Appendix D. Change Summary

This Implementation Guide (007030X333) defines the X12 requirements for the Benefit Enrollment and Maintenance. It is based on version/release/subrelease 007030 of the ASC X12 standards.

LocationX333 | Benefit Enrollment and Maintenance
2.3 Transaction Set Listing
ActionModify Segment Repeat
PER: in implementation for Loops 2100A, 2100F, 2100G (position 0400)
Change segment repeat from 1 To 5
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0100
ST - Transaction Set Header
ActionModify Data Element Note
Changed to "The Transaction Set Control Numbers in ST02 and SE02 must be identical. The number is assigned by the originator and must be unique within a functional group (GS-GE). For example, start with the number 0001 and increment from there. The number also aids in error resolution research."
CR 999Revise the ST02 notes across the TR3's to make them consistent.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0200
BGN - Beginning Segment
ActionModify Data Element Code Note
on DTP01 code 00 (Originial):
From
If the original transaction has already been processed, an incoming transaction using this code may be rejected by the receiver. The rejection will be identified to the sender by telephone or other direct contact.

The "00" indicates the first time the transaction is sent.

To
Use when the transaction is being sent for the first time.

Explanation: If the original transaction has already been processed, an incoming transaction using this code may be rejected by the receiver. The rejection will be identified to the sender by telephone or other direct contact.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0600
QTY - Transaction Set Control Totals
ActionAdd Segment Note
Note #1:
This is intended to submit the total number of members within the file.
CR 1163Add notes to the QTY to clarify the values transmitted in the elements.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0600
QTY - Transaction Set Control Totals
ActionAdd Data Element Code Note
to QTY01 code TO (Total):
Use when quantifying the total number of Member Level Detail (2000 Loops) within the ST-SE.
CR 476Clarify that the QTY02 quantity is a record count that may not represent the number of unique members in the transmission.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0600
QTY - Transaction Set Control Totals
ActionAdd Data Element Code Note
to QTY01 code ET (Employee Total):
Use when quantifying the total number of subscribers (INS01 = Y) within the ST-SE.
CR 476Clarify that the QTY02 quantity is a record count that may not represent the number of unique members in the transmission.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0600
QTY - Transaction Set Control Totals
ActionAdd Data Element Code Note
to QTY01 code DT (Dependent Total):
Use when quantifying the total number of dependents (INS01 = N) within the ST-SE.
CR 476Clarify that the QTY02 quantity is a record count that may not represent the number of unique members in the transmission.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0600
QTY - Transaction Set Control Totals
ActionAdd Segment Note
#2:
The QTY02 values, when QTY01 = ET plus when QTY01 = DT, equals the QTY02 value when QTY01 = TO.

Count values: QTY02 + QTY02 = QTY02
When QTY01 = ET + DT = TO
CR 476Clarify that the QTY02 quantity is a record count that may not represent the number of unique members in the transmission.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0600
QTY - Transaction Set Control Totals
ActionAdd Segment Note
#3:
Since an individual member's record may be transmitted more than once within the ST-SE, the quantity in QTY02 when QTY01 = TO, does not necessarily reflect a count of unique member records.
CR 476Clarify that the QTY02 quantity is a record count that may not represent the number of unique members in the transmission.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0100 | 2000
INS - Member Level Detail
ActionAdd Data Element Code Value
s to INS06-01:
F - Medicare Part D
G - Medicare Part A and D
H - Medicare Part B and D
I - Medicare Part A, B and D
CR 490Add data element values to INS06-1 to describe Medicare coverage combinations.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0100 | 2000
INS - Member Level Detail
ActionAdd Data Element Code Value
to INS08:
IA (Inactive)
CR 487Add codes to INS08 and DTP01 to support inactive employee reporting.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0100 | 2000
INS - Member Level Detail
ActionModify Data Element Code Note
on INS02 code 23 (Sponsored Dependent):
From
Dependents age 19 and older; qualifications may vary depending on policy.

To
Use when the dependent is age 26 or older; qualifications may vary depending on policy.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0100 | 2000
INS - Member Level Detail
ActionModify Data Element Code Note
on INS08 code FT (Full-time):
From
Full time active employee

To
Use when the subscriber is a full-time active employee.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0100 | 2000
INS - Member Level Detail
ActionModify Data Element Code Note
on INS08 code PT (Part-time):
From
Part time Active Employee

To
Use when the subscriber is a part-time active employee.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0100 | 2000
INS - Member Level Detail
ActionAdd Data Element Code Note
to INS08 code IA (Inactive):
Use when the subscriber has employer coverage but does not meet the definition of an active employee e.g. full-time, part-time, etc . For example this would be someone on long term disability who still has employer sponsored coverage.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0100 | 2000
INS - Member Level Detail
ActionModify Data Element Situational Rule
on INS09:
From
Required when describing a non-spouse dependent whose age requires a qualifying condition for enrollment (e.g., being an active student). See the Plan contract for details of the age requirements for student status usage. If not required by this implementation guide, do not send.

To
Required when describing a non-spouse dependent whose age requires a qualifying condition for enrollment (e.g., being an active student). If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0100 | 2000
INS - Member Level Detail
ActionModify Data Element Situational Rule
on INS12:
From
Required if the subscriber/dependent is deceased. If not required by this implementation guide, do not send. This is the date of death for the subscriber/dependent and does not replace the use of the termination date within the 2300 loop.

To
Required when the Insured is known to be deceased. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0100 | 2000
INS - Member Level Detail
ActionModify Data Element Situational Rule
on INS04:
From
Required when the payer needs to know the reason for the change. If not required by this implementation guide, do not send.
To
Required when the member maintenance reason is required when obligated by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0100 | 2000
INS - Member Level Detail
ActionModify Data Element Code Note
on INS02 code 38 (Collateral Dependent):
From
Relative related by blood or marriage who resides in the home and is dependent on the insured for a major portion of their support.

To
Use when the dependent is a relative related by blood or marriage who resides in the home and depends on the insured for a major portion of their support.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0100 | 2000
INS - Member Level Detail
ActionModify Data Element Code Note
on INS02 code 53 (Life Partner):
From
This is a partner that acts like a spouse without a legal marriage committment.

