Benefits Enrollment and Maintenance Standard 3.1

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UHIN Benefits Enrollment and Maintenance Standard is compatible with all HIPAA requirements.

Purpose:  The purpose of this Standard is to detail the Standard transactions for the transmission of health care benefits enrollment and maintenance in the state of Utah.

Applicability:  The Benefits Enrollment and Maintenance Standard applies to all health care benefits enrollment and maintenance transactions when agreed upon by trading partners.

Detail:

  1. Standard Benefits Enrollment and Maintenance transaction:

The UHIN Standard for benefits enrollment and maintenance transaction is the HIPAA ASC X12 834 005010X220A1 Benefits Enrollment and Maintenance.

See the Washington Publishing Company web site (http://www.wpc-edi.com) to purchase a copy of the implementation guide.

  1. It is recommended, but not required, that a 999 be returned to acknowledge receipt and communicate problems with data.
  2. As of this writing there is no named national standard response to the enrollment transaction and data issues may be handled by non EDI communications, such as:
    • Communications via phone, fax or email
  3. Connectivity guidelines are specified in the UHIN Connectivity Companion Guide.

Insurance Line Codes

The Insurance Line Codes do not cover all current lines of business. The UHIN community has agreed that for these new lines of business, the following are required: 

For Health Savings Plan (HSA)

Loop 2300

In the HD03 use insurance line code HLT, with a Health Savings Plan description in the plan coverage description HD04

 

For Health Reimbursement Arrangement (HRA)

Loop 2300

In the HD03 use insurance line code HLT, with a Health Reimbursement Arrangement description in the plan coverage description HD04

 

For Medical Savings Account (MSA)

Loop 2300

In the HD03 use insurance line code HLT, with a Medical Savings Account description in the plan coverage description HD04

 

For other lines of business that may be created the same method may be used. 

 

Note: Prior usage trading partners need to agree on the descriptive text in Loop 2300, Health Coverage Segment - HD04.

 

IMPLEMENTATION ISSUE:

  1. Update files need to be processed by the receiver in the order the files are created. Creation date and time is found in Beginning Segment - BGN03/04. By not processing them in chronological order, eligibility may be adversely affected.
  2. Some payers may have multiple records for the same individual, with different member ID numbers.

 

 

Version 1

Version 2

A* 2.1

V3

V3.1

ORIGINATION DATE

12/14/99

08/2002

03/09/04

2/9/2010

8/13/2014

APPROVAL DATE

04/11/01

09/09/02

11/06/04

02/02/2011

9/10/2014

EFFECTIVE DATE

05/11/01

09/09/02

12/06/04

03/02/2011

11/5/2014

 

 

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