A change file as found in section 1.4.5 of the 834 v5010 implementation guide, is defined as transactions that contains information about the changed members. What was the intended definition of a change file, in terms of remittance of multiple time spans or a single point in time for ease of processing? Is it compliant that a change file contain members who contained a change, but will contain the members full history with the sponsor? The change will be somewhere in the history but likely in one part of the history, not all. Complete historical remittance would seem to not be in alignment with the change file being the most efficient method for regular maintenance of enrollment files.
Additionally should the full history of a member be allowed on a change file, what would be the value for Loop 2300 HD segment HD001, if all time spans are not changing? Should only the changing time span be submitted with code 002, or is it compliant that all time spans have 002, when not all spans are being modified?
This issue is specifically addressed in the 005010X220A1 TR3. The BGN08 element, Code ‘2’ specifies that a change file is ‘a transaction of additions, terminations and changes to the current enrollment”. Therefore a change file would not include a member’s full history with the sponsor and would only address changes at a point in time (current enrollment). A change file could address multiple time spans, assuming the coverage related to those differing times spans is being changed (modified, added or deleted) and not just being reported as historical data. Additionally, the 2300 HD Segment Situational Rule for usage states the segment is ‘Required when enrolling a new member or when adding, updating removing coverage or auditing an existing member. If not required by this implementation guide, do not send’. Therefore, if a particular coverage is not being changed (updated, added, removed) at the current time, such is the case with historical data, it should not be sent.
The applicable 2300 HD01 code to be sent on a change is dependent on the type of coverage change or update being reported. A change or update to existing coverage would be reported using code 001. Code 002 would be used to delete a previously reported, incorrect coverage record. Code 021 would be used to report the addition of a new type of coverage, and so on.