In the VBC model, I pay capitation to facility based on members assigned to that facility. I also pay capitation to the member's Primay Care Physician. How do I communicate via an 834 that the member is no longer effective with a facility without terming any of the other effective dates (pcp, health plan, benefit option, etc).
The implementation guide represents that PLA01 can only be 2 - change(update) how can I say that the change is an to date and not a from date.
Member is associated with Primary Care Provider Dr. Jones.
Member is associated with Facility ACME LTC.
I now want to communicate that the member is no longer associated with ACME LTC (perhaps they have been sent home for hospice). Dr. Jones is still their PCP.
This example falls outside the defined business usage of the x220 834 TR3 and fits better within the business usage of the x318 834 TR3. The x220 TR3 is used to send information from the sponsor to the health plan, while the x318 TR3 is used to send information from a “submitter of insurance coverage, benefits, or policy” to a receiver. The PLA01 in the 2310 loop within the x318 TR3 has been expanded to allow additions, changes, deletions, and no change. This allows delineation of the purpose or intent of the information being shared with the receiver.
For the use case provided in the question, the user should utilize the x318 834 TR3 for sending information to the facility regarding removal of the member from their assigned list. Related information – CAQH CORE has an operating rule, The Attributed Patient Roster Rule Set, which also references using the x318 TR3 for this business purpose.