To
Use when indicating a partner that acts like a spouse without a legal marriage commitment.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0200 | 2000
REF - Member Supplemental Identifier
ActionModify Data Element Code Note
on REF01 code 23 (Client Number):
From
To be used to pass a payer specific identifier for a member. Not to be used after the HIPAA standard National Identifier for Individuals is implemented.

To
Use when reporting a payer specific identifier for a member.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Member Level Dates
ActionAdd Data Element Code Value
Member Level Dates: DTP01:
W02 (Status Change)
CR 487Add codes to INS08 and DTP01 to support inactive employee reporting.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Member Level Dates
ActionModify Segment Repeat
:
From 24 To 25
CR 487Add codes to INS08 and DTP01 to support inactive employee reporting.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Member Level Dates
ActionAdd Data Element Code Note
to DTP01 Code W02 (Status Change):
Use when a status is reported in the INS08 and an effective date of that status is needed.
CR 487Add codes to INS08 and DTP01 to support inactive employee reporting.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Member Level Dates
ActionAdd Data Element Code Value
to DTP01:
AEC (Medicare Part A Coverage Effective Date)
CR 1492Need the capability to associate specific member-level dates and coverages (such as Part A or Part D) for enrollment purposes.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Member Level Dates
ActionAdd Data Element Code Value
to DTP01:
AEG (Medicare Part B Coverage Effective Date)
CR 1492Need the capability to associate specific member-level dates and coverages (such as Part A or Part D) for enrollment purposes.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Member Level Dates
ActionAdd Data Element Code Value
to DTP01:
AFC (Medicare Part D Coverage Effective Date)
CR 1492Need the capability to associate specific member-level dates and coverages (such as Part A or Part D) for enrollment purposes.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Member Level Dates
ActionAdd Data Element Code Value
to DTP01:
AED (Medicare Part A Coverage Termination Date)
CR 1492Need the capability to associate specific member-level dates and coverages (such as Part A or Part D) for enrollment purposes.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Member Level Dates
ActionAdd Data Element Code Value
to DTP01:
AEH (Medicare Part B Coverage Termination Date)
CR 1492Need the capability to associate specific member-level dates and coverages (such as Part A or Part D) for enrollment purposes.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Member Level Dates
ActionAdd Data Element Code Value
to DTP01:
AFD (Medicare Part D Coverage Termination Date)
CR 1492Need the capability to associate specific member-level dates and coverages (such as Part A or Part D) for enrollment purposes.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Member Level Dates
ActionAdd Data Element Code Note
To DTP01 Code 338 (Medicare Begin):
Use for Medicare Part C (Medicare Advantage) Coverage Effective Date
CR 1492Need the capability to associate specific member-level dates and coverages (such as Part A or Part D) for enrollment purposes.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Member Level Dates
ActionAdd Data Element Code Note
To DTP01 Code 339 (Medicare End):
Use for Medicare Part C (Medicare Advantage) Coverage Termination Date
CR 1492Need the capability to associate specific member-level dates and coverages (such as Part A or Part D) for enrollment purposes.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Member Level Dates
ActionModify Data Element Code Note
on DTP01 Code 357 (Eligibility End):
From
The eligibility end date represents the last date of coverage for which claims will be paid for the individual being terminated. For example, if a date of 02/28/2001 is passed then claims for this individual will be paid through 11:59 p.m. on 02/28/2001.

To
Use when reporting the last date of coverage for which the member's claims will be paid. For example, if a date of 02/28/2014 is reported then claims for this member will be paid through 11:59 p.m. on 02/28/2014
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0250 | 2000
DTP - Online Application Date/Time
ActionAdd Segment
DTP - Online/Application Date/Time
CR 1352Add a date and time stamp indicating when the enrollee completed the application submission.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100A
NM1 - Member Name
ActionModify Data Element Code Value
on NM108:
From:
ZZ (Mutually Defined)

To:
II (Standard Unique Health Identifier for each Individual in the United States)
CR 1165In NM108, replace the generic ZZ qualifier with the new specific qualifier II.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100A
NM1 - Member Name
ActionAdd Data Element Code Value
to NM108:
TI (Individual Taxpayer Identification Number (ITIN) )
CR 1428Health plans in border states cover patients who do not have a SSN but have an identifier from another country, such as an ITIN (Individual Taxpayer Identification Number). NM109 should accommodate these members, requiring a new qualifier.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100A
NM1 - Member Name
ActionModify Multiple Locations
Code Note
From
The Social Security Number must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid.

To
Use when reporting a Social Security Number.

The Social Security Number must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid.
CR 1112Remove the restriction on use of the Social Security Number in the 2100A Member Name NM108, as Federal Rules govern SSN use.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100A
NM1 - Member Name
ActionModify Data Element Situational Rule
on NM108:
From
Required when the provider is mandated to obtain an National Provider ID or when an atypical provider has an alternate identification number that has been assigned by the payer.

To
Required when NM109 is used. If not required by this implementation guide, do not send.
CR 1478Remove duplication of situational rules between the element and the code qualifier across the TR3.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100A
PER - Member Communications Numbers Contact Information
ActionAdd Segment Note
#2:
Send communication information in the order of preference when contacting the member.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100A
PER - Member Communications Numbers Contact Information
ActionModify Segment Repeat
:
From 1 To 5
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100A
PER - Member Communications Numbers Contact Information
ActionAdd Data Element Code Value
To PER03:
TS (Text Messaging Address)
OT (Other Residential Telephone number )
EA (Internet Email Address)
WC (Work Cellular)
PC (Personal Cellular)
NP (Night Phone)
PP (Personal Phone)
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100A
PER - Member Communications Numbers Contact Information
ActionAdd Data Element Code Value
To PER05:
TS (Text Messaging Address)
OT (Other Residential Telephone number )
EA (Internet Email Address)
WC (Work Cellular)
PC (Personal Cellular)
NP (Night Phone)
PP (Personal Phone)
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100A
PER - Member Communications Numbers Contact Information
ActionAdd Data Element Code Value
To PER07:
TS (Text Messaging Address)
OT (Other Residential Telephone number )
EA (Internet Email Address)
WC (Work Cellular)
PC (Personal Cellular)
NP (Night Phone)
PP (Personal Phone)
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100A
PER - Member Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code OT (Other Residential Telephone Number):
Use when reporting a TTY communication number.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100A
PER - Member Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code EA (Internet Email Address):
Use when reporting a secondary or alternate email address.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100A
PER - Member Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code AP (Alternate Telephone):
Use when reporting the phone number for the individual's closest relative.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100A
PER - Member Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code TE (Telephone):
Use when identifying the primary phone number.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100A
PER - Member Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code CP (Cellular Phone):
Use when the cellular phone ownership is unknown.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0500 | 2100A
N3 - Member Address
ActionModify Segment Situational Rule
:
From
Required when enrolling subscribers, dependents with different address information, or when changing a member's address. If not required by this implementation guide, do not send.

