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Back  RFI # 2007: 834: DTP segment for Medicare?

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Submitter

Declan Moore

Description

When the Health Insurance Claim Number (HICN) is received for a Medicare-enrollee in a REF segment of the 2000 loop, what Member Level Dates are required in the following DTP segment(s)?
Are any Member Level Dates absolutely required?

Submitter Assigned Keywords

Medicare HICN DTP

Response

The 2000 Loop DTP – Member Level Detail segment’s Situational usage rule states: “Required when enrolling a member or when the sponsor is informed of a change to any applicable date listed in DTP01. Only those dates that apply to the particular insurance contract need to be sent. If not required by this implementation guide, do not send.”

Therefore, when sending an 834 for enrollment, or for a change to an enrollment involving a date listed in DTP01, the associated date(s) (DTP01) that are required to be sent are defined by the Trading Partners involved in the exchange of the transaction and are only the dates that apply to the particular insurance contract.
Submission 1/27/2015
Status Date 2/27/2015
Status F - Final
Primary References
Document 005010X220
Section2.4
Page57
Table2
Loop2000
Segment Position0200
Segment IDREF
Element Position01
Code ValueF6
Secondary References
RFI ID 2490
Document 005010X220
Section2.4
Page59
Segment IDDTP
Element Position01