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Back  RFI # 764: Reporting Member Dates in 834

Formal vs. Informal Help Informal Formal

Submitter

Penny Probst

Description

We have a project that requires us to report an effective date for members affected by Michelle's Law (College students on a medical leave from classes). We inititally looked at using the Member Level DTP segment, but did not see an appropriate qualifier. How can this be reported on the 4010A1 834?

Thanks

Response

This issue isn't explicitly addressed in guide 004010X095. There are two possible locations for this information. Since INS09 will indicate the enrollee is a student, the 2200 loop (Disability Information) can be used to indicate that the enrollee is also disabled as a student. The disability dates would then identify the begin and end dates for this situation. In addition, or as an alternative, the HD04 element can contain text specifically agreed to by the health plan for carrying information related to this situation.

Recommendation

Use the 2200 loop to identify the date(s) related to the student's medical leave from classes and use the HD04 element to specifically carry the term "Michelle's Law", along with any other information specified by the health plan.
Submission 4/16/2009
Status Date 6/10/2009
Status F - Final
Primary References
Document 004010X095
SectionDetail
Page59
Set ID834
Table2
Loop2000