To
Required when enrolling subscribers or when enrolling dependents with an address different from the subscribers or when changing a member's address. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0500 | 2100A
N3 - Member Address
ActionModify Data Element Situational Rule
on N302:
From
Required when a second address line is needed. If not required by this implementation guide, do not send.

To
Required when a second address line exists. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0600 | 2100A
N4 - Member City, State, ZIP Code
ActionModify Segment Situational Rule
:
From
Required when enrolling subscribers, dependents with different address information, or when changing a member's address. If not required by this implementation guide, do not send.

To
Required when enrolling subscribers or when enrolling dependents with an address different from the subscribers or when changing a member's address. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0600 | 2100A
N4 - Member City, State, ZIP Code
ActionModify Data Element Situational Rule
on N405:
From
Required when such transmission is required under the insurance contract between the sponsor and payer and allowed by federal and state regulations. If not required by this implementation guide, do not send.

To
Required when obligated by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0600 | 2100A
N4 - Member City, State, ZIP Code
ActionModify Data Element Situational Rule
on N406:
From
Required when such transmission is required under the insurance contract between the sponsor and payer and allowed by federal and state regulations. If not required by this implementation guide, do not send.

To
Required when obligated by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0800 | 2100A
DMG - Member Demographic Information
ActionModify Data Element Usage
of DMG05-01:
From Situational to Not Used.
Race and ethnicity is reported in DMG05-02 and DMG05-03.
CR 1335Need to modify the race/ethnicity reporting in the 834 to support the OMB guidance. Refer to the requirements at http://www.whitehouse.gov/omb/fedreg_1997standards/.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0800 | 2100A
DMG - Member Demographic Information
ActionModify Data Element Usage
of DMG05-02:
From Situational to Required
CR 1335Need to modify the race/ethnicity reporting in the 834 to support the OMB guidance. Refer to the requirements at http://www.whitehouse.gov/omb/fedreg_1997standards/.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0800 | 2100A
DMG - Member Demographic Information
ActionModify Data Element Usage
of DMG05-03:
From Situational to Required
CR 1335Need to modify the race/ethnicity reporting in the 834 to support the OMB guidance. Refer to the requirements at http://www.whitehouse.gov/omb/fedreg_1997standards/.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0800 | 2100A
DMG - Member Demographic Information
ActionModify Segment Situational Rule
:
From
Required when enrolling a new member, changing a member's demographic information, or terminating a member. If not required by this implementation guide, do not send.

To:
Required when enrolling a new member, changing a member's demographic information, or terminating a member. If not required by this implementation guide, may be provided at the sender's discretion but cannot be required by the receiver.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0800 | 2100A
DMG - Member Demographic Information
ActionModify Data Element Situational Rule
on DMG05:
From
Required when such transmission is required under the insurance contract between the sponsor and payer and allowed by federal and state regulations. If not required by this implementation guide, do not send.

To
Required when obligated under the insurance contract and not restricted by federal or state regulations. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0800 | 2100A
DMG - Member Demographic Information
ActionModify Data Element Situational Rule
on DMG10:
From
Required when such transmission is required under the insurance contract between the sponsor and payer and allowed by federal and state regulations. If not required by this implementation guide, do not send.

To
Required when obligated under the insurance contract to specify how the Information in DMG05, including any repeats, was collected. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0800 | 2100A
DMG - Member Demographic Information
ActionModify Data Element Situational Rule
on DMG11:
From
Required when there is a need to specify how the information in DMG05, including any repeats, was collected. If not required by this implementation guide, do not send.

To
Required when obligated under the insurance contract to specify how the Information in DMG05, including any repeats, was collected. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1100 | 2100A
ICM - Member Income
ActionModify Segment Situational Rule
:
From
Required when such transmission is required under the insurance contract between the sponsor and payer. If not required by this implementation guide, do not send.

