RFP_31786-00192_Appendix_7.6_Benefits_Administration_834_Guidance_Manual.docx

Benefits Administration 834 Guidance Manual

Revised: 07/23/2026

Version 6.0

Content Benefits Administration 834 Guidance Manual: v 6.0 10

Purpose

The State of Tennessee’s Benefits Administration 834 Guidance Manual accompanies the HIPAA ASC X12N 834 (005010X220A1) standard required by the HIPAA Transaction Rules (generally referred to as the “834 file”.

Even though the State of Tennessee does use an 834 file, you will need to customize your system to process the file’s information accurately. This manual contains business practice information, technical information, contact information and key details. The purpose of this manual is to inform you of the unique features found in our 834 file so you can prepare for its processing.

File Transmission

The 834 files normally generate weekly on Saturdays and they move to the State of TN’s server on Sunday mornings at 4am. Occasionally the time the file will be available can temporarily change as a result of holidays or system maintenance or upgrades. If we anticipate a change in the availability of the file, we will notify you via email. The State does not submit files. You will need to retrieve them from the server and you can set up a sweep to pick up the file or retrieve it manually. We will provide you with the Business Partner Interfaces Quick Start Guide to help you obtain access to the server. The first production file is ready by the week of Thanksgiving.

TN State File Characteristics

1. The State has two file servers: one for test environments and one for production. You will need to support both servers. The State requires a separate SSH Keypair for each server. The state can only accept SSH for authentication.

2. The 834 file is a full replacement file every time. We do not send change files in between. Since it is a full population file, one would expect only the latest or most recent plan id or coverage type present on the file. However, the State of TN’s files can show dual coverage for the same member so you will need to be able to customize for a member being enrolled in two coverages at the same time. Additional information on this situation is in the testing scenarios section of this manual.

3. The REF03 and the REF04 fields are being used. In the current ASC X12N/005010X220 834 file, these fields are supposed to be empty. These fields contain State of TN specific information which some vendors use to categorize members by benefits group or agency. These fields populated can cause the file to fail compliance on your system. You will need to prepare for this situation.

4. The file can transmit both the home address and the mailing address. If the mailing address is present, it will need to load to your system. If it is not, load the home address.

5. The file will send coverage begin dates prior to the start of your contract with the State of TN if the existing benefit plan codes are used for your product. These dates can go back many years and are not necessarily the true coverage begin date. The effective date provided will be the date a change in plan or coverage level was last made. Your system will need to be able to accept effective dates that are prior to the start of the contract go live date (usually January 1 of following year).

6. The file will only send a DTP*348 (effective date) or a DTP*349 (coverage end date) on a record; not both. Benefit coverage end dates (DTP*349 line) will always be on the file as the 1st of a month, however the actual last day of coverage is the day before (last day of the month before). Termination dates can also change. You will need to tailor your system in order to collect the true last day of coverage.

7. Benefit coverage terminations can appear on the file in advance for many weeks or they could only appear once. It will depend on the file maintenance date and the date of the termination. You will need to make sure your system can handle the same terminations appearing in subsequent files (see test scenario #10) Also, if the termination is a date in the past (prior to the maintenance file date) you must be able to capture and load it even though it’s at least 30 days in the past. The date will only appear once.

8. The file can have dependent only coverage levels for medical plans. The coverage will be associated with the Head of Contract’s (HOC) record on the file. You will need to figure out how to “split” the HOC coverage from the dependent coverage on your system since they will be together on the file (see test scenario # 16).

9. The primary identifier on the file is the employee id found on the REF*OF line of a record instead of the social security number found on the NM1* line.

10. There is no way to predict the “order” of the member records appearing on the file. For instance, a new coverage entry appears before the termination entry. Or the same member appears more than once on the same file and not necessarily in subsequent order (see test scenario #12).

Testing Process Once the contract is signed and your access to the state’s SFTP server is set up, we can provide you with a test enrollment file to begin testing. We can provide as many test files as you need. The State has two file servers: one for test environments and one for production. You will need to support both servers. The username will be the same for each server (example: ebeneadmin). The State requires a separate SSH Keypair for each.

Additionally, the State only requires your public key for each key pair. Password authentication is no longer allowed. The state can only accept SSH for authentication.

