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Posted by on Mar 19, 2014 in Healthcare Reform

SHOP Update: Applications, Commissions, Invoices and Access to Care

SHOP Update: Applications, Commissions, Invoices and Access to Care

Covered California appreciates the work that you are doing to improve access to health care in your communities and for all of California. We are aware that there continue to be delays in processing applications for the Small Business Health Options Program (SHOP), and that you have faced challenges in seeking application status, enrollment confirmation and billing for your small group clients.

Since the SHOP enrollment portal has been taken offline, Covered California has adapted a paper-based operation while working aggressively to streamline the enrollment process. This has temporarily impacted processing times, and we apologize for the frustration you and your clients have experienced. We are confident that you will notice a marked improvement in SHOP agent support, processing times and quality over the next couple of months.

Pinnacle Claims Management, Inc., SHOP’s contracted administrator, recently expanded its role to meet service demands while Covered California SHOP’s enrollment, eligibility and billing system is upgraded. While the enrollment portal is offline, Pinnacle is manually processing SHOP enrollment applications, change requests and eligibility transmissions to the SHOP medical and dental insurance carriers. Pinnacle is also implementing a new billing system for processing invoices and disbursing timely commissions, in addition to providing more staff to answer the influx of calls received at the SHOP service center. Beginning in the next few weeks you can expect to see more efficient enrollment and invoicing, quicker response to issues, and shorter wait times when contacting the SHOP service center.

Keep in mind that Covered California also works closely with our SHOP General Agent partners and the California Association of Health Underwriters (CAHU) to ensure that they receive updates and important information. We encourage you to take advantage of the wide range of services provided by these experienced professionals.

Frequently Asked Questions

Below are answers to common questions Covered California is receiving about the current SHOP enrollment process:

What is the Status of My SHOP Application?

Covered California has received a high volume of SHOP applications and is processing them in the order in which they are received. Once payment is received and applied against the invoice, eligibility is transmitted to the carrier. We are working to improve the data transmission process to our SHOP health insurance carriers, which will result in quicker access to care.

As a reminder, SHOP paper applications are the only way to enroll in SHOP while the enrollment portal is offline. Paper applications can also be sent via U.S. mail or to SHOP’s dedicated fax number. Please see our SHOP Enrollment FAQ here for this contact information. Paper applications can also be sent to a Covered California authorized SHOP General Agent.

When Will My Client Receive Their Invoice?

Invoices for new SHOP applications are expected to be generated by the end of March for your client’s chosen coverage effective date. A new billing system is being implemented over the next few weeks which will allow us to send you and your clients their monthly invoice for SHOP coverage more efficiently. If you/your client have received an incorrect invoice, please note that changes to enrollment may not be reflected on your current statement.  Please remit payment as billed.  Adjustments will appear on subsequent invoices.

When Will I Receive My Commission?

We apologize and regret the delays agents have experienced in receiving their commission payments. We anticipate commission payments for January and February will arrive by early April. Going forward, we are confident that commission payments will be made in a timely manner as we work to streamline our operations. Further details about commission statements and an overview of our process will be discussed in an agent webinar that is being scheduled for the end of this month.

My Client Is Having Issues Accessing Care: What Should I Do?

Covered California’s top priority is to make sure that anyone who has successfully completed enrollment and paid their premium to date has immediate access to the care they need. If your client is having an issue receiving access to care, please contact us at SHOP@covered.ca.gov, and we will address their concerns as soon as possible. Please include “Access to Care” in the subject line to ensure that the e-mail receives our prompt attention.

Who Should I Contact for Assistance?

If you have any questions or concerns, you can direct your questions to the SHOP Service Center at (877) 453-9198 or to one of our SHOP General Agent partners. Our SHOP General Agent partners include Claremont Insurance Services of Walnut Creek, Dickerson Employee Benefits of Los Angeles, LISI Inc. of San Mateo and Warner Pacific Insurance Services of Westlake Village.