To
Required when obligated by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1100 | 2100A
ICM - Member Income
ActionAdd Data Element Note
to ICM03:
This is the maximum number of hours worked in one calendar week. Report 168 hours or less (24 hours/day x 7 days/week).
CR 1106Modify the length of ICM03 for efficiency. Restricting elements to their logical maximum creates more efficient implementations.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1100 | 2100A
ICM - Member Income
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1200 | 2100A
AMT - Member Policy Amounts
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionDelete Data Element Code Value
from HLH01-01:
X (Tobacco Use and Substance Abuse)
CR 1167Add code values to HLH01-01 and a situational rule to HLH01-02.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionAdd Data Element Situational Rule
to HLH01-01:
Required on initial enrollment to report tobacco use, substance abuse or pregnancy status when the member's information is available.
OR
Required on an enrollment update to report a change in tobacco use, substance abuse or pregnancy status when the member's information is available.
If not required by this implementation guide, do not send.
CR 1115Add a pregnant indicator and the ability to indicate a changes in status between "No", "Yes", and "Unknown".
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionAdd Data Element Code Value
to HLH01-01:
P (Pregnancy)
CR 1115Add a pregnant indicator and the ability to indicate a changes in status between "No", "Yes", and "Unknown".
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionModify Data Element Situational Rule
on HLH01-02:
From
Required when an `S', `T', or `X' is sent in the health related code. If not required by this implementation guide, do not send.
To
Required when a `P', `S', `T', or `X' is sent in the health related code. If not required by this implementation guide, do not send.
CR 1115Add a pregnant indicator and the ability to indicate a changes in status between "No", "Yes", and "Unknown".
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionAdd Data Element Note
to HLH01-02:
Use to report a health related condition is present, not present (N) or unknown.
CR 1115Add a pregnant indicator and the ability to indicate a changes in status between "No", "Yes", and "Unknown".
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionAdd Data Element Code Value
to HLH01-03:
771 = Status
W02 = Status Change
ABC = Estimated Date of Birth
CR 1116Smoking is a rating factor for many policies. Issuers who do not do their own applications need to know the dates someone stopped smoking or began smoking.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionAdd Data Element Situational Rule
to HLH01-03:
Required when a status effective date for tobacco use or substance abuse is available.
Or
Required when an estimated pregnancy due date is available.
If not required, do not send.
CR 1116Smoking is a rating factor for many policies. Issuers who do not do their own applications need to know the dates someone stopped smoking or began smoking.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionAdd Data Element Situational Rule
to HLH01-04:
Required when C061-03 is populated. If not required, do not send.
CR 1116Smoking is a rating factor for many policies. Issuers who do not do their own applications need to know the dates someone stopped smoking or began smoking.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionAdd Data Element Code Note
to HLH01-03 code 771 (Status):
Use when reporting a tobacco use or substance abuse status for the first time.
CR 1116Smoking is a rating factor for many policies. Issuers who do not do their own applications need to know the dates someone stopped smoking or began smoking.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionAdd Data Element Code Note
to HLH01-03 code W02 (Status Change):
Use when reporting a change in tobacco use or substance abuse status for the first time or when reporting a change of estimated date of birth.
CR 1116Smoking is a rating factor for many policies. Issuers who do not do their own applications need to know the dates someone stopped smoking or began smoking.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionAdd Data Element Code Note
to HLH01-03 code ABC (Estimated Date of Birth):
Use when reporting the estimated date of birth for the first time.
CR 1116Smoking is a rating factor for many policies. Issuers who do not do their own applications need to know the dates someone stopped smoking or began smoking.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionModify Segment Situational Rule
:
From
Required on initial enrollment of a member when appropriate medical information about the member is available. If not required by this implementation guide, do not send.

To
Required on initial enrollment of a member when appropriate medical information about the member is available
Or
Required on an enrollment update when a member's medical information has changed and is available.
If not required by this implementation guide, do not send.
CR 1117Revise the HLH Situational Rule to allow transmission during an enrollment period.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionModify Data Element Usage
on HLH01:
From Required to Situational
CR 1117Revise the HLH Situational Rule to allow transmission during an enrollment period.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1300 | 2100A
HLH - Member Health Information
ActionAdd Data Element Situational Rule
to HLH01:
Required on initial enrollment to report tobacco use, substance abuse or pregnancy status when the member's information is available.
OR
Required on an enrollment update to report tobacco use, substance abuse or pregnancy status when member's information is available.
If not required by this implementation guide, do not send.
CR 1117Revise the HLH Situational Rule to allow transmission during an enrollment period.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1500 | 2100A
LUI - Member Language
ActionModify Segment Situational Rule
:
From
Required if the sponsor knows that the member's primary language is not English, and such transmission is required under the insurance contract between the sponsor and payer and allowed by federal and state regulations. If not required by this implementation guide do not send.

To
Required when the sponsor collects the member's preferred language, and is legally allowed to share it. If not required by this implementation guide do not send.
CR 1459Remove the English default presumption, add a qualifier for Unknown, and require accurate reporting of the member's language.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 1500 | 2100A
LUI - Member Language
ActionModify Segment Note
:
From
Any need to send/collect this information will need to be contained in the trading partner agreement

To
Any need to collect this information will be due to a requirement external to the transaction (e.g. Trading partner agreement, legal requirement, program requirement).
CR 1459Remove the English default presumption, add a qualifier for Unknown, and require accurate reporting of the member's language.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100B
NM1 - Incorrect Member Name
ActionModify Data Element Code Value
on NM108:
From:
ZZ (Mutually Defined)

To:
II (Standard Unique Health Identifier for each Individual in the United States)
CR 1165In NM108, replace the generic ZZ qualifier with the new specific qualifier II.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100B
NM1 - Incorrect Member Name
ActionModify Data Element Usage
on NM103:
From Required to Situational
CR 478Change the usage for 2100B NM103 to situational.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100B
NM1 - Incorrect Member Name
ActionAdd Data Element Situational Rule
to NM103:
Required when a corrected last name is submitted in Loop 2100A (Member Name). If not required by this implementation guide, do not send.
CR 478Change the usage for 2100B NM103 to situational.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100B
NM1 - Incorrect Member Name
ActionModify Data Element Industry Name
on NM109:
From
Prior Incorrect Insured Identifier

To
Prior Incorrect Member Identifier
CR 1107Change the implementation name of 2100B NM1 to "Prior Incorrect Member" for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100B
NM1 - Incorrect Member Name
ActionModify Multiple Locations
Code Note
From
The Social Security Number must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid.

To
Use when reporting a Social Security Number.

The Social Security Number must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid.
CR 1112Remove the restriction on use of the Social Security Number in the 2100A Member Name NM108, as Federal Rules govern SSN use.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100B
NM1 - Incorrect Member Name
ActionModify Data Element Situational Rule
on NM104
From
Required when NM102 is equal to "1" (person) and the person has a first name. If not required by this implementation guide, do not send.

To
Required when a corrected first name is submitted in Loop 2100A (Member Name). If not required by this implementation guide, do not send.
CR 478Change the usage for 2100B NM103 to situational.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100B
NM1 - Incorrect Member Name
ActionModify Data Element Situational Rule
on NM105
From
Required if supplied by member. If not required by this implementation guide, do not send.

