How often are the EDI change files sent to Anthem?
All employee adds, changes, deletes and terminations for medical QLE submissions in FormFire are electronically submitted to Anthem via semi-weekly EDI file transmissions.
- Changes submitted in FormFire on Monday, Tuesday, and Wednesday before 5 a.m. ET will be transmitted on the Wednesday file.
- Changes submitted in FormFire Wednesday (after 5 a.m. ET), Thursday – Sunday, and Monday before 5 a.m. ET will be transmitted in the Monday file.
Ancillary QLE changes must still be faxed or emailed to the designated Anthem department within the timeframe for QLE changes.
- Dental: email@example.com or fax to 1-800-821-5946
- Vision: fax to 1-800-883-7919
- Life: firstname.lastname@example.org
How long will it take for Anthem to process the weekly change file?
Once the file has been generated, changes will be electronically transmitted to Anthem for processing.
- When Anthem receives clean files by 4:00 p.m. ET, members are updated that night (assuming it is a normal business day).
- Files received after 4:00 p.m. ET may not load until the next business day.
When will EDI be available for ancillary products?
Currently, there is no ETA regarding the availability of EDI with ancillary products.
Will I still receive QLE email notifications?
Yes, QLE email notifications will be generated, and forms will still be attached for ancillary QLE change notifications. The group must be in closed status to receive the QLE email notification.
What steps can I take to ensure successful EDI transmission?
You can ensure EDI changes are successfully transmitted by taking the following steps:
- An HR group contact (not the broker or service rep) with an active email address must be assigned to the employer group. If there are any discrepancies with the information that is received, Anthem will contact the HR manager for clarification.
- Make sure the employer group is in a Closed Workflow If the employer group is left in an Open Workflow status,
- Brokers and HR managers will not receive QLE notifications.
- Employees will not receive the correct QLE prompts or options when signing into their accounts.
- Make sure you have Assigned Plans to the employer group and have designated Plan Elections for each active and covered employee. Without designating both pieces of information, the EDI file cannot pull employees for the group.
- When the HR manager completes the Employer Application, be sure an eligibility waiting period has been indicated. If an eligibility waiting period is not established, the system will default new enrollees as being effective after zero days of employment.
Will the EDI process cover normal employer sold-group submissions?
No, Anthem for SOCA BP Sold Group submissions should follow the normal workflow process. You can consult our online Support Center for further guidance.
Who should I contact when there has been a human error made during the QLE submission process?
To correct errors that were made during the QLE process, you should correct the error in FormFire so that the change may be captured on the next file.
How do I handle emergency QLE change submissions?
Emergency submissions should be processed via FormFire. In addition, fax the emergency QLE submission to Anthem at 1-800-883-7919.
Who do I contact with EDI questions?
You may contact email@example.com with EDI questions.