In every organization that manages employee benefits in house, integrations to multiple benefits providers are a necessary business process. There are several challenges in these processes. For smaller organizations, the processes are more than likely manual. Usually the Benefits Administrator enters the updates through an online session on the provider’s website. Each provider would have their own site along with their own data entry methods. This process is inherently slow and prone to data entry errors. The paperwork for the updates must be tracked to ensure that the information was entered into the in house benefits system as well as the benefits provider’s website. If the updates are not timely or are missed altogether, employees may not get the coverage when claims are submitted and have to go through the inconvenience of communicating with the Benefits Administrator to get the matter resolved and the claim processed. These issues may result in:
- A negative employee experience
- Unproductive time spent resolving the issue
Midsize to large organizations frequently have an electronic interface that transfers eligibility updates to their benefit providers. These electronic interfaces have their own challenges. Each provider will have their own format or may utilize the 834 industry standard format for the data being transmitted. The interfaces are typically custom code that is maintained by an internal IT function. Anytime there are changes to the format or when new providers are engaged, it is up to the IT department to make the changes to the interfaces affected or develop an entirely new extract. The benefits department then has to test these interfaces before the new or modified integration can be deployed to production. This could be a significant effort on the in house staff depending on the complexity of the integration and the amount of testing required.
eVerge Group fit into the first category, making manual updates for all benefit eligibility changes directly with their vendors. Some of the primary business reasons eVerge implemented HCM Fusion was to consolidate, automate and simplify business processes. To that end, eVerge implemented Fusion Automated Benefits. Delivered with Fusion Benefits is a standard benefits extract process that can be used to transfer benefit eligibility updates and changes to 3rd party benefits administrators/vendors. The challenge with this extract process is that different benefit vendors (and there are a lot of them!) have different formats that do not match this delivered extract, therefore requiring a custom version to be created for each vendor. eVerge’s solution to this problem was to engage an Oracle solutions partner called Benefits XML (BenefiX). BenefiX provides a service where the Fusion delivered benefits extract is transmitted to BenefiX. The data is then reformatted to each benefit vendor’s specifications and submitted to them on eVerge’s behalf. BenefiX has the responsibility for setting up and then maintaining distinct vendor interface formats.
Setting Up the BenefiX Integration
eVerge was responsible for initial setup of a Structure Spreadsheet for each vendor’s specifications. These spreadsheets acted as requirements documents for how to map employer-specific information needed for each vendor’s interface file. Initial mapping and setup included Tax Id, Policy Id, Group Policy name as well as other vendor specific information. BenefiX then used this information to prepare the vendor specific files with the data from the Fusion Benefits extract.
The file transfer protocol details were provided by BenefiX and were setup in the Manage Plan Carriers area in Fusion.
Additional configurations were needed in the Plan Setup area.
Tip: Oracle or BenefiX can provide a ‘How to Document’ with screenshots that are very helpful in completing the additional setup. The document is “Configuring Benefits for Integration with 3rd Party Provider.doc”.
The Benefits Extract file is generated and transmitted securely (encrypted) to the BenefiX SFTP site.
Benefits extract detail can be reviewed to verify the data being transmitted. This page link retrieves up to 500 rows and is used to do a cursory review of the file information.
Tip: This link can be used to review the data and can be downloaded to an Excel Spreadsheet for more detailed review. This is especially helpful when trouble shooting data issues.
The files are processed by BenefiX at which time audits are performed and a summary report is sent back to eVerge. If any errors are identified in the file by BenefiX, for example a missing social security number for a covered dependent, they are addressed or corrected within Fusion and a new file is re-transmitted.
If the file has no errors, the data is reformatted by BenefiX into the appropriate benefit vendor format and then transmitted to each vendor. A copy of the reformatted ‘vendor’ file is also sent back to eVerge to be used in trouble shooting any issues. The vendors receive the reformatted file, process the information and send eVerge the results including any potential errors/exceptions that need to be corrected.
Here are some “Bumps in the Road” we encountered while implementing the Benefits extract integration.
- Data issues in the Contact (Dependents) information where corrections were made by our users to the most current effective dated row only and the historical rows were not changed. This caused a duplication of dependent info that was being extracted.
Lesson: Pay close attention to Historical rows when doing corrections
- During test runs, data errors were encountered such as missing or mismatched SSNs between Fusion data and what the carriers had on file. This actually ended up being a good thing because it helped us get our data cleaned up before going live in production with the interface.
Lesson: Use the testing phase to help identify and clean up data issues.
- Being such a new option on an early release of Fusion (Release 5), we did encounter some bugs that needed Oracle support to resolve. Fortunately they were few and easily resolved. There will probably be some more “challenges” until the processes have been through several more implementations.
Lesson: Be prepared to engage Oracle Support as well as your BenefiX liaison and/or Benefits Vendor representative when an issue comes up with the processing.
The cost for services provided by BenefiX were very reasonable in our estimation, once you factor in the amount of time spent manually maintaining benefits eligibility with multiple vendors for all of our employees and their families! You will pay a one-time setup fee for each vendor and then a nominal monthly cost per employee for the services BenefiX provides.
The author of this article/blog is Zack Bakarich. Zack is a Principal Fusion HCM Implementation Consultant resource for eVerge Group with more than 20 years of software packages implementation and support experience.
To learn more about Fusion and how we can help implement Fusion for your organization, please contact us at 888-548-1973. Watch for upcoming blogs about our Fusion HCM Release 7 upgrade project, year-end payroll processing and more!