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Back  RFI # 824: Full file replace and terms

Formal vs. Informal Help Informal Formal

Submitter

Lori Harvey

Description

We would like a clarification on the IG/TR3 x220. We would like to specify in our TPA with our partners that if we receive a full replacment type file, we will not terminate members by absence. We would like to require our partners to send termination records, so that we can insure the intent of the partner. We believe we can do this, based on the information in business usage sections 1.4.4 and 1.4.5.

Can you please confirm that we can specify this in our trading partner agreements and we are in no violation with the intended usage of the full replacement function and the IG.

Response

This issue is explicitly addressed in guide 005010X220. Section 1.4.4 states "In the case of a full file replacement, member records that were previously reported as covered and subsequently omitted from the full file replacement can be processed in various ways by the receiver as described in their trading partner agreement." As a result, it is consistant with this guide to specify in your trading partner agreement (TPA) that you will not terminate members missing from a full replacement file and that you require a specific termination instruction.

Recommendation

Independent of the guide termination instructions related to a full file replacement, it is prudent for your TPA to also identify what action you will take when active members are missing from a full file replacement and a separate termination instruction is not received, so as to maintain the accuracy of your enrollment database.
Submission 7/31/2009
Status Date 9/20/2009
Status F - Final
Primary References
Document 834 x220
Section1.4.5
Page4
Set ID834