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HIPAA EDI 834 Change In Coverage For An Employee With A Divorce Does Not Appear On The HIPAA Full-File-Audit File (Doc ID 2013584.1)

Last updated on JULY 25, 2019

Applies to:

PeopleSoft Enterprise HCM Human Resources - Version 9.1 to 9.2 [Release 9]
Information in this document applies to any platform.


When an employee changes a Health benefit election due to divorce, where the coverage code only is changed and the Deduction Begin Date is earlier than the Coverage Begin Date of the new record, the employee's and their children’s coverage does not appear on any HIPAA Full File Replacement file created between the two dates.

The issue can be reproduced at will with the following steps:

1. Hire a new employee on Feb 1/12. Employee is married with spouse and 2 children. Employee is on bi-weekly payroll.
2. Process the HIR event. Enroll the employee in KUMED2, coverage code 4 family coverage, as of Feb 1/12.
3. Employee is divorced as of Oct 21/14.
4. Employee's enrollment is changed to coverage code 3 in KUMED2, as of Nov 1/14.
5. Ran HIPAA 834 3 times for the test - dates and results
a. Jan 1/13 - to show Full File Audit baseline record. All records there with E6D family coverage
b. Oct 26/14 - to get the baseline after the Divorce FSC event was processed.
Only the divorced ex-spouse is in the HIPAA output file, with her coverage termination record.
The revised coverage code info for the rest of the Klein family is not showing. It should still be included in the Full File Audit as they still
have coverage.
c. Nov 1/14 - to confirm the records reappear as of the coverage begin date. All records there with E5D employee + children coverage




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