To
Required when a corrected middle name is submitted in Loop 2100A (Member Name). If not required by this implementation guide, do not send.
CR 478Change the usage for 2100B NM103 to situational.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100B
NM1 - Incorrect Member Name
ActionModify Data Element Situational Rule
on NM106
From
Required if supplied by member. If not required by this implementation guide, do not send.

To
Required when a corrected name prefix is submitted in Loop 2100A (Member Name). If not required by this implementation guide, do not send.
CR 478Change the usage for 2100B NM103 to situational.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100B
NM1 - Incorrect Member Name
ActionModify Data Element Situational Rule
on NM107
From
Required if supplied by member. If not required by this implementation guide, do not send.

To
Required when a corrected name suffix is submitted in Loop 2100A (Member Name). If not required by this implementation guide, do not send.
CR 478Change the usage for 2100B NM103 to situational.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0800 | 2100B
DMG - Incorrect Member Demographic Information
ActionModify Data Element Situational Rule
on DMG11:
From:
Required when the member's Race or Ethnicity is being corrected. If not required by this implementation guide, do not send.

To:
Required when the member's Race or Ethnicity Collection Code is being corrected. If not required by this implementation guide, do not send.
CR 1153Clarify the intended use and instructions for the reassociation of dollars and data.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0800 | 2100B
DMG - Incorrect Member Demographic Information
ActionModify Data Element Usage
of DMG05-01:
From Situational to Not Used.
Race and ethnicity is reported in DMG05-02 and DMG05-03.
CR 1335Need to modify the race/ethnicity reporting in the 834 to support the OMB guidance. Refer to the requirements at http://www.whitehouse.gov/omb/fedreg_1997standards/.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0800 | 2100B
DMG - Incorrect Member Demographic Information
ActionModify Data Element Usage
of DMG05-02:
From Situational to Required.
CR 1335Need to modify the race/ethnicity reporting in the 834 to support the OMB guidance. Refer to the requirements at http://www.whitehouse.gov/omb/fedreg_1997standards/.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0800 | 2100B
DMG - Incorrect Member Demographic Information
ActionModify Data Element Usage
of DMG05-03:
From Situational to Required.
CR 1335Need to modify the race/ethnicity reporting in the 834 to support the OMB guidance. Refer to the requirements at http://www.whitehouse.gov/omb/fedreg_1997standards/.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0500 | 2100C
N3 - Member Mail Address
ActionModify Data Element Situational Rule
on N302:
From
Required when a second address line is needed. If not required by this implementation guide, do not send.

To
Required when a second address line exists. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100D
NM1 - Member Employer
ActionModify Data Element Situational Rule
on NM108:
From
Required when the provider is mandated to obtain an National Provider ID or when an atypical provider has an alternate identification number that has been assigned by the payer.

To
Required when NM109 is used. If not required by this implementation guide, do not send.
CR 1478Remove duplication of situational rules between the element and the code qualifier across the TR3.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0500 | 2100D
N3 - Member Employer Address
ActionModify Data Element Situational Rule
on N302:
From
Required when a second address line is needed. If not required by this implementation guide, do not send.

To
Required when a second address line exists. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100E
PER - Member School Communications Numbers Contact Information
ActionAdd Segment Note
#2:
Send communication information in the order of preference when contacting the member.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0500 | 2100E
N3 - Member School Address
ActionModify Data Element Situational Rule
on N302:
From
Required when a second address line is needed. If not required by this implementation guide, do not send.

To
Required when a second address line exists. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100F
NM1 - Custodial Parent
ActionModify Data Element Code Value
on NM108:
From:
ZZ (Mutually Defined)

To:
II (Standard Unique Health Identifier for each Individual in the United States)
CR 1165In NM108, replace the generic ZZ qualifier with the new specific qualifier II.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100F
NM1 - Custodial Parent
ActionModify Data Element Usage
on NM104:
From Required to Situational
CR 1113Change 2100F - Custodial Parent First Name (NM104) to situational for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100F
NM1 - Custodial Parent
ActionAdd Data Element Situational Rule
to NM104:
Required when NM102 is equal to "1" (person) and the person has a first name. If not required by this implementation guide, do not send.
CR 1113Change 2100F - Custodial Parent First Name (NM104) to situational for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100F
NM1 - Custodial Parent
ActionModify Multiple Locations
Code Note
From
The Social Security Number must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid.

To
Use when reporting a Social Security Number.

The Social Security Number must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid.
CR 1112Remove the restriction on use of the Social Security Number in the 2100A Member Name NM108, as Federal Rules govern SSN use.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100F
NM1 - Custodial Parent
ActionModify Data Element Situational Rule
on NM108:
From
Required when the provider is mandated to obtain an National Provider ID or when an atypical provider has an alternate identification number that has been assigned by the payer.

To
Required when NM109 is used. If not required by this implementation guide, do not send.
CR 1478Remove duplication of situational rules between the element and the code qualifier across the TR3.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100F
PER - Custodial Parent Communications Numbers Contact Information
ActionAdd Segment Note
#2:
Send communication information in the order of preference when contacting the member.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100F
PER - Custodial Parent Communications Numbers Contact Information
ActionModify Segment Repeat
:
From 1 To 5
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100F
PER - Custodial Parent Communications Numbers Contact Information
ActionAdd Data Element Code Value
To PER03:
TS (Text Messaging Address)
OT (Other Residential Telephone number )
EA (Internet Email Address)
WC (Work Cellular)
PC (Personal Cellular)
NP (Night Phone)
PP (Personal Phone)
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100F
PER - Custodial Parent Communications Numbers Contact Information
ActionAdd Data Element Code Value
To PER05:
TS (Text Messaging Address)
OT (Other Residential Telephone number )
EA (Internet Email Address)
WC (Work Cellular)
PC (Personal Cellular)
NP (Night Phone)
PP (Personal Phone)
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100F
PER - Custodial Parent Communications Numbers Contact Information
ActionAdd Data Element Code Value
To PER07:
TS (Text Messaging Address)
OT (Other Residential Telephone number )
EA (Internet Email Address)
WC (Work Cellular)
PC (Personal Cellular)
NP (Night Phone)
PP (Personal Phone)
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100F
PER - Custodial Parent Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code OT (Other Residential Telephone Number):
Use when reporting a TTY communication number.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100F
PER - Custodial Parent Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code EA (Internet Email Address):
Use when reporting a secondary or alternate email address.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100F
PER - Custodial Parent Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code AP (Alternate Telephone):
Use when reporting the phone number for the individual's closest relative.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100F
PER - Custodial Parent Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code TE (Telephone):
Use when identifying the primary phone number.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100F
PER - Custodial Parent Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code CP (Cellular Phone):
Use when the cellular phone ownership is unknown.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0500 | 2100F
N3 - Custodial Parent Address
ActionModify Data Element Situational Rule
on N302:
From
Required when a second address line is needed. If not required by this implementation guide, do not send.

