Section title: Requests for Interpretation
RFI #
2412
834 ANSI Full Replacement File
Description

I have a few questions regarding the 834 ANSI Specifications document. Please see below.
For the Full Replacement File (BEGN08 code of RX):

1. The specification document says it includes, "all active members at a given point in time". Does that include future members who have enrolled in the health plan but are not currently active yet? See example below.
Example: On 12/1/2019, a member in the health plan's system only has one, future eligibility span of 1/1/2020-12/31/2020. Should this member be included in the Full Replacement File?

2. For the active members in the Health Plan's system, should the members' active and future eligibility spans be included in the Full Replacement File?

Example: On 3/1/2019, a member in the health plan's system only has an active eligibility span of 1/1/2019-12/31/2019 and a future eligibility span of 1/1/2020-999999. Should both the active and future eligibility spans be included in the Full Replacement File?

Response

Section 1.4.5 of the 005010X220A1 clarifies that a full file replacement (BGN08=RX) is intended to identify all active members at a given point of time. The point in time is identified by the File Effective Date DTP (DTP01=007 Effective). Whether terminated members are included in a full file replacement is defined through the trading partner agreement.

RFI Recommendation

Although a full file replacement can be used to update a system, it is not recommended to use a full file replacement in lieu of an update file to send additions terminations and changes due to cost and demands on resources to process full replacement files

DOCUMENT ID
005010X220A1