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📅 Last updated February 9, 2024.
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Table of contents
Overview
Supporting Group Coverage HRA or MERP plans with 501(r) is a simple process. Doing so saves members money (less out-of-pocket expenses) as well as plans money (when the member has no cost share, the plan reimburses less).
Follow the steps below to get started.
Set up plan configurations
- Log into your Goodbill partner account.
- Go to Configuration.
- Consult with Goodbill on how to add your HRA plans.
- Set the “When will claims be engaged for 501(r) / financial assistance?” configuration value to “Post-payment” and check the “Is HRA?” checkbox.
- Set **“How many days does Goodbill have to engage members for financial assistance after a claim is processed?” **to however many days you’d like to give Goodbill to engage the member before moving forward with reimbursement or payment, as usual.
Send HRA eligibility and accumulations
-
Create the eligibility files (or add HRA eligible members to any existing eligibility files you’re already sending to Goodbill).
-
Send the eligibility files as specified in Technical Implementation Guide
If you want Goodbill to automatically calculate savings based on HRA accumulators, please follow the data specification below:
| Data |
Type |
Required? |
Notes |
| First Name |
String |
Required |
|
| Last Name |
String |
Required |
|
| Group ID |
String |
Required |
|
| Member ID |
Alphanumeric |
Required |
- Must be unique |
| Subscriber ID |
Alphanumeric |
Required |
|
| Relationship |
String |
Required |
Example options: Subscriber, Spouse, Partner, Son, Daughter |
| Date of Birth |
Date |
Required |
|
| Plan ID |
String |
Required |
|
| Social security number |
Integer |
Optional |
|
| Plan Enrollment Date |
Date |
Optional |
|
| Plan Termination Date |
Date |
Optional |
|
| Status |
String |
Required |
- Options: Active, Terminated |
| Address 1 |
String |
Required* |
- Required, if available |
- Either address, email, or phone number must be present |
| Address 2 | String | Required* | - Required, if available
- Either address, email, or phone number must be present |
| City | String | Required* | - Required, if available
- Either address, email, or phone number must be present |
| State | String | Required* | - Required, if available
- Either address, email, or phone number must be present |
| Zip Code | Integer | Required* | - Required, if available
- Either address, email, or phone number must be present |
| Email | String | Required* | - Required, if available
- Either address, email, or phone number must be present |
| Phone Number | Integer | Required* | - Required, if available
- Either address, email, or phone number must be present |
| Plan Year | Date | Required | For example, “2024” |
| HRA Deductible Maximum | String or Float | Required* | - Required, if Goodbill is to calculate savings
- When a string, can be “N/A” or something similar
- If there is a zero or greater deductible, please format as a float. For example, “0.0,” or “250.0”. |
| HRA Deductible Counter | String or Float | Required* | - Required, if Goodbill is to calculate savings
- When a string, can be “N/A” or something similar
- If there is a zero or greater deductible, please format as a float. For example, “0.0,” or “250.0”. |
| HRA Reimbursement Maximum | String or Float | Required* | - Required, if Goodbill is to calculate savings
- When a string, can be “N/A” or something similar
- If there is a zero or greater deductible, please format as a float. For example, “0.0,” or “250.0”. |
| HRA Reimbursement Maximum Counter | String or Float | Required* | - Required, if Goodbill is to calculate savings
- When a string, can be “N/A” or something similar
- If there is a zero or greater deductible, please format as a float. For example, “0.0,” or “250.0”. |
Send 835/EOB
Sending an 835 or EOB is the best way to trigger Goodbill to begin member outreach for a new claim.
An 835 or EOB can be sent via SFTP into the /to-goodbill/eobs/ directory as either PDFs, CSVs, 835i files, or as text documents containing R4 ExplanationOfBenefit FHIR resource. It may also be passed as an R4 ExplanationOfBenefit FHIR resource via API.
When Goodbill receives a new 835/EOB, we will match it to the correct member and begin outreach. We will work with the member to complete and submit their 501(r) application with the facility and/or negotiate, and will follow-up until a determination is made.