Why do we sometimes need to assign a new ID number in Emerge?

1. A new/additional/separate Emerge number is needed when accumulators such as deductibles and CatCaps must accrue separately, start over, or begin to accrue on a new cycle.

1. A new/separate Emerge number may be needed to preserve the integrity of the claim history.

1. A new Emerge number may be needed so that restrictions such as the pre-existing condition limitation are properly enforced.

1. Sometimes, a new Emerge number is needed simply due to system restrictions and limitations.

Example situations where a new Emerge number is needed

1. The member re-enrolled in a new plan to get lower, entry-level premium rates (including insureds who move from Corporate to Retail). A new Emerge number is needed because the insured will need to satisfy a new pre-existing conditions limitation period and the deductibles and CatCaps must start over.

1. Splitting up two-sponsor families. Both the member and the spouse are in the military and they both qualify for TRICARE individually. If the TRICARE records are split, the supplement records must also be split. Each person needs a separate Emerge number so that deductibles and CatCaps accumulate separately.

1. The member marries a new spouse. If the original record included a spouse, but that spouse is now deceased or divorced from the member and the member has now married a *new* spouse, a new record in Emerge will be needed. The new spouse must have his or her own separate claims history, accumulators, etc.

1. Member and spouse/child enroll for different plan options. For example, one person signs up first and is on an old plan no longer available for enrollment (such as the Comprehensive plan). If new family members later sign up for coverage, they may be placed on a new business plan (such as High Option II). These family members cannot have the same Emerge number.

1. A new person needs to be listed as the military sponsor. This cannot be changed correctly without creating a new Emerge record.

1. The Corporate member pays via payroll deduction, but the employer will not deduct for the spouse or child premium. In this case, the member and spouse/child must have separate Emerge numbers.

1. Re-enrolling after a gap in coverage and the new effective date does *not* align with the beginning of a plan year (October 1 for TRICARE or January 1 for CHAMPVA). A new Emerge number is needed so that the deductible will re-set to zero.

1. Moving from CHAMPVA to TRICARE or vice versa. A new Emerge number will be needed so that the deductible and CatCap accumulators can accrue on the correct cycle (calendar year or fiscal year).

1. The member and the spouse divorce and the spouse will continue on his/her own separate record because he/she qualifies for TRICARE. The spouse will need a new Emerge record.

1. The Retail member has Prime but the spouse has Standard or vice versa. They will need separate records in Emerge. With Corporate, separate Emerge numbers would *not* be needed in this situation.

1. The Corporate member/spouse/child qualifies for CHCBP. A new Emerge number will be needed because CHCBP has its own separate CatCap. Any affected insureds in the family will need to be placed under the new Emerge number.

If Enrollment or IT assigns a new Emerge number, someone must make sure the Claims Department is notified.

The Claims Department should be notified when a new Emerge (XRef) number is assigned by another department. Certain changes do not sync from InsPro to Emerge.

If a CSR receives a call because claims are being processed incorrectly in the system and the problem may be due to one of the above changes, the CSR should notify the Claims Department using the standard claims inquiry procedure.

There are many situations where a new Emerge number is *not* needed.

If the situation does not fall into one of the above scenarios, then a new/separate Emerge number is probably not needed. When in doubt, please research with the Claims Department.