Currently, a patient in Hint can only be enrolled in a single active membership at a time. However, some patients may be eligible for memberships spanning different employers and/or under different primary employees.

For example, Jane Doe's current membership is sponsored by her employer, "ABC Corp", and includes her husband, Jon Doe, as a dependent. Jon Doe, however, is currently enrolled in a sponsored plan for the same practice under his Employer, "Hint Health", with Jane Doe as the dependent. When Hint is ingesting eligibility files, the system must decide how to enroll/update the Jane Doe and Jon Doe memberships.

After reviewing the different use cases, we have implemented logic that prioritizes active memberships in which the patient is the employee.

Duplicates within the same file

Hint will check for duplicate patients within a file by matching on First Name, Last Name, and DOB. When duplicates are detected, the system will then assess which row to process vs which rows to ‘ignore’ using the following hierarchy:

  1. If only one of the rows has an active membership then Hint will process that row. All inactive rows are ignored.

  2. If multiple rows have an active membership, then Hint will process the row in which the patient is an Employee. If there are no rows or multiple rows in which they are an Employee, then Hint processes the sequentially first active row out of the set of Employees. Hint ignores all others.

  3. If all rows are inactive, then Hint processes the row in which the patient is an Employee. If there are no rows or multiple rows in which they are an Employee, then Hint processes the sequentially first row out of the set of Employees. Hint ignores all others.

Duplicates across different files

When a patient in the file is enrolled on a retail plan or with a different company in Hint (either one not on a file or on a different file), an error will appear for the overlapping membership.

For manual files, feel free to resolve or mute these errors as you see fit.

For Eligibility AutoSync files, dedicated Hint staff will resolve the error using the following logic:

  • If patient is enrolled in a retail membership in Hint, we will terminate the existing membership and enroll the patient in the employer-sponsored membership on the file. However, if the patient's retail plan bills quarterly or yearly, we will contact the practice to assist in resolution.

  • If patient is enrolled as a dependent in a sponsored membership in Hint, but is covered in the file as an employee with dependents, we will terminate the patient's existing membership and enroll them as an employee to ensure the dependents have coverage.

  • If patient is enrolled as a dependent in a sponsored membership in Hint, but is covered in the file as an employee without dependents, we will leave the existing membership and mute the error.

  • If patient is enrolled as an employee in Hint, but is covered in the file as a dependent, we will leave the existing membership and mute the error.

  • If patient is enrolled as a dependent in Hint, and is covered in the file as a dependent, we will leave the existing membership and mute the error.

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