834 Full File Submission Information (Prevea360 Health Plan)
834 Full File Submission is not allowed if the number of enrolled members is greater than 500. Change Only file submission will need to be utilized.
This excludes the initial full eligibility file for production go-live and quarterly audit files. A full file is defined as BGN08 = 4 and Member Level Detail Loop 2000 INS01 = 03. For a full file, Loop 2300 Health Coverage Dates, DTP01 = 348 should be submitted as follows:
- Dates always contain the Member’s Original Coverage Effective date. These Original Coverage Effective dates do not change annually; OR
- Dates always align with the coverage year being reported or updated. Once coverage for an upcoming/new coverage year has been submitted to Prevea360 Health Plan, any changes to the current coverage year must be handled with one of the following options:
- Integrate prior coverage year transactions containing previous coverage dates with the current coverage year full file. Note that one transaction per member per file is allowed.
- Send the prior coverage year transactions containing the previous coverage dates in a separate change file.
- Manual Reporting/Processing. Identified updates must be sent for manual processing. Please discuss this option with the EDI team.
To learn more about EDI and become a certified EDI Professional please visit our course schedule page.