Jacqueline, the message you are receiving citing the IG Front Matter is
already telling you the answer. The full file audit is intended to
identify all active members, and may or may not include terminated members.
The full audit file is not intended to accrete or terminate members. Take
a look at both Sections 2.5 and 2.6 in the front matter to get the full
understanding of the uses of the 834 in these situations.
Robert C. Pozniak
NYS Department of Health
HIPAA Practice Group
"Dougherty,
Jacqueline" To: "WEDI SNIP Transactions
Workgroup List"
<[EMAIL PROTECTED] <[EMAIL PROTECTED]>
com> cc:
Subject: 834 Transaction and full file
audit mode question
03/25/2003 11:27
AM
Please respond to
"Dougherty,
Jacqueline"
We are using two different compliance analysis tools and each give us
errors on the following.
Per the IG for the 834 Addenda:
2.6: Updates Versus Full File Audits
A full file audit lists all current members, whether involved in a
change or not. This facilitates keeping the sponsors and payer's
systems in sync. This is not intended to contain a history of all
previous enrollments. The full file audit is intended to identify all
active members, at a given time in time and may or may not include
terminated members based on the TPA. This type of transaction is
identified by a BGN08 code value of '4', Verify. Any response back to
the sponsor from the received transactions are outside the scope of the
834 and are the responsibility of the sponsor and payer.
We have BGN08 set to '4'.
On the 834 transaction in full file audit mode, how do you provide the
reason for termination when you want to terminate a member?
INS03 = 030 appears to be wrong regardless of the value in INS04
All feedback is most welcome!
Thank you,
Jacqueline Dougherty
HIPAA UAT Testing
First Consulting Group
425-918-3312
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