Just out of curiosity, perhaps you can elaborate as to why the 834 is being used for your business scenario as opposed to the 271 eligibility roster? Now on to your questions...
The definition of handicapped and disabled is not incorporated into the guide because these are generally defined as part of the contract between the sponsor (usually an employer) and payer/plan or intermediary. The most common example is where a child's insurance coverage ends at a particular age (usually 23 years old) unless that child is handicapped. In order for the insurance to continue, sponsors usually are required to report the handicap status of the child in order to prevent payers from automatically terminating the child's coverage.
What to do if you don't know the handicap status of the member? Interesting question, since we made the element required IF the member is handicapped. What we authors probably should have done is incorporate situational language similar to what we did with INS09 (Student Status Code).
If the member did not report handicap status upon enrollment, then my opinion is that you do not know their proper status and this element is not reported at all in your 834. I don't think that defaulting the value to "N" is a good option as this implies you do know the handicap status of your membership. Others may disagree. Another debate that comes to mind is that, as a covered entity, shouldn't you be capturing this information in the first place if you are enrolling membership and reporting it to others using the 834?
The DSB disability loop was intended to provide additional information relative to subscribers covered by components of the insurance contract for short-term, long-term, or total disability. Many carriers stratify their groups into active and disabled membership; employers often have different benefits for their disabled employees. The IG's industry segment note refers to using the DSB loop when enrolling a disabled member, but this conflicts with the X12 standard's DSB set note #1 which states that "The DSB loop may only appear for the Subscriber". My opinion is that this loop is only be used to report the disability status of a subscriber. If your subscribers are not indicating their disability status to you, then you don't know what their disability status is so the DSB segment wouldn't be sent.
Since we did not explicitly specify in the IG that INS10 (Handicap Indicator) was for non-spouse dependents with a qualifying condition (blah blah blah), and in the absence of definitive language relative to handicap vs. disabled in your trading partner agreement or benefit plan documents, it may behoove senders of the 834 that have handicapped/disabled subscribers to set INS10 to "Y" and also send the DSB loop for the subscriber. If you are reporting a handicapped/disabled dependent, then INS10 gets set to "Y" but the DSB isn't sent because of the set note that specifies that it is for the subscriber only.
Hope this helps!
Paul Weber
916-449-6970
----- Original Message -----
From: "Tatge, Ellen" <[EMAIL PROTECTED]>
Date: Thu, 18 Jul 2002 16:09:47 -0600
To: "''[EMAIL PROTECTED]''" <[EMAIL PROTECTED]>
Subject: 834 Handicapped/Disability Data
We are a health plan and are currently working on creating the 834 enrollment transaction to send to our trading partners who pay claims on our behalf. We have questions on how others are handling Handicap and Disability information
1) Handicap Indicator (Loop 2000, INS10). This is a situational element, but "REQUIRED if the member is handicapped". We collect this information for some but not all members within all lines of business. It is not information that is used to determine claim payment.
- does anyone have an operative definition of "handicapped" for the purposes of completing this transaction?
- how are others approaching supplying data for this field - is anyone else finding that the line of business doesn't require collecting handicapped data so that they cannot determine whether this field should be set to "yes" or "no"?
2) Disability Information (Loop 2200). This is a situational loop and "should only be sent when enrolling a disabled member." The loop requires specification of whether the disability is short-term, long-term, or permanent/total. We do not currently collect any such information; nor is it needed to determine claim payment.
- does anyone have an operative definition of "disabled"?
- how are you handling this field?
3) If 'Handicap Indicator' is sent as "yes", must Disability information also be sent on the transaction? The IG is silent on this relationship, but unless 'handicap' is defined differently than 'disability', it would seem that if a person is handicapped, the type of disability is being required.
thanks,
Ellen Tatge
IS Project Manager
Presbyterian Healthcare Services
505/923-6882
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********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request. ====================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.