Also during testing, make sure you are testing all the scenarios applicable to your file mentioned in the testing scenarios section. We can send you the first test file and then a second test file with these scenarios so you can compare the two files. We can provide some member id numbers to look for in the file that are in these known scenarios. The test files do contain production data, it will not be the most current data but it is production data and will look just like a production file. Be sure to take extra caution and avoid unintentionally loading a test file into your production environment.

Errors During testing we can work with you on the types of errors you encounter and help determine which errors are necessary to report back to us after implementation.

Contact information The State of TN file team is available Monday – Friday 8:00am to 4:00pm CT

Primary file contacts after implementation:

· ben.admin.syssup@tn.gov - use this email address for ongoing processing questions, errors, file transmission or connectivity issues

· Charlotte.Gamache@tn.gov; Ian.Harris@tn.gov - Please contact Charlotte and Ian directly in order to escalate an issue

· Loreen.Vhumisai@tn.gov - Contact Loreen to further escalate an issue or as back up to Charlotte and/or Ian

State of TN 834 File Format – Tables

Tables 1 - 7B: Header Information Table 1: Interchange Control Header

Reference Description

Name

Codes

Comments

Always Blank

Always Blank

unless otherwise requested.

Defined by Vendor. If not specified, State of Tennessee will use vendor name.

T Production Test

Table 2: Functional Group Header

Defined by Vendor. If not defined, TN01 will be used.

Defined by Vendor. If not defined, TN01 will be used.

State of Tennessee will always send 005010X220A1

Table 3: Transaction Set Header

0003, etc.

Sequential segment number. There are multiple segments sent on file. This number indicates which segment is beginning.

Table 4: Beginning Segment

send 00

Code will be ISA08+ISA13+ST02

Not used

Not used

Not used

Table 5: DTP – File Effective Date in Header

generated.

Table 6: DTP – File Effective Date in Header

format - date the file was generated.

Table 7A: Header 1000A Loop

Non Payroll Always State of Tennessee Non Payroll

Not used

Not used

Table 7B: Header 1000B Loop

Vendor Name

Vendor’s EIN

Not used

Not used

Tables 8A – 8Q: Member Detail (INS thru DTP lines)

8A: INS

INS02

Individual Relationship Code Spouse Self Child Ex-Spouse Collateral Dependent * See Note 1

Not used

INS06-01

Medicare Plan Code

A

E A – Only applicable to Pharmacy vendors. Indicates the State’s prescription drug coverage is secondary.

E – Only applicable to Pharmacy vendors. Indicates the State’s prescription drug coverage is primary

Not used

Not used

Not used

INS07

COBRA Qualifying Termination Reduction in Hours Death Divorce Married Dependent

INS08

Employment Status Code

FT L1 PT RT

TE

Full-time Leave of Absence Part-time Retired Terminated

Not used

Qualifier

Not used

Not used

Not used

Not used

Not used

Not used

Number assigned to differentiate between dependents with the same birthdate.

8B-8C: REF

B

0F

Not used

Not used

C

BLANK_VALU

REF03

Description

program codes See Note 3

three characters ZZ: See Note 3

8D-8E: DTP

D Loop

ID

Reference Description

date)

E

This line not sent for dependents

DTP01

Date Time Qualifier Retirement Employment Begin Medicare Begin Medicare End

8F: NM1

Name Middle Name or Middle Initial

Suffix Name Suffix

number Member’s Social Security Number

Not used

Not used

Not used

8G: PER

Not used

2100A

PER04

Communication Number 10 digit number (no dashes)

Member’s Phone Number

or not used Will either be alternate phone or email or not used. See Note 8

PER06

Communication Number 10 digit number (no dashes) and/or email

Member’s Alternate Phone Number or Email Address (file may have none, one, or both)

PER07

Communication Number Qualifier EM (if the record already has

AP)

Member’s email address if the record has an alternate phone number in PER06)

address Member’s email address if there is one in the database

Not used

8H: N3

Street Address or P O Box Number See Note 4

Continuation of Address, if needed

8I: N4

City Name

Abbreviation State

number Zip Code + 4 digits

N404

Country Code

3 Letter Abbreviation Only used if member’s residence is outside of the United States. 3 Letter abbreviation for the name of the Country

Not used

Not used

Not used

8J: DMG

DMG03

Gender Code

DMG04

Marital Status Code

Common Law or Head of Household Widowed See Note 5

Information

Not used

Not used

Not used

Not used

Not used

Abbreviation If applicable, country abbreviation sent

Not used

Not used

Not used

Not used

8K: EC

Not applicable to Dependents

Hourly Salaried

Not used

Not used

Not used

Not used

Not used

8L: HLH

HLH01

Health-Related Code

T U

Tobacco Use Unknown Ignore this field, not used for eligibility

Not used

Not used

Not used

Not used

Not used

Not used

8M: NM1

2100C

NM1

Member Mailing Address

Sent when member mailing address is different from home address. This line will be sent, followed by Loop ID 2100C N3 and Loop ID 2100C N4 lines containing the mailing address.