To
Required when a second address line exists. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100G
NM1 - Responsible Person
ActionModify Data Element Code Value
on NM108:
From:
ZZ (Mutually Defined)

To:
II (Standard Unique Health Identifier for each Individual in the United States)
CR 1165In NM108, replace the generic ZZ qualifier with the new specific qualifier II.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100G
NM1 - Responsible Person
ActionModify Data Element Code Note
on code E1 (Person or Other Entity Legally Responsible for a Child):
From
Used to identify a legal indemnity situation.

This code is used when a Qualified Medical Child Support Order (QMSCO) is present.

To
Use when a Qualified Medical Child Support Order (QMSCO) is present. Explanation: Identifies a legal indemnification situation.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100G
NM1 - Responsible Person
ActionModify Multiple Locations
Code Note
From
The Social Security Number must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid.

To
Use when reporting a Social Security Number.

The Social Security Number must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid.
CR 1112Remove the restriction on use of the Social Security Number in the 2100A Member Name NM108, as Federal Rules govern SSN use.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100G
NM1 - Responsible Person
ActionModify Data Element Situational Rule
on NM108:
From
Required when the provider is mandated to obtain an National Provider ID or when an atypical provider has an alternate identification number that has been assigned by the payer.

To
Required when NM109 is used. If not required by this implementation guide, do not send.
CR 1478Remove duplication of situational rules between the element and the code qualifier across the TR3.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100G
PER - Responsible Person Communications Numbers Contact Information
ActionAdd Segment Note
:
Send communication information in the order of preference when contacting the member.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100G
PER - Responsible Person Communications Numbers Contact Information
ActionModify Segment Repeat
:
From 1 To 5
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100G
PER - Responsible Person Communications Numbers Contact Information
ActionAdd Data Element Code Value
To PER03:
TS (Text Messaging Address)
OT (Other Residential Telephone number )
EA (Internet Email Address)
WC (Work Cellular)
PC (Personal Cellular)
NP (Night Phone)
PP (Personal Phone)
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100G
PER - Responsible Person Communications Numbers Contact Information
ActionAdd Data Element Code Value
To PER05:
TS (Text Messaging Address)
OT (Other Residential Telephone number )
EA (Internet Email Address)
WC (Work Cellular)
PC (Personal Cellular)
NP (Night Phone)
PP (Personal Phone)
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100G
PER - Responsible Person Communications Numbers Contact Information
ActionAdd Data Element Code Value
To PER07:
TS (Text Messaging Address)
OT (Other Residential Telephone number )
EA (Internet Email Address)
WC (Work Cellular)
PC (Personal Cellular)
NP (Night Phone)
PP (Personal Phone)
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100G
PER - Responsible Person Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code OT (Other Residential Telephone Number):
Use when reporting a TTY communication number.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100G
PER - Responsible Person Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code EA (Internet Email Address):
Use when reporting a secondary or alternate email address.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100G
PER - Responsible Person Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code AP (Alternate Telephone):
Use when reporting the phone number for the individual's closest relative.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100G
PER - Responsible Person Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code TE (Telephone):
Use when identifying the primary phone number.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0400 | 2100G
PER - Responsible Person Communications Numbers Contact Information
ActionAdd Data Element Code Note
To PER03, PER05, PER07 code CP (Cellular Phone):
Use when the cellular phone ownership is unknown.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0500 | 2100G
N3 - Responsible Person Address
ActionModify Data Element Situational Rule
on N302:
From
Required when a second address line is needed. If not required by this implementation guide, do not send.

To
Required when a second address line exists. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0300 | 2100H
NM1 - Drop Off Location
ActionModify Data Element Usage
on NM103, NM104, NM105, NM106 and NM107:
From Situational to Not Used
CR 1171NM103 through NM107 should be changed from situational to not used.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 0500 | 2100H
N3 - Drop Off Location Address
ActionModify Data Element Situational Rule
on N302:
From
Required when a second address line is needed. If not required by this implementation guide, do not send.

To
Required when a second address line exists. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2000 | 2200
DSB - Disability Information
ActionModify Data Element Code Value
on DSB07:
From:
ZZ (Mutually Defined)

To:
DC (International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM))
CR 1165In NM108, replace the generic ZZ qualifier with the new specific qualifier II.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2000 | 2200
DSB - Disability Information
ActionModify Data Element Situational Rule
on DSB08:
From
Required when called for in the insurance contract between the sponsor and payer and allowed by federal and state regulations. If not required by this implementation guide, do not send.
To
Required when obligated by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionAdd Data Element Code Value
to HD02:
All INS04 code values added to align these data elements.
CR 1379Change the usage, notes, and code values of HD02 for consistency across TR3s.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionAdd Data Element Code Value
to HD03:
CDV (Combined Dental and Vision)
CR 1453An additional code is required in HD03 for ancillary products that do not required the same level of member identification as other health care products.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionAdd Data Element Code Value
to HD03:
COM (Combined insurance lines other than dental and vision)
CR 1453An additional code is required in HD03 for ancillary products that do not required the same level of member identification as other health care products.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionAdd Data Element Code Note
to HD03 code COM (Combined insurance lines other than dental and vision):
Use when identifying combined insurance lines other than dental and vision that are not QHP Products
CR 1453An additional code is required in HD03 for ancillary products that do not required the same level of member identification as other health care products.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionAdd Data Element Code Note
on HD02 code XN (Notification Only):
Use when sending a complete enrollment transmission, for the full file audit. Required when HD01 is equal to 030 (Audit or Compare).
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionModify Data Element Situational Rule
on HD09:
From
Required when there is a need to designate a member as a late enrollee. If not required
by this implementation guide, do not send.

