We will be consuming
the 834 enrollment and require data that does not appear to have a place on the 834v220A1. It is our understanding that this data can then be sent in the Reporting Category Reference loop 2750.
We would try to use the appropriate Reference Identification Qualfier at 2750.REF01 and need a more detailed description for each:
00 Contracting District Number
17 Client Reporting Category
18 Plan Number
19 Division Identifier
26 Union Number
3L Branch Identifier
6M Application Number
9V Payment Category
9X Account Category
GE Geographic Number
LU Location Number
PID Program Identification Number
XX1 Special Program Code
XX2 Service Area Code
YY Geographic Key
ZZ Mutually Defined
In addition, is the 834 still in compliance used a qualfier for a different purpose (i.e., used LU Location Number qualfier to reference a billing exclusion flag)? There will be multiple values that need to be reported so ZZ cannot be used for each unless the loop is repeated, correct?
The qualifiers for which an extended definition is available in the underlying ASC X12 standard are as follows:
17 Client Reporting Category - Code assigned by the client to categorize participants for reporting requirements
18 Plan Number - The unique identification number assigned for a defined contribution plan.
The TR3 does not define the qualifiers further. The member reporting category being reported is named in the N1 segment and the REF segment contains the identifier for the member reporting category that is identified in the N1. The qualifier in REF01 identifies what the type of identifier is.
Qualifier ZZ in the 2750 REF01 can only be used to identify one type of identifier within an implementation. If, for example, LU=Location Number, is the identifier for member reporting category “Billing exclusion flag”, this would be clarified within a companion guide.
The absence of specific definitions for qualifiers in the TR3 allows business partners to define their meaning within the context of their business.
Section 2.2.1.1 clarifies transaction compliance, which is “when it satisfies the requirements as defined within the implementation guide.” Compliance under HIPAA is a policy issue and is the responsibility of CMS not ASC X12.