Not used

Not used

Not used

Not used

Not used

Not used

Not used

Not used

Not used

Not used

8N: N3

n

P O Box Number See Note 4

Continuation of Address, if needed

8O: N4

Code

City Name

Abbreviation State

number Zip Code + 4 digits

2100C

N404

Country Code

outside of the United States. 3 Letter abbreviation for the name of the Country

Not used

Not used

Not used

8P: HD

024 -Cancellation or Termination 030 -Audit or Compare

Code

Not used

HD03

Insurance Line Code

DEN HLT

VIS

Dental Health (sent to medical, pharmacy and behavioral health) Vision

HD04

Plan Coverage Description

Description

Refer to the Appendix for a list of benefit plan coverage codes

SPO

Not used

Not used

Code

Not used

Indicator

Not used

Not used

Response Code

Not used

8Q: DTP

Benefit Begin Benefit End See Note 7

Table Notes 8A-8Q File Detail Note 1 The relationship code 38 denotes a child claimed on income tax (CT) or a child intended to be claimed on income tax (CI).

Note 2 The identifier will be present on all records unless enrolled in COBRA. COBRA enrollees sometimes have an ID number starting with a “C” and the employee ID number may not be only eight digits.

Note 3 These fields contain TN specific information that is not defined on a typical 834 file. Since these fields contain information and are not empty, it can cause the 834 file not to pass your HIPAA compliance process.

Note 4 The mailing address following [NM1*31*1] shall be loaded if available (Loop ID 2100A). Otherwise, residence address should be loaded (Loop ID 2100A).

Note 5 The marital status is not sent for dependents.

Note 6 The Head of Contract (HOC) records will be present on the file for these coverage codes. These codes are how to identify the coverage is dependent only.

Note 7 The 349 loop will only be present when an end-date exists otherwise, eligibility is open-ended (default 12/31/9999).

Note 8 A member’s entry will stop at PER04, PER06, or PER08 depending upon what information is in the system.

Tables 9A – 9C: Trailer Information Table 9A: Transaction Set Trailer

SE02

Transaction Set Control Number

Number Segment Number - There are multiple segments sent on file. This number indicates which segment is ending.

Table 9B: Functional Group Trailer

Table 9C: Interchange Control Trailer

Will match ISA13

Test Scenarios Scenario 1 – Use of REF03 and REF04 fields The State of TN uses the ASC X12N/005010X220 version of the 834 file. The accepted guidelines for this file format indicate the REF03 and REF04 remain empty. However, the 834 files from the State do have these lines populated on all the records. Since these fields have data present, it can cause the files to not pass HIPAA compliance measures on your end or not pass other various file upload pre-checks on your system. You will need to determine if the file can upload on your system with these fields filled in.

· REF*OF line has the employee id number

· REF*1L line has the member benefits group and budget code (agency number) File extract example – All members, Heads of Contract (HOC) and Dependents (Dep) will have these REF03 and REF04 lines populated.

INS*Y*18*030*XN*A*E**FT**N~ REF*0F*00999999~

REF*1L*0717111*CSA Central State Active*ZZ:32712~ DTP*303*D8*20180501~

DTP*336*D8*20020516~

NM1*IL*1*Ball*Krystal*H***34*888888888~ PER*IP**HP*7777777777~ N3*31 Fortune Drive~ N4*Majestic*TN*555556666~ DMG*D8*19720118*M*I~

EC*08~ HLH*U~

HD*030**HLT*PRPV1N*ECH******~ DTP*348*D8*20180101~

INS*N*19*030*XN*A*E****N~ REF*0F*00999999~

REF*1L*0717111*CSA Central State Active*ZZ:32712~ DTP*303*D8*20180501~ NM1*IL*1*Ball*Ray*S***34*878787878~ PER*IP**HP*7777777777~ N3*31 Fortune Drive~ N4*Majestic*TN*555556666~ DMG*D8*20020119*M~

HLH*U~ HD*030**HLT*PRPV1N*******~

DTP*348*D8*20180101~

HOC

Dep 1

Scenario 2 – Two different addresses for the same member Members can keep more than one active address on our database, one of which is a “home” address and the other a “mailing” address. The file can provide two addresses for the same member. When two addresses are present use the “mailing address.”

