I have a 834 5010 file (This is a test Non-PHI file) below. A member appears twice on the file within two separate ST/SE segments.
The first is the latest eligibility date range in the 2300.
The second is them terming the old one in the 2300.
I thought that a member could not appear in a file more than once and that this should have been collapsed into the first occurrence and they would have done 2 2300 loops. First with the terming of the old coverage and the second is the listing of the new coverage. Should they not only be in the file once with all the coverage listed in the 2300 loop?
In the additional examples supplied by the submitter, the file is a Full File Audit, which is not intended to be used to make changes to the enrollment database. The file also contained a different Group or Policy ID in Loop 2000 for the records showing an Eligibility Start/End vs. just an Eligibility Start. In this case, sending these in two different ST-SE transaction sets is much clearer to the receiver when using the information for their audit/compare processing.
While it is not the intent of the authors of the 834 transaction for member records to be sent in separate ST-SE transaction sets when everything within Loops 1000 and 2000 are the same, there is nothing in the TR3 which precludes this from occurring.
Regardless of which way the enrollment information is sent, receivers need to process the information based on the qualifiers and dates within each record, not based on the order of transaction sets in which they are sent.