Understanding Reason Codes When Entities Decline Coverage

Evident's member submission workflow helps ensure the accuracy of your entities' submissions by presenting them with the specific items they need to meet your requirements and prompting them to explicitly choose those that are evidenced in their documents. Having your entities affirm and review the details of their submission reduces the chances of errors and improves their chances of becoming compliant with your needs.

As part of this workflow, and in order to improve the communications between you and your entities, they can choose from one of several options as to why they don't have one or more of the items you require (for example, a sole proprietor who doesn't have a workers compensation policy because they're the sole employee).

Your entities can choose from one of the following "reason codes" for each requirement they decline:

  • I’m declining coverage
  • I’d like to request an exception/waiver
  • I’m not renewing my policy
  • I don’t have this coverage

These reason codes are visible to you on the Entity Details page, using the Submission History feature, and whenever you use our compliance needs API endpoint to review non-compliant reasons for a particular entity.

Your entities are made aware in our workflow that selecting one of these reasons doesn't guarantee they'll be compliant with your requirements.

 

Viewing Reason Codes on the Entity Details Page

Now, when this situation occurs, you'll see the options displayed on the Entity Details page for the requirement(s) your entities declined.

 

Entity Details screen when entities choose "I’m declining coverage":

 

Entity Details screen when entities choose "I’d like to request an exception/waiver":

When you see this screen, you can click the green "Grant Exception for Requirement" button to grant an exception to this requirement. If there are no other non-compliant reasons for this entity, they will become compliant. This exception will be permanent until you remove it by clicking on the three-dot "Actions" menu.

You can of course grant an exception for any of the other reasons an entity declines a requirement as well; the view of this reason simply gives you a more direct way to accept an entity's request for a waiver or exception.

Note: If you don't allow your entities to request an exception or waiver, we recommend updating the text in your email templates to include this guidance in all notifications.

 

Entity Details screen when entities choose "I'm not renewing this policy":

 

Entity Details screen when entities choose "I don’t have this requirement":

 

If we've previously extracted data from an entity for a particular requirement and that entity doesn't include this requirement in a subsequent submission, we'll continue to show the most recently extracted data on the Entity Details page.

 

Viewing Reason Codes in the Submission History Feature

The specific reasons why an entity declines a requirement can also be viewed in the Submission History feature. When an entity chooses not to provide a requirement, you'll see a red triangle icon in the "Submission Date" column along with the reason.

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