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Back  RFI # 159: HD data validation

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Submitter

Angela Hendrix

Description

004010X095A1 HD Send this segment is REQUIRED when enrolling a new member or when adding, updating or removing coverage from an existing
member. Is this validated against the INS03 or INS04? (Since the INS03 is required, it would seem the best validation would be INS03 = 001, 021, 024, or 025. However, the business scenarios show the INS with codes 001, 024, and 025 without also sending an HD.)

Submitter Assigned Keywords

HD INS enrolling 834

Response

The HD segment is required when the INS03 is ‘021’ indicating an add. This takes care of the enrolling a new member requirement. The other times when the HD segment is required are related directly to the HD segment itself. The HD segment represents the coverage of a member, so if you are adding, updating or removing coverage of a member, then the HD segment is required.

The INS03 element is used to indicate the reason that maintenance is being performed on the member, but not necessarily on the member’s coverage. A member can have a change of address, yet there is no change in the member’s coverage. This is an example of where INS03 would = ‘001’ and the HD segment would not be sent at all.
Submission 12/1/2004
Status Date 1/21/2005
Status F - Final
Primary References
Document 004010X095A1
SectionDetail
Page128
Set ID834
Table2
Loop2300
Segment Position260
Segment IDHD
Secondary References
RFI ID 122
Document 004010X095
Section4.6
Page162
Set ID834