To
Required when obligated by the insurance contract. If not required by this
implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionModify Data Element Usage
on HD02:
From Not Used to Situational
CR 1379Change the usage, notes, and code values of HD02 for consistency across TR3s.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionModify Data Element Situational Rule
on HD05:
From
Required when called for in the insurance contract between the sponsor and payer and allowed by federal and state regulations. If not required by this implementation guide, do not send.
To
Required when obligated by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionModify Data Element Situational Rule
on HD04:
From
Required when additional information is needed to describe the exact type of coverage being provided. If not required by this implementation guide, do not send.

To
Required when additional information is needed to describe the exact type of coverage. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionAdd Data Element Situational Rule
on HD02:
Required when the member maintenance reason is required when obligated by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionModify Data Element Code Note
to HD01 code 032 (Employee Information Not Applicable):
From
Certain situations, such as military duty and CHAMPUS/TRICARE, classify the subscriber as ineligible for coverage or benefits. However, dependents of the subscribers are still eligible for coverage or benefits under the subscriber. Subscriber identifying elements are needed to accurately identify dependents.

To
Use when dependents of an ineligible subscriber are eligible for coverage.

Explanation: Certain situations, such as military duty and CHAMPUS/TRICARE, classify the subscriber as ineligible for coverage or benefits. However, dependents of the subscribers are still eligible for coverage or benefits under the subscriber. Subscriber identifying elements are needed to accurately identify dependents.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionModify Data Element Code Note
on HD03 code HLT (Health):
From
Includes both hospital and professional coverage.

To
Use when reporting hospital or professional coverage.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2600 | 2300
HD - Health Coverage
ActionModify Data Element Code Note
on HD05 code E1D (Employee and One Dependent):
From
For this code, the dependent is a non-spouse dependent. This code is not used for identification of Employee and Spouse. See code ESP.

To:
Use when the dependent is a non-spouse dependent.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2700 | 2300
DTP - Health Coverage Dates
ActionModify Data Element Code Note
on DTP01 code 695 (Previous Period):
From
This value is only to be used when reporting Previous Coverage Months.

To
Use when DTP01 is equal to 695 - Previous Period.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2700 | 2300
DTP - Health Coverage Dates
ActionAdd Data Element Code Value
to DTP01:
606 (Certification Period Start)
CR 1555Add a Certification Date DTP segment in Loop 2300 so the payer knows how long the member is currently eligible to be in the program.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2700 | 2300
DTP - Health Coverage Dates
ActionModify Segment Repeat
:
From 6 to 8
CR 1555Add a Certification Date DTP segment in Loop 2300 so the payer knows how long the member is currently eligible to be in the program.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2700 | 2300
DTP - Health Coverage Dates
ActionAdd Data Element Code Note
on DTP01 code 606 (Certification Period Start):
Use when reporting the member's date of certification or qualification for the coverage being sent in Loop 2300. Benefit Begin Date is reported using code value 348. Certification Period Start and Benefit Begin Date may or may not be the same.
CR 1555Add a Certification Date DTP segment in Loop 2300 so the payer knows how long the member is currently eligible to be in the program.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2700 | 2300
DTP - Online Application Date/Time
ActionAdd Segment
DTP - Online/Application Date/Time segment
CR 1352Add a date and time stamp indicating when the enrollee completed the application submission.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2800 | 2300
AMT - Health Coverage Policy Amount
ActionModify Segment Repeat
:
From 9 to 3
CR 1168Review the number of qualifiers and the number of repeats and revise if necessary.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2800 | 2300
AMT - Health Coverage Policy Amount
ActionModify Segment Situational Rule
:
From
Required when such transmission is required under the insurance contract between the sponsor and the payer. If not required by this implementation guide, do not send.

To
Required when obligated by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2800 | 2300
AMT - Health Coverage Policy Amount
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2900 | 2300
REF - Health Coverage Policy Number
ActionModify Segment Repeat
:
From 14 to 4
CR 1168Review the number of qualifiers and the number of repeats and revise if necessary.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2900 | 2300
REF - Prior Coverage Months
ActionModify Data Element Code Note
on REF01 code QQ (Unit Number):
From
This code is used in this implementation guide to indicate that the value in REF02 is the response required under the portability provisions of HIPAA.

To
Use when required to indicate the number of months of prior health coverage under the portability provisions of HIPAA.
CR 1396Revise the code value notes for consistency.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 2900 | 2300
REF - Prior Coverage Months
ActionModify Segment Situational Rule
:
From
Required when the portability provisions of the Health Insurance Portability and Accountability Act require reporting of the number of months of prior health coverage that meet the certification requirements of the Act.

To
Required when there are prior months of health coverage that meet the certification requirements of the portability provisions within the Health Insurance Portability and Accountability Act. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 3000 | 2300
IDC - Identification Card
ActionModify Segment Situational Rule
:
From
Required when requesting the production of an identification card as the result of an enrollment add, change, or statement. If not required by this implementation guide, do not send.

To
Required when requesting the production of an identification card. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 3200 | 2310
NM1 - Provider Name
ActionDelete Data Element Code Value
Provider Name: NM108: Deleted Codes:
34 (Social Security Number)
FI (Federal Taxpayer's Identification Number)
CR 11692310 NM1: The NPI is mandated, remove other qualifiers.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 3200 | 2310
NM1 - Provider Name
ActionModify Data Element Situational Rule
on NM108:
From
Required when the provider is mandated to obtain an National Provider ID or when an atypical provider has an alternate identification number that has been assigned by the payer.

