Translating the Health Tech Lingo
The technical problems with HealthCare.gov revealed a universe of jargon most people had not heard before. Below is a guide to terms used by health technology and policy experts.
834 forms: The reports that are sent every evening to insurance companies to provide them with information about consumers who have enrolled in their plans.
Account transfer: A tool that is supposed to send Medicaid enrollment data from HealthCare.gov to state agencies. It was slated to go live on Oct. 1 but was delayed. It is being tested in some states.
Back-end issues: The problems with the website that consumers don’t see. These include errors in the enrollment data that HealthCare.gov sends to insurers. It also includes the parts of the website that haven’t been built yet — including ways for federal officials to compare their enrollment data with insurers’ lists. Another part of the site that’s still under construction is a tool to trade money between the federal government and insurers, so the feds can give funds to insurers for customers’ subsidies and insurers can pay their user fees to the federal government.
Direct enrollment: The process of insurers enrolling customers without going through the federal marketplace website — except to calculate subsidies —that handles enrollment for 36 states.
Orphan or ghost reports: A form with a customer’s enrollment data that disappears somewhere in transmittal between HealthCare.gov and an insurance company.
Queuing system: A virtual “waiting room” on HealthCare.gov. If the site becomes overwhelmed with traffic, it will ask some users to jump off. When there is less demand and the site is operating smoothly, those users will get an email asking them to return. On the first day it was used, about 60 percent of people returned the same day.
Reconciliation: The process for matching up the list of new customers who enrolled through HealthCare.gov with the lists that insurance companies received of those customers.
The three Rs:
Reinsurance is money that the federal government pays to insurers for many of the most expensive patients. Risk adjustment is money that insurers who have mostly healthy customers give to insurers that have a sicker, more expensive mix of patients. Risk corridors are limits that the federal government set on insurers’ profits and losses. Under risk corridors, if insurers make more money than expected, they give some back to the government. If insurers lose more than projected, federal officials pony up.