Group Sales API

Electronic Groups Enrollment Process Overview

Humana’s electronic small business group enrollments process aims to enable our external sales partners with a set of technology tools they can use to sell community rated Humana medical, dental and vision plans to employers. These tools are designed for partners with internal technology capabilities; specifically, the ability to create their own enrollment forms that call Humana’s RESTful API. For more information on RESTful APIs, visit http://www.restapitutorial.com/lessons/whatisrest.html.

Getting Started

Plan and Rate Data for Quoting

Your onboarding manager can help you gain access to Humana plan and rate date data for your quoting needs. Humana enables delivery of plan and rata data files through its ETSS (Electronic Transmission Self Service) program. We’ll collect some information from you, and then set up a periodic batch delivery of a flat file to a secure DropBox location. We’ll provide you with the credentials you’ll need to access that file at will, either manually, or by automating your own systems to download it on a scheduled basis.

Preparing Your Enrollment System and using The Humana APIs

Group Sales Partners who wish to submit enrollments via our API will need to know how to build their enrollment forms to meet Humana enrollment requirements. Humana will provide you documentation detailing all of the required form fields, along with plan, group and agent business rules and form logic. This documentation will be available to your developers in our API Developer Portal, or from your Humana onboarding manager.

Your developers will need comprehensive API documentation, also found in our developer portal. Our API endpoints support creating an employer group, populating it with members, and submitting the entire package of data to Humana for enrollment in the selected plans. Each of these steps consists of a form submission from you that makes a specific API call to Humana’s system. In each case, our API will return a response. If there is a problem with the submission, the API will return useful error messages. If it is a successful submission, the API will return a message acknowledging this, along with other data your system will need to advance to the next step of the enrollment process.

The Enrollment Process – Four Steps

Create a Group

The first step is creating a Group in the Humana system. Collect the required group information, e.g. employer name, address, and preliminary member census data. You will build a group enrollment form that meets the specifications of our business rules documentation (as described above), and program it to connect to our API server. Upon successful form submission, the API will return a Humana Group ID. You’ll retain this for use in the subsequent steps.

Validate Members

As open enrollment proceeds, you will collect your subscriber, spouse and dependent details. As you gather the required data fields, you will store them locally until open enrollment ends. Humana will ask you to do two things with this data during this period:

Submit the data fields for each covered life to our validation API. If there are any missing fields or flaws in the field values, the API will return an error message that you can use to effect corrections.

Once validated, assemble the field values in an EDI 834 file format for final enrollment in a subsequent step.

Finalize Group

When all of your member data is collected and validated, you will need to make an API call to finalize the group, which allows our system to validate and finalize the plan rates. This readies the Humana system for the final step, enrolling plan members.

Enroll Members

The final API call triggers an upload of your EDI member file. The API will acknowledge receipt of the file. Our internal enrollment processes will not be completed instantly, so you may elect to make another API call designed to return a status report on the enrollment file. When the processing is complete, the file status API call will return a success message, and the entire process is complete.

We’re Here to Help

Your onboarding manager will help you through every stage of the partner onboarding process. The final step of onboarding will be access to our developer portal. At this time you may elect to begin integrating our API into your enrollment system.

All of the info you will need may be found at developer.humana.com, where you will first create an account, then name and describe your enrollment application. Finally, you’ll request an API key that allows you to tie your application to our APIs. As you begin to test the APIs our technical team will be available to answer questions. When you are ready to move from the test environment to live enrollments, our technical team will coordinate a “soft launch” with you, where we collaborate to track each live enrollment end-to-end. Once both parties are assured that the connection is fully functional, your transition to electronic enrollments with Humana plans will be successfully completed.

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