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President Obama’s Most Important Number

[By Staff Reporters]

This is an “834 EDI transmission.”

Health Insurers sometimes call it, more simply, “an 834.” It is a technical, back-end reporting tool that consumers never see on the Federal Website. It is meant to be read by computers, not human beings. It’s the form that tells the insurer’s system who you are and what you need. And, it might be the new health-care law’s biggest problem.

Insurers report that, in some cases, 834s are coming in wrong. That’s a much more serious problem than the online traffic bottlenecks that have dominated coverage of the health-care law’s rollout.

Washington Post Article:

This is an “834 EDI transmission.” Insurers sometimes call it, more simply, “an 834.” It is a technical, back-end reporting tool that consumers never see. It is meant to be read by computers, not human beings. It’s the form that tells the insurer’s system who you are and what you need. And it might be the new health-care law’s biggest problem.

Insurers report that, in some cases, 834s are coming in wrong. That’s a much more serious problem than the online traffic bottlenecks that have dominated coverage of the health-care law’s rollout.

What is the ANSI 834 Enrollment Implementation Format?

The 834 Transaction is the HIPAA-compliant Benefit Enrollment and Maintenance Transaction. Its purpose is to electronically transmit enrollment and dis-enrollment information.

In 2004, DHCS implemented a 4010 834 solution, however, this was implemented along with a supplemental transaction that held eligibility history.

The HIPAA 5010 version of all transactions is scheduled to be implemented on January 1st, 2012. DHCS will implement a compliant 5010 834 on this date. The current FAME file will continue to be made available for a short period of time after this date to allow plans time to transition. Once this transition period has been completed the FAME file will no longer be made available to managed care plans.

Impacted Covered Entities

Internal DHCS program areas and DHCS Health Plan trading partners.

Links:

• 5010 834 Documents
• General Fame Documents
• Medi-Care Part D Information

5010 834 Documents

• 5010 834 Generic Test Data Overview (pdf)

General FAME Documents

• FAME Data Element Dictionary (pdf)

MEDICARE PART D INFORMATION

Project Information

DHCS Medicare Part D information web page

MMA Part D Carrier Cross Reference Table (pdf)

File Layouts

MMEF 2100 Medicare Part D layout (pdf)

MMEF REC Medicare Part D layout (pdf)

Assessment

Conclusion

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Filed under: Drugs and Pharma, Health Insurance, Information Technology, Risk Management | Tagged: ACA, Accountable Care Act, Form 834, Medicare Part D, PP-ACA | Leave a comment »