· NM1*31*1 line is present on the file for a member when there is a mailing address

· LoopID 2100C N3

· LoopID 2100C N4 File extract example – Member has more than one active address. The mailing address follows the NM1*31*1 line.

INS*Y*18*030*XN*A*E**FT**N~ REF*0F*00989898~

REF*1L*0717111*CSA Central State Active*ZZ:31705~ DTP*303*D8*20180501~

DTP*336*D8*19960401~

NM1*IL*1*Daize*Summer*G***34*777777777~ PER*IP**HP*6666666666~ N3*317 Poppy Street~ N4*Moony*TN*555554444~ DMG*D8*19771212*F*I~

EC*08~ HLH*U~ NM1*31*1~

N3*PO Box 31212~ N4*Moony*TN*555554444~ HD*030**HLT*PRPV1N*ECH******~ DTP*348*D8*20180101~

INS*N*19*030*XN*A*E****N~ REF*0F*00989898~

REF*1L*0717111*CSA Central State Active*ZZ:31705~ DTP*303*D8*20180501~ NM1*IL*1*Daize*Jack*F***34*767676767~ PER*IP**HP*6666666666~ N3*317 Poppy Street~ N4*Moony*TN*555554444~ DMG*D8*19970418*M~

HLH*U~ HD*030**HLT*PRPV1N*******~

HOC

Benefits Administration 834 Guidance Manual: v 6.0 18

Scenario 3 – Dependents in the same family sharing same birthdate or name Occasionally the file will include dependents in the family with the same birthdate or same name. These are not duplicates. The file assigns a different dependent sequence number to each dependent record when the birthdate is the same. If the dependents’ names are the same, this sequence number is not assigned. You will have to decipher one dependent from the other using other demographic information such as birthdate or SSN. In this situation the indicators would be:

· For same birthdate: DMG* line will have the exact same birthdate for two or more dependents

· For same birthdate and/or same name: NM1* line will often have different SSN#’s (There are times when the file does not have accurate SSN#’s for newborns for a few months however.)

· For same birthdate: INS* line will have a dependent sequence number at the very end (only present when sharing same birthdate)

· For same name: NM1* line not necessarily both the first and last name are shared by dependents. One of these names will be different.

File extract example - Dependent (Dep) 1 and 2 share the same birthdate. Indicator present on the INS line

INS*N*19*030*XN*A*E****N*******1~ REF*0F*00979797~

REF*1L*0717111*RCS Retiree Central State*ZZ:71100~ DTP*303*D8*20180601~ NM1*IL*1*Day*Avery*L***34*676676767~ PER*IP**HP*5555555555~ N3*1234 Golden Valley~ N4*Sunrise*FL*444443333~ DMG*D8*20121224*F~

HLH*U~ HD*030**HLT*PRPV1N*******~ DTP*348*D8*20180101~

INS*N*19*030*XN*A*E****N*******2~ REF*0F*00101325~

REF*1L*0717111*RCS Retiree Central State*ZZ:71100~ DTP*303*D8*20180601~ NM1*IL*1*Day*Holly*M***34*676676768~ PER*IP**HP*5555555555~ N3*1234 Golden Valley~ N4*Sunrise*FL*444443333~ DMG*D8*20121224*F~

HLH*U~ HD*030**HLT*PRPV1N*******~

Dep 1

Dep 2

File extract example - Dependent (Dep) 1 and 2 share the same first name. No indicator present on the INS line since their birthdates are different. However, their last names are different, birthdates are different, and SSNs are different

Benefits Administration 834 Guidance Manual: v 6.0 19

REF*1L*0717111*RCS Retiree Central State*ZZ:71100~ DTP*303*D8*20180601~ NM1*IL*1*Day*Avery*L***34*676676767~ PER*IP**HP*5555555555~ N3*1234 Golden Valley~ N4*Sunrise*FL*444443333~ DMG*D8*20121224*F~

