents