HIPAA 834 5010 Request For Functionality To Use Loop 2300 With DTP*303 Segments Rather Than Only Loop 2000 (Doc ID 1503382.1)

Last updated on NOVEMBER 01, 2024

Applies to:

Symptoms

The instructions for the DTP record of '303' suggest loop 2300 should be used rather than loop 2000.

Request the option to generate HIPAA 834 5010 enrollment information using loop 2300 (Health Coverage Level) with 303 (maintenance effective date) and/or 348 (benefit begin date) segments, rather than just the current default of loop 2000 (Member Level).

In loop 2300, the product only generates Date Time Qualifier values 348 (Start date), and 349 (End date).  The  value '303' is never generated.  The definition has not changed between 4010 and 5010, so there were no changes to the logic.

The following is more detail on criteria for loop 2300 to be used in HIPAA 834 output files:

Group numbers are provided at the Loop 2300 level, but only if they are different between plans. The vendor can always get the group number from Loop 2000 if it is the same for all plans.

The file hierarchy per vendor is as follows:

Vendor
--> Member (employee) level data (Loop 2000)
---> Plan type 1/plan xxx (Loop 2300)
---> Plan type 2/plan yyy
---> Plan type 3/plan zzz
---> etc

If the group numbers are the SAME for all the plans within the 3 plan types, then no group numbers are generated at the lower loop 2300, and the common group number is generated at the higher Loop 2000 member level instead.

If ONE OR MORE of the group numbers for the plans within the 3 plan types IS DIFFERENT, then there isn’t  a common group number to put at the higher Loop 2000 member level, and they have to be kept individually at the lower plan level loop 2300.
The idea is that if the group number is the same for all plans the employee is enrolled in FOR THAT VENDOR, then it has to be provided only once at the higher Member level.  Conversely, if just one of them is different, then the group numbers are kept at the lower Loop 2300 plan level.

This logic fits the Loop 2000 REF Member Policy number situational rule per the HIPAA guide.


On a demo sandbox replication, the following was the configuration:

Medical
Vendor USAKUKAISR has been set up with group number M55555
This vendor is used on 2 medical plan type 10 plans: KUHMO2 and KUHMO3.  On those plans, the same M55555 group number has been defined (prompts for group numbers from the vendor setup).

Dental
Similarly, vendor USAKUDELTA is set up with group number D345676
This vendor is used on 2 dental plan type 11 plans: KUDEN1 and KUDEN2.  On those plans, the same D345676 group number has been defined

Vision
Vendor USAKUSP is set up with group number V00123
This vendor is used on 2 vision plan type 14 plans: KUVIS1 and KUVIS2.  On those plans, the same V00123 group number has been defined

Cause

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