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Back  RFI # 229: 834 - Clarify Policy Number

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Submitter

Mark Minadeo

Description

We have a clarification issue as to the requirement for entering a policy number on the 834 transaction. According to our interpretation of the IG, there are 3 places you can enter a policy number in the 834:
1. Header Level REF, qualifier 38
2. 2000 Loop Member Detail REF, qualifier 1L
3. 2300 Loop Health Coverage REF, qualifier 1L

The note at the header level defines a master policy number that can be used for the entire transaction set. The note at the member (2000) level defines a policy number in the REF segment which is required unless the policy number is entered at the coverage level. The note at the coverage (2300) level identifies the policy number in this REF segment as 'should be used when not entered in the header (REF02 1-030) or member (REF02 2-020) levels'. Can the header level policy number represent the whole transaction, without also having to enter a policy number in either the 2000 or 2300 loop?

Thanks very much,
Mark Minadeo

Response

You cannot use only the Header/REF Transaction Set Policy Number [see note on the 2000/REF]. The policy number must be present in either the 2000/REF Member Policy Number OR the 2300/REF Health Coverage Policy number.
Submission 4/1/2005
Status Date 6/13/2005
Status F - Final
Primary References
Document 004010X095A1
Section2000
Page53
Set ID834