834 File Requirements (Prevea360 Health Plan)
834 File will be used as an audit file to make sure the records for both parties are in sync prior to moving to production. While Prevea360 can accept both full enrollment files and change only files, it prefers to receive change only/event only files on an ongoing basis for groups with greater than 500 members. Below are the different options for submitting 834 Benefit Maintenance Transactions. Limitations do apply.
Regardless of sending a full file or a change only file, the trading partners must send a new or updated Health Coverage effective date (Loop 2300, Health Coverage Dates, DTP01 = 348) in the below situations:
- Initial Member Enrollment: Member enrolls for coverage effective on 1/1/2017. Member’s Health Coverage effective date will be 1/1/2017 on the 834 file.
- Gap in Coverage: Member initially enrolled effective 1/1/2010. Member termed 12/31/2015 and a termination was provided at that time. The Member comes back effective 1/1/2017 the Member’s effective date will be 1/1/2017 on the 834 file.
- Division/Plan Coverage Change: Member initially enrolled effective 1/1/2010. Member changes to a retiree coverage effective 1/1/2017. Member’s effective date for the new coverage will be 1/1/2017 on the 834 file. The group/policy number will reflect the new division.
Identified demographic changes will use the Maintenance Effective date if present (Loop 2300, Health Coverage Dates, DTP01 = 303). If this date is not present then demographic changes will be made effective with the file’s process date.
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