Section title: Requests for Interpretation
Plan Medicare A and Plan B Effective Dates

The X12 guideline for the 834 transaction only provides a single field for the Medicare Begin date. Is there any provision in the 834 to pass both the Medicare Plan A and the Medicare Plan B Begin dates as separate and distinct elements?


A new Medicare enrollment is received in an 834 add transaction. The subscriber is enrolling in Plan B, but is already enrolled in Plan A. The business requirement is to capture both the subscriber's original enrollment date for Plan A, and their enrollment date in Plan B.

RFI Response

Technical Report Type 3 for 834 Benefit Enrollment and Maintenance (005010X220A1) does allow reporting of separate enrollment dates for Medicare Part A and Medicare Part B. This is accomplished using two iterations of loop 2320 (Coordination of Benefits), one for Part A and one for Part B. In each case, the effective date is sent in loop 2320 segment DTP and the Medicare Part A or Medicare Part B insurer name is sent in NM103 (Coordination of Benefits Insurer Name) of the nested loop 2330.