HLH*U~ HD*030**HLT*PRPV1N*******~ DTP*348*D8*20180101~

INS*N*19*030*XN*A*E****N~ REF*0F*00101325~

REF*1L*0717111*RCS Retiree Central State*ZZ:71100~ DTP*303*D8*20180601~ NM1*IL*1*Knight*Avery*M***34*676676768~ PER*IP**HP*5555555555~ N3*1234 Golden Valley~ N4*Sunrise*FL*444443333~ DMG*D8*20121224*F~

HLH*U~ HD*030**HLT*PRPV1N*******~

Scenario 4 - Changes to demographics Sometimes the demographic information of an existing enrolled member is changed. This change can cause an issue with the vendor that loads the file because the vendor’s system creates a new enrollment record for the member. However, it is the same member and only has a demographic data change. A file will provide the new demographic information and no other indicators of the change. Any of these file lines may be different from one file to the next depending on what demographic information changed.

· NM1*, PER*, N3*, N4*, DMG* lines will have the new information

· Same coverage begin date on DTP*348 line, no new effective date on the DTP*348 line for the recent change File extract example - Dependent (Dep) 1 of the Head of Contract (HOC) had a last name change. The only line different is the NM1*.

REF*1L*0717111*CSA Central State Active*ZZ:31501~ DTP*303*D8*20180401~ DTP*336*D8*20150209~ NM1*IL*1*Christmas*Tim*B***34*565656565~ PER*IP**HP*4444444444~ N3*32 Northern Lights~ N4*Pole*TN*333332222~ DMG*D8*19861226*M*I~

EC*08~ HLH*U~

HD*030**HLT*PPOV1N*ESP******~ DTP*348*D8*20180101~

INS*N*01*030*XN*A*E****N~ REF*0F*00969696~

REF*1L*0717111*CSA Central State Active*ZZ:31501~ DTP*303*D8*20180401~ NM1*IL*1*Daniels*Mary*N***34*454545454~ PER*IP**HP*4444444444~ N3*32 Northern Lights~ N4*Pole*TN*333332222~ DMG*D8*19840301*F~

HLH*U~ HD*030**HLT*PPOV1N*******~

H O C e p 1

INS*Y*18*030*XN*A*E**FT**N~ REF*0F*00969696~

REF*1L*0717111*CSA Central State Active*ZZ:31501~ DTP*303*D8*20180401~

DTP*336*D8*20150209~

NM1*IL*1*Christmas*Tim*B***34*565656565~ PER*IP**HP*4444444444~ N3*32 Northern Lights~ N4*Pole*TN*333332222~ DMG*D8*19861226*M*I~

EC*08~ HLH*U~

HD*030**HLT*PPOV1N*ESP******~ DTP*348*D8*20180101~

INS*N*01*030*XN*A*E****N~ REF*0F*00969696~

REF*1L*0717111*CSA Central State Active*ZZ:31501~ DTP*303*D8*20180401~ NM1*IL*1*Christmas*Mary*N***34*454545454~ PER*IP**HP*4444444444~ N3*32 Northern Lights~ N4*Pole*TN*333332222~ DMG*D8*19840301*F~

HLH*U~ HD*030**HLT*PPOV1N*******~ DTP*348*D8*20180101~

Scenario 5 - Changes in relationship to head of contract (HOC) This scenario occurs when a member has a coverage change that also includes a change in relationship with one of the covered dependents. One common situation is a divorce typically when a dependent is terming coverage. Similar to the demographic change scenario, this relationship code change sometimes creates an issue with the vendor that loads the file because the vendor’s system creates a new member however; it is the same member as before but with a relationship code data change. For a list of the relationship codes refer to Table 8A: INS.

· New relationship code on the dependent’s INS* line

· New DTP*349 line sent for terminating dependent’s coverage File extract example –The INS* line updates from the spouse relationship code to ex-spouse do to a divorce

REF*1L*0717111*GA2 Local Gov Active Prem Level 2*ZZ:50937~

DTP*303*D8*20180401~ DTP*336*D8*20160401~

NM1*IL*1*Myer*Oscar*Preston***34*434343434~ PER*IP**HP*3333333333~ N3*40 Buds Lane~ N4*Reneiw*TN*111119999~ DMG*D8*19830405*M*M~

