Change Only File Submission Information (Prevea360)
Change Only File Submission Information method is required to be used when the enrolled number of members is greater than 500. A Change Only file is defined as BGN08 = 2 and Member Level Detail Loop 2000 INS01 <> 030.
Loop 2300, Health Coverage Dates, DTP01 = 348 should be submitted as follows:
- Dates align with the coverage year being reported or updated; or
- Dates always contain the Member’s Original Coverage Effective date. These Original Coverage Effective dates do not change annually.
When submitting change only files, Quarterly Audit files may or may not be submitted, but Prevea360 highly recommends audit files to ensure enrollment data is in sync (Full File defined as BGN08 = 4, and Member Level Detail Loop 2000 INS03 = 030 and Health Coverage Loop 2300 HD01 = 030). Annual Open Enrollment Files may or may not be submitted. Files received with no member level detail information (Loop 2000) will be rejected.
To learn more about EDI and become a certified EDI Professional please visit our course schedule page.