New CMS rules for enrollment updates and their impact
As of July 19, 2024, CMS is blocking agents and brokers from making changes to a consumer’s FFM enrollment unless the agent is already associated with the consumer’s enrollment. This applies to all agent-assisted enrollment applications across all enrollment platforms.
The team at HealthSherpa understands that this CMS change causes a major disruption to agents who are trying to help consumers update policies. We are working with CMS to understand the intent of this change and to clarify details. As we learn more, we will update agents who use HealthSherpa.
What this means for agents: When an agent submits an update to an enrollment that their NPN is not already associated with, that agent will see the following error from CMS:
How to submit policy changes when encountering this error
CMS has outlined additional steps that agents can take to complete these enrollments. If you encounter this new error, you may complete the consumer’s enrollment update in two ways:
Call the Marketplace Call Center
Call the Marketplace Call Center at 1-855-788-6275 with the consumer on the line for a 3-way call and ask a representative to update the consumer’s coverage.
Have the consumer submit the changes themselves
You can help a consumer complete their own application change by doing the following:
Assist the consumer to make policy updates as you normally would.
Before submitting, or when you encounter the new CMS error, send the consumer their in-progress application by finding the consumer in your Client List and copying the Resume link.
Have your consumer use the Resume link to complete any additional updates and submit the application.
To submit feedback or ask questions about these changes from CMS, reach out to the Marketplace Call Center at 1-855-788-6275.
If you are having any technical issues using HealthSherpa, please contact our Agent Support team at (888) 684-1373, at [email protected], or via chat from within your account.
