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Employee Uploads: Enrollment and Billing Logic
Employee Uploads: Enrollment and Billing Logic

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Tasha Demkiw avatar
Written by Tasha Demkiw
Updated over 8 months ago

How does Hint determine the start date for a membership?

Employee uploads use the following rules to determine when to enroll a patient or when to update their start date if it changes on the file:

  • Start dates in Hint are always restricted to the first of the month (can never be mid-month) and are determined based on the Enrollment Cutoff Day.

    • Enrollment Cutoff Day (found under Employer's Account & Pricing section): If the start date in the file is prior or equal to the cutoff day, they will be enrolled from the 1st of the indicated month. If the start date in the file is after the cutoff day, their membership will be started on the first of the next month.

  • We do not change the start date in Hint once the membership is billed. For example, if a patient is enrolled and billed for the month of July and the start date changes on the August file to June, we will not update the start date to match the June enrollment date.

  • We do not create 0-day memberships (e.g. when the start date and end date listed on the file are 1/1/2021).

For example, if the Enrollment Cutoff Day = 10 and:

  • Start date in file = 5/1/2021 --> Start date in Hint = 5/1/2021

  • Start date in file = 7/12/2021 --> Start date in Hint = 8/1/2021

  • Start date in file = 6/10/2021 --> Start date in Hint = 6/1/2021

Please Note: In creating a membership, the system tries to use the start date in the file (as compared to the Enrollment Cutoff Day). However, if there are previous memberships on the patient account, Hint will alter the start date to prevent overlapping memberships and potentially duplicative billing.

e.g. Jon Doe in Hint has the following membership history:

  • Enrolled from 1/1/2021 - 3/1/2021

  • Enrolled from 5/1/2021 - 7/1/2021

In the file, Jon Doe has a start date of 1/1/2021. In this case, Hint will create a membership starting 7/1/2021.

How does Hint determine the billing start date for a membership?

Found under Employer's Account & Pricing section, there is a setting called Limit backbilling. By default, this is set to ON with a backbill limit of 6 months - thus Hint will only bill a membership up to 6 months in the past. You may alter this setting as you see fit.

If you would like to only backbill for the current month, you should set the backbill setting to 1. For example, a patient is enrolled via a 5/12/2021 file upload with a 5/1/2021 start date. If our limit backbilling setting is set to 0 we will start billing for this member on 6/1/2021. If limit backbilling is set to 1, we will backbill them for the current month starting on 5/1/2021.

Please Note: Hint does not backbill when new dependents are added to a membership. A warning will be thrown when new dependents are added to a previously billed membership.

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