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Back  RFI # 1844: 834 2100B DMG Demographics

Formal vs. Informal Help Informal Formal

Submitter

CHERYL KELLY

Description

005010X220A1
If a member does not have any changes to the data elements contained in the 2100B DMG segment (DOB, gender, Race, or Ethnicity) is it compliant to not send the segment? Our understanding is that the use of the 2100B DMG segment has no dependency when the Member Entity Identifier Code 2100A NM101 =IL (Insured or Subscriber) and the Incorrect Member Name Entity Identifier Code 2100B NM101= 70 (Prior Incorrect Insured). If the only changes apply to the 2100B NM1 Incorrect Member name segment, the 2100B DMG segment does not need to be reported. Is this correct? Our validation product is returning an error indicating that the 2100B DMG segment is required based on the NM101 values. Please advise.

Submitter Assigned Keywords

2100B DMG Incorrect Member Demographics

Response

The situational rule for Loop 2100B DMG requires sending the prior incorrect demographic information in this loop only when the member’s demographic information, i.e. birth date, gender, marital status, race or ethnicity or citizenship status, is being corrected. If this requirement is not met, then the DMG is not sent.

The Loop 2100B NM1 Incorrect Member Name TR3 note clarifies that when both 2100A and 2100B Loops are present and the NM101 values are 2100A NM101=IL and the 2100B NM101=70, only demographic information is being corrected and the 2100B DMG is sent with the prior incorrect demographic information. If changes are only to the identifying information, Loop 2100A NM101=74.
Submission 8/13/2013
Status Date 10/18/2013
Status F - Final
Primary References
Document 005010X220
SectionTable 2
Page89
Set ID005010
Table2
Loop2100B
Segment Position0800
Segment IDDMG
Element Position01
Industry NameDate Time Period Format Qualifier