To
Required when NM109 is used. If not required by this implementation guide, do not send.
CR 1478Remove duplication of situational rules between the element and the code qualifier across the TR3.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 3500 | 2310
N3 - Provider Address
ActionModify Segment Repeat
:
From 2 to 1
CR 1172Only one provider address (2310 N3) is needed.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 3500 | 2310
N3 - Provider Address
ActionModify Data Element Situational Rule
on N302:
From
Required when a second address line is needed. If not required by this implementation guide, do not send.

To
Required when a second address line exists. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 3700 | 2310
PER - Provider Communications Numbers Contact Information
ActionAdd Segment Note
#2:
Send communication information in the order of preference when contacting the member.
CR 1114There is a need for more contact numbers than the TR3 currently supports. There also needs to be guidance for how to identify the preferred contact method. May need additional qualifiers for other contact methods such as text and an alternate contact not living in your household.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 4000 | 2320
COB - Coordination of Benefits
ActionModify Loop Repeat
:
From 5 to 10
CR 1168Review the number of qualifiers and the number of repeats and revise if necessary.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 4000 | 2320
COB - Coordination of Benefits
ActionModify Segment Situational Rule
:
From
Required whenever an individual has another insurance plan with benefits similar to those covered by the insurance product specified in the HD segment for this occurrence of Loop ID-2300. If not required by this implementation guide, do not send.

To
Required when an individual has another insurance plan with benefits similar to those covered by the insurance product specified in this occurrence of Loop ID-2300. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 4000 | 2320
COB - Coordination of Benefits
ActionModify Data Element Situational Rule
on COB04:
From
Required when detailed COB coverage information is agreed to be exchanged. If not required by this implementation guide, do not send.

To
Required when detailed COB coverage information is obligated to be provided by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 4070 | 2320
DTP - Coordination of Benefits Eligibility Dates
ActionModify Segment Situational Rule
:
From
Required when the submitter needs to send effective dates for coordination of benefits. If not required by this implementation guide, do not send.

To
Required when the submitter needs to send effective dates for coordination of benefits. If not required by this implementation guide, may be provided by the sender's discretion but cannot be required by the receiver.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 4100 | 2330
NM1 - Coordination of Benefits Related Entity
ActionModify Segment Situational Rule
:
From
Required to send the name of the insurance company when provided to the sponsor. If not required by this implementation guide, do not send.

To
Required when information identifying the related insurance company is provided to the sponsor. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 4100 | 2330
NM1 - Coordination of Benefits Related Entity
ActionModify Data Element Situational Rule
on NM103:
From
Required to send the insurance company name if no standard identifier is available to pass in NM109. If not required by this implementation guide, do not send.

To
Required when no standard identifier is available in NM109. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 4100 | 2330
NM1 - Coordination of Benefits Related Entity
ActionModify Data Element Situational Rule
on NM108:
From
Required when the provider is mandated to obtain an National Provider ID or when an atypical provider has an alternate identification number that has been assigned by the payer.

To
Required when NM109 is used. If not required by this implementation guide, do not send.
CR 1478Remove duplication of situational rules between the element and the code qualifier across the TR3.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 4300 | 2330
N3 - Coordination of Benefits Related Entity Address
ActionModify Data Element Situational Rule
on N302:
From
Required when a second address line is needed. If not required by this implementation guide, do not send.

To
Required when a second address line exists. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 4300 | 2330
N3 - Coordination of Benefits Related Entity Address
ActionModify Segment Situational Rule
:
From
Required when detailed COB coverage information is agreed to be exchanged. If not required by this implementation guide, do not send.
To
Required when detailed COB coverage information is obligated to be provided by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 4400 | 2330
N4 - Coordination of Benefits Other Insurance Company City, State, ZIP Code
ActionModify Segment Situational Rule
:
From
Required when detailed COB coverage information is agreed to be exchanged. If not required by this implementation guide, do not send.

To
Required when detailed COB coverage information is obligated to be provided by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 4500 | 2330
PER - Administrative Communications Contact Information
ActionModify Segment Situational Rule
:
From
Required when detailed COB coverage information is agreed to be exchanged. If not required by this implementation guide, do not send.

To
Required when detailed COB coverage information is obligated to be provided by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 5500 | 2500
FSA - Tax Advantage Account
ActionAdd Loop
2500 Tax Advantage Account
CR 1170Tax Advantage Account information is required with enrollments. Suggest adding a new loop with the necessary information.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 5600 | 2500
AMT - Tax Advantage Account Amount
ActionAdd Data Element Note
to DE 782 (Monetary Amount):

The maximum length of this instance of data element 782 is 10.
CR 1013Add a consistent element note explaining the maximum length to every monetary amount element.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 6882 | 2750
N1 - Reporting Category
ActionModify Segment Usage
:
From Situational to Required
CR 1407Change the usage of the 2750 loop N1 (position 180) and REF (position 181) segments to required to align with the underlying standard.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 6882 | 2750
N1 - Reporting Category
ActionAdd Segment Note
#1:
Use to specify the name of the reporting category of the member's participating entity.
CR 1407Change the usage of the 2750 loop N1 (position 180) and REF (position 181) segments to required to align with the underlying standard.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 6883 | 2750
REF - Reporting Category Reference
ActionModify Segment Usage
:
From Situational to Required
CR 1407Change the usage of the 2750 loop N1 (position 180) and REF (position 181) segments to required to align with the underlying standard.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 6883 | 2750
REF - Reporting Category Reference
ActionAdd Segment Note
#1:
Used to specify the reference identifier associated with the reporting category of the member's participating entity.
CR 1407Change the usage of the 2750 loop N1 (position 180) and REF (position 181) segments to required to align with the underlying standard.
LocationX333 | Benefit Enrollment and Maintenance | 834 | 6884 | 2750
DTP - Reporting Category Date
ActionModify Segment Situational Rule
:
From
Required when called for in the insurance contract between the sponsor and payer. If not required by this implementation guide, do not send.

To
Required when obligated by the insurance contract. If not required by this implementation guide, do not send.
CR 1541Review the situational rules to ensure consistent formatting and wording, as applicable.