EC*08~ HLH*U~

HD*030**HLT*PPOV1N*ESP******~ DTP*348*D8*20160501~

INS*N*01*030*XN*A*E****N~ REF*0F*00959595~

REF*1L*0717111*GA2 Local Gov Active Prem Level 2*ZZ:50937~

DTP*303*D8*20180401~

NM1*IL*1*Myer*Michelle*S***34*232323232~ PER*IP**HP*3333333333~ N3*40 Buds Lane~ N4*Reneiw*TN*111119999 DMG*D8*19841121*F~

HLH*U~

HD*030**HLT*PPOV1N*******~ DTP*348*D8*20160501~

H O C

INS*Y*18*030*XN*A*E**FT**N~ REF*0F*00959595~

REF*1L*0717111*GA2 Local Gov Active Prem Level 2*ZZ:50937~ DTP*303*D8*20180401~

DTP*336*D8*20160401~

NM1*IL*1*Myer*Oscar*Preston***34*434343434~ PER*IP**HP*3333333333~ N3*40 Buds Lane~ N4*Reneiw*TN*111119999~ DMG*D8*19830405*M*M~

EC*08~ HLH*U~

HD*030**HLT*PPOV1N*EMP******~ DTP*348*D8*20180401~

INS*N*25*030*XN*A*E***N*N~ REF*0F*00959595~

REF*1L*0717111*GA2 Local Gov Active Prem Level 2*ZZ:50937~ DTP*303*D8*20180401~ NM1*IL*1*Myer*Michelle*S***34*232323232~ PER*IP**HP*3333333333~ N3*40 Buds Lane~ N4*Reneiw*TN*111119999 DMG*D8*19841121*F~

HLH*U~ HD*024**HLT*PPOV1N*******~ DTP*349*D8*20180401~

Scenario 6 - Plan code change There are times when the plan code will change mid-year due to a special qualifying event where the member can make enrollment changes. The file will not provide the end date on a DTP*349 line for the former plan code. For a list of the State of TN’s plan codes, refer to the Appendix. This situation is not an additional member record; it is updated information to an existing member record. Indicators of a plan code change would be:

· New (plan) code appearing on HD* line for the covered HOC and any dependent (Dep).

· New date on DTP*348 line for covered HOC and any enrolled dependents File extract example -This member has changed from a Standard PPO plan to a CDHP/HSA plan instead resulting in a plan code change to both the HOC and covered Dep 1.

REF*1L*FA06165*CSA Central State Active*ZZ:33503~ DTP*303*D8*20180501~

DTP*336*D8*20080602~

NM1*IL*1*Mellow*Graham*A***34*121212121~ PER*IP**HP*2222222222~ N3*840 Camp Dr~ N4*Smoreville*TN*111118888~ DMG*D8*19690317*M*I~

EC*08~ HLH*U~

HD*030**HLT*PPOV2N*ECH******~ DTP*348*D8*20150901~

INS*N*19*030*XN*A*E****N~ REF*0F*00949494~

REF*1L*FA06165*CSA Central State Active*ZZ:33503~ DTP*303*D8*20180501~ NM1*IL*1*Mellow*Marsha*B***34*010101011~ PER*IP**HP*2222222222~ N3*840 Camp Dr~ N4*Smoreville*TN*111118888~ DMG*D8*19960129*F~

HLH*U~

HD*030**HLT*PPOV2N*******~

H O C

INS*Y*18*030*XN*A*E**FT**N~ REF*0F*00949494~

REF*1L*FA06165*CSA Central State Active*ZZ:33503~ DTP*303*D8*20180501~

DTP*336*D8*20080602~

NM1*IL*1*Mellow*Graham*A***34*121212121~ PER*IP**HP*2222222222~ N3*840 Camp Dr~ N4*Smoreville*TN*111118888~ DMG*D8*19690317*M*I~

EC*08~ HLH*U~

HD*030**HLT*HSAV2N*ECH******~ DTP*348*D8*20180501~

INS*N*19*030*XN*A*E****N~ REF*0F*00949494~

REF*1L*FA06165*CSA Central State Active*ZZ:33503~ DTP*303*D8*20180501~ NM1*IL*1*Mellow*Marsha*B***34*010101011~ PER*IP**HP*2222222222~ N3*840 Camp Dr~ N4*Smoreville*TN*111118888~ DMG*D8*19960129*F~

HLH*U~

HD*030**HLT*HSAV2N*******~

DTP*348*D8*20150901~

DTP*348*D8*20180501~

Scenario 7 - Entire family is terminating coverage The State