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Compliance team looks at how issuers are overseeing YOU

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Members of a federal review team found that the plan issuers they examined had many problems with complying program standards in 2014.

The team, from the Centers for Medicare & Medicaid Services (CMS), that conducted the review aimed to find out how well the organizations that sold coverage through understood and followed the federal exchange program’s rules.

The team looked at 18 QHP issuers in 15 states. They also looked at three Consumer Operated and Oriented Plan (CO-OP) carriers and two stand-alone dental plan issuers.

Team members analyzed management policies, operating procedures and testing programs related to many different areas, such as provider networks, Patient Protection and Affordable Care Act (PPACA) enrollment period rules, records retention and marketing.

One of the other areas the team studied was how well the product issuers followed the rules governing insurance agents and brokers.

The team found that all of the issuers studied had at least one of the required policies or procedures in operations, but that all lacked a required policy or procedure in at least one area.

“All 23 issuers had findings related to oversight of affiliated agents/brokers,” according to the review team’s report

For a look at three things the reviewers said about the agent/broker findings, which are somewhat similar to the findings in other areas, read on.

Yes or no

1. Issuers were not great about establishing procedures for verifying whether producers had completed registration requirements.

Eighty-three percent did not have policies or procedures to verify that producers had completed the registration process before paying them for enrollments.

See also: CMS posts exchange producer registration drafts 

NPN lookup

2. Issuers weren’t great at the theory or practical aspects of keeping track of producers’ National Producer Numbers (NPNs).

Regulators use NPNs to keep track of producers. Seventy-eight percent of the issuers CMS reviewed had problems with verifying and storing NPNs.

“A comparison of NPNs against the [CMS] registry revealed that provider NPNs often did not match CMS records,” according to the review team’s report.

See also: CMS tips: How to keep from forgetting you

A hand making a payment

3. Some issuers got through the entire 2014 plan year without having an official producer compensation policy in place.

Apparently, four of the 23 issuers never had formal policies related affiliated agent/broker oversight or agent/broker agreements in effect in 2014.

See also: 

How the PPACA exchange program still infuriates agents 

Global regulations: The vise on agents and advisors tightens


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