Common use of Enrollment Services Clause in Contracts

Enrollment Services. Although the DEPARTMENT is responsible for eligibility determination and enrollment, WPS shall maintain an enrollment/eligibility system to support the BOARD'S HEALTH BENEFIT PLAN. WPS shall not process any premium transactions related to enrollment, except for those direct pay SUBSCRIBERS from whom WPS will collect premiums and credit same to DEPARTMENT. Monthly, or upon request by the DEPARTMENT, WPS shall submit a data file (or audit listing, if requested by the DEPARTMENT) to update the DEPARTMENT’S membership files in a file format as identified by the DEPARTMENT after seeking input from WPS. WPS shall submit these files using the SUBSCRIBER identifiers (currently Social Security Number) determined by the DEPARTMENT. WPS shall create separate files for SUBSCRIBERS and DEPENDENTS in a format and timeframe specified by the DEPARTMENT, and submit them to the DEPARTMENT or its designated database administrator. When the DEPARTMENT sends WPS error reports showing SUBSCRIBER and DEPENDENT records failing one or more edits, WPS shall correct and resubmit the failed records with its next update. WPS shall collect from SUBSCRIBERS coordination of benefits information necessary to coordinate BENEFITS under the Wisconsin Administrative Code and report this information to the DEPARTMENT at least annually. WPS must follow the DEPARTMENT’S file transfer protocols (FTP), such as using the DEPARTMENT’S secured FTP site to submit and retrieve files.

Enrollment Services. ‌ Although the DEPARTMENT is responsible for eligibility determination and enrollment, WPS shall maintain an enrollment/eligibility system to support the BOARD'S HEALTH BENEFIT PLAN. WPS shall not process any premium transactions related to enrollment, except for those direct pay SUBSCRIBERS from whom WPS will collect premiums and credit same to DEPARTMENT. Monthly, or upon request by the DEPARTMENT, WPS shall submit a data file (or audit listing, if requested by the DEPARTMENT) to update the DEPARTMENT’S membership files in a file format as identified by the DEPARTMENT after seeking input from WPS. WPS shall submit these files using the SUBSCRIBER identifiers (currently Social Security Number) determined by the DEPARTMENT. WPS shall create separate files for SUBSCRIBERS and DEPENDENTS in a format and timeframe specified by the DEPARTMENT, and submit them to the DEPARTMENT or its designated database administrator. When the DEPARTMENT sends WPS error reports showing SUBSCRIBER and DEPENDENT records failing one or more edits, WPS shall correct and resubmit the failed records with its next update. WPS shall collect from SUBSCRIBERS coordination of benefits information necessary to coordinate BENEFITS under the Wisconsin Administrative Code and report this information to the DEPARTMENT at least annually. WPS must follow the DEPARTMENT’S file transfer protocols (FTP), such as using the DEPARTMENT’S secured FTP site to submit and retrieve files.