Agents/Brokers: Important NPN Tips for Re-enrollments

The Centers for Medicare & Medicaid Services (CMS) would like to provide you with a few tips to ensure that your National Producer Number (NPN) is retained when your clients re-enroll in coverage through the Marketplace for plan year 2016.

Please note that the following guidance applies only to the Marketplace for Individuals and Families. NPNs are automatically carried over when agents and brokers assist small employers when logged into the Small Business Health Option Program (SHOP) Marketplace Agent/Broker Portal.

·         Tip #1: When helping a consumer use the “Side-by-Side” (i.e., Marketplace) enrollment pathway at HealthCare.gov, check to see if your NPN is included on the application. If not, have the consumer enter it before the consumer closes out the application. Ensure the consumer enters the correct NPN and then direct the consumer to click “Save & Continue” to move forward. If contacting the Marketplace Call Center about a consumer’s application, ensure your NPN is still associated with the application. If your NPN is not there, consumers may have the Marketplace Call Center add or re-enter your NPN to an application when making updates to it.

·         Tip #2: When helping a consumer with a renewal for plan year 2016 using the Direct Enrollment pathway, make sure to move the consumer through “Report a Life Change” to make updates and confirm information. If an application submitted via Direct Enrollment last year is not touched by you this year, the auto re-enrolled application may not contain your NPN; thus, this NPN may not be included in the enrollment transaction sent to the issuer. If you continue to the partner (i.e., issuer or web-broker) website after helping the client use “Reporting a Life Change” and selecting the same or a new qualified health plan (QHP), your NPN will be generated on the enrollment transaction sent to the issuer.

If you have a legitimate reason to believe you should be credited for a Federally-Facilitated Marketplace (FFM) enrollment, but have not been credited for it, you should contact the respective QHP issuer directly to discuss the specific situation. If the QHP issuer believes you did, in fact, assist a consumer, but the NPN was erroneously left off of the enrollment transaction, the QHP issuer may pay the commission accordingly. Please note that agents and brokers must meet registration requirements prior to assisting with an FFM application to be credited for the enrollment transaction. For more information about plan year 2016 FFM registration requirements, please visit the Agents and Brokers Resources webpage.

For general questions about the agent and broker program, please email the FFM Producer and Assister Help Desk at FFMProducer-AssisterHelpDesk@cms.hhs.gov. You may also contact the Agent and Broker Call Center by calling 1-855-CMS-1515 (855-267-1515) and selecting option “1.” Call Center Representatives will be available Monday through Saturday from 8:00 AM to 10:00 PM Eastern Time (ET) and will also be available during limited hours on Sundays and holidays through November. Please note that this call center will not have access to consumer information and will not be able to handle specific questions or issues with a consumer’s application. Agents and brokers should continue to call the Marketplace Call Center at 1-800-318-2596 for assistance related to enrolling consumers into coverage through the Individual Marketplace. For assistance related to coverage through the SHOP Marketplace, contact the SHOP Call Center at 1-800-706-7893.