834 HIPAA Transaction Scenarios (Prevea360 Health Plan)

In today’s post we offer four 834 Transaction Scenarios. Find below the description and mapping.

Adding a Subscriber Scenario

John Doe is enrolling into the plan as a new-hire. His coverage is effective 4/1/17. His employment begin date is 4/1/17.

834 Transaction Scenarios

Changes include transactions such as address, name, phone number and divisions/plan/coverage changes. The example below shows an address change. John Doe changed his address effective 5/1/17.

834 HIPAA

Dependent Add Scenario example John Doe wishes to add his spouse Jane Doe to his plan effective 8/1/17. Subscriber information must always be included with dependent transactions.

834 mapping

834 EDI

Terminating a Subscriber Scenario

John Doe’s coverage is terminating on 9/30/17. You can submit termination transactions for all family members. Note though that a subscriber term will term the entire family. When terminating only a dependent, ensure that a change transaction for the subscriber is also submitted.

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