Eligibility Sync Overview

Eligibility Sync is an automated process that keeps employee records up to date inside SigmaMD. When enabled, the employer sends regular data files containing employee information, and SigmaMD automatically processes these files to update the employer roster.

This feature ensures that employee data stays accurate without requiring manual updates. To enable it, please contact our support team.

How it works

  1. The employer sends an eligibility file

    The data file contains basic employee information such as name, date of birth, email, employment dates, benefit start date, and other fields included by the employer.

  2. SigmaMD processes the file automatically

    After the file is processed, all employees listed in the file appear in the Eligibility Sync tab for that employer.

  3. The table is updated with the latest information

    When a new data file is received, existing employees are updated and new employees are added automatically.

How employees appear in this list

Employees are displayed in this section only if they are included in a successfully processed eligibility file. If an employee is missing from the file or has outdated information, the next file submission will update the record.

Automatic enrollment

Eligibility Sync can enroll employees for you, so new hires get a patient chart and a membership without a manual step. Automatic enrollment is set per employer and is off by default. To turn it on, go to the employer's Overview tab, click the edit button on the Eligibility Sync section, and turn on Automatic enrollment. You also select a default location and a default clinician, which are applied to the charts created from the file. Changes take effect on the next file sync.

With it on, each processed file is reviewed employee by employee:

  • Employees who already have an active membership with this employer are skipped.
  • Employees without a patient chart get one created from the file data. If the employee matches an existing patient, no chart is created and you receive an error email so you can link the records yourself.
  • The membership starts on the benefit start date, or the hire date when there is no benefit start date. Past dates are enrolled retroactively; future dates wait until the date arrives.
  • When the employer has several membership plans, the plan name in the file is matched against the plan names in SigmaMD. If nothing matches, the employee is skipped and you receive an error email.
  • Dependents are added to the employee's membership as extra seats, or enrolled on their own membership when the employee is not enrolled.

Turning automatic enrollment on does not enroll the employees already listed in the table. It applies to the next file received.

Automatic termination

Automatic termination is the counterpart: it cancels memberships when employees leave, so the employer is not billed past the employee's term date. It is also set per employer, off by default, and turned on from the same Eligibility Sync edit screen.

Two settings come with it:

  • Grace period — extra days to keep the membership after the term date, up to 365. The default is 0, which cancels on the term date itself.
  • Inactivate chart — how many days after the termination the patient chart moves to Inactive, up to 90. On by default with a 30-day delay, so the care team can close out any remaining care.

With it on:

  • The membership is canceled at 11:59 pm on the term date in the file, using the benefit end date when there is no term date. A date already in the past cancels right away.
  • Terminating the employee also ends coverage for their dependents. A dependent's own term date removes only that dependent.
  • The employee is marked Ineligible at the end of the day of the term date, and the row shows an upcoming termination indicator before that.
  • Re-enrolling someone who returns is always a manual action.

An employee who simply stops appearing in the file is not terminated. Only a term date or a benefit end date triggers an automatic termination.

Actions from the Eligibility Sync screen

From this table, you can review and manage an employee’s link to SigmaMD:

If the employee already has a patient profile in SigmaMD, you can manually link the employee record to that patient.

Enroll the employee in a membership plan

If the employee is eligible, you can enroll them directly into any of the employer’s membership plans.

Remove a membership

If needed, you can remove the employee from their membership plan through this same page.

These actions will be covered in detail in separate articles.

Data files

All processed eligibility files are stored in the Data Files section on the right side of the page.

From there, you can:

  • View the list of past files
  • Download any file for review
  • Confirm the date each file was processed

Downloading data files can be helpful for verifying the information submitted by the employer or troubleshooting inconsistencies in employee data.

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