Section title: Requests for Interpretation
RFI #
2413
H-Number Assignment in 834
Description

For a Medicare Advantage, where do you expect the Health Plan to communicate its CMS assigned H-Number (ex: H1234) in REF*1L*_____ in the 2000 loop?

Option 1: REF*1L*H1234 in the 2000 loop
Option 2: REF*1L*H1234 and HD05 field in the 2300 loop

Additional clarification regarding who the sending entity is in terms of payer, sponsor, etc. not specific entity names and confirmation where the 834 is being sent was requested from the submitter:
We're not sending the 834 to CMS. We send the 834 to downstream vendor partners who need it. As part of the 834, we need to include the plan's H number (ex: H1234), which CMS assigns to us. The question is:
Where do you expect us (the Health Plan) to populate the member plan's H-Number (ex: H1234) in REF*1L*_____ in the 2000 loop?
Option 1: REF*1L*H1234 in the 2000 loop
Option 2: REF*1L*H1234 and HD05 field in the 2300 loop

Response

The ‘H’ number, which we interpret to be the HIOS number, is assigned to the payer not to the member, so it is incorrect to send this in Loop 2000 Member Policy Number REF or Loop 2300 Health Coverage Policy Number REF. In both instances, the number sent when REF01=1L is the group or policy number assigned by the payer to the group that the member is a part of. These REFs do not convey numbers that are assigned to the payer. The payer is identified in Loop 1000B Payer N1 and N104 contains the payer identifier. The available qualifiers do not include one for the HIOS number.

RFI Recommendation

The Interchange Control Header ISA segment can be used to transmit the HIOS number. When the payer is the sender, it will be in ISA06 with ISA05=ZZ. When the payer is the receiver, it will be in ISA08 with ISA07=ZZ. Definition that the ZZ=HIOS Number would be done in the trading partner agreement.

DOCUMENT ID
005010X220A1