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Back  RFI # 2021: INS06 COB in 834

Formal vs. Informal Help Informal Formal

Submitter

Jason Martin

Description

We have a vendor who is insisting on sending C:0 in INS06, in combination with the SSN, for a member who has Medicare Part A & B already. Our compliance checker is throwing an error because it believes that the vendor is attempting to enroll the member in Medicare. We believe that the Medicare Part A & B should show in the COB loop instead.

Submitter Assigned Keywords

COB 834 INS06

Response

INS06 is Required when a member is being enrolled or disenrolled in Medicare, is currently in Medicare or has terminated or changed their Medicare enrollment. This conveys the Medicare status of the member. The coverage in which the member is being enrolled or is enrolled in is defined in other data elements within the transaction (see Loop 2300 Health Coverage), not INS06.

If the coverage in which the member is being enrolled or is enrolled is a Federally administered program, then the SSN may not be used to identify the member.

If the member is known to have another insurance plan with benefits similar to those covered by the insurance product specified in Loop 2300 Health Coverage, then information about that insurance plan is sent in the Coordination of Benefit loops (2320, 2330)
Submission 2/26/2015
Status Date 4/6/2015
Status F - Final
Primary References
Document 005010X220A1
SectionTable 2