Automatic Enrollment with Eligibility Sync

Automatic enrollment lets Eligibility Sync do the enrollment work for you. When it is turned on, every eligible employee in a processed eligibility file is created as a patient and enrolled in the employer's membership plan, with no manual step in between.

This is the counterpart to automatic termination: one keeps new hires enrolled, the other ends memberships when employees leave.

Automatic enrollment requires Eligibility Sync to be set up for the employer. To learn how eligibility files are received and processed, see Eligibility Sync Overview.

Turning automatic enrollment on

Automatic enrollment is a per-employer setting, off by default, so you can automate some employers and keep others manual.

Go to Employers and select the employer.
On the Overview tab, find the Eligibility Sync section and click the edit button.
Turn on Automatic enrollment, set the enrollment defaults described below, then save.

Changes take effect on the next file sync. While automatic enrollment is off, nothing about your current workflow changes: employees still appear in the Eligibility Sync table after each file, and memberships are created only when you create them.

Enrollment defaults

Charts created from an eligibility file need a location and a clinician, since the file does not carry either. When you turn automatic enrollment on, you set a default location and a default clinician that every automatically created chart is assigned to.

If your practice has a single location, it is used automatically and you are not asked to choose. The same applies to the clinician when only one clinician is available at that location. You can reassign any patient afterward from their chart.

Membership start dates

Enrollment runs at 12:00 am on the start date, in the practice's time zone. The start date decides not only when billing begins, but also when the enrollment happens at all:

The date has already passed — the employee is enrolled right away, with the membership backdated to that date.
Date in the future — nothing is created yet. The chart and the membership are both created when the date arrives. This is intentional: an active chart before the coverage start date could suggest the employee is ready to be seen when billing is not yet possible.
Date changes before it arrives — if a later file has a different start date for an employee who is still waiting to be enrolled, the new date replaces the old one.
No date at all — if the file has neither a benefit start date nor a hire date, the employee is skipped.

How dependents are handled

Dependents are always processed after every employee in the file, so their subscriber's status is known first.

The employee is enrolled — dependents are added to that membership as additional seats, using the same start date rules. Seats are filled youngest first until the plan's seat limit is reached. If there is no seat left, the dependent is skipped and you receive an error email.
The employee is not enrolled — the dependent is enrolled on their own membership instead, following the same plan and start date rules. A dependent is never left out only because their subscriber could not be enrolled.

Dependents go through the same checks as employees: already-enrolled dependents are skipped, charts are created when needed, and a plan name that does not match results in a skip and an error email.

When an employee is not enrolled

Practice admins receive an Error processing automatic enrollment email for every employee who could not be enrolled. These alerts follow the same notification preference as the daily eligibility sync summary, set in Team Management.

In every case, the employee stays in the Eligibility Sync table, so you can always resolve it there.

Notifications

The daily Eligibility Sync summary email shows (Automatic) next to every employer with automatic enrollment turned on, so you can tell at a glance which rosters are being maintained for you and which ones still need manual work. Error emails are sent as they happen, one per skipped employee.

Rehires and re-enrollment

An employee who returns with a canceled membership and a new benefit start or rehire date is treated as a new enrollment: a new membership is created from that date on the existing patient chart. Their history stays in the chart.

One case stays manual. If an employee was previously marked as ineligible because they disappeared from the file and later reappears without a termination date, they are not enrolled automatically. Re-enrolling them is a deliberate action you take from the Eligibility Sync table.

What automatic enrollment does not do

It does not enroll the employees already in the table. Turning the setting on has no retroactive effect. It applies to the next file received.
It does not change enrollment fees. Automatically enrolled memberships follow the plan's standard enrollment fee configuration.
It does not replace review. Employees who fail any check are left for you to handle from the Eligibility Sync table.