834 EDI

Prevea360 Health Plan EDI 834 Implementation Guides

EDI 834 Transactions must be submitted in the proper order to ensure correct processing. For example, an add transactions must be submitted on a file and processed prior to a termination transaction being submitted for a given member. It is recommended that the full population is submitted in the 834 file (including retirees and COBRA divisions). Once a group goes live with an 834 file Prevea360 Connect portal can no longer be used for any enrollment changes, including those for members in divisions not included in the 834 file, and paper applications will need to be used.

Typically multiple transactions for the same person should not be included on the same file. If your system commonly generates multiple transactions for the same member within the same file, please contact the EDI team for additional details on the “request submit timestamp” functionality within the 2700 Additional Reporting Category Loop.

Prevea360 will not process termination records by omission or dropped records; a maintenance reason code and a termination/coverage end date must be sent on the 834 file for each terminated record. When sending a Full File, continue to send terminations until the termination date has passed. To send a cancel or void transaction for a member that was sent in error and should be removed from Prevea360 system, send the member with a Loop 2300 DTP segment where the Benefit Begin and Benefit End dates are equal.

To learn more about EDI and become a certified  EDI Professional please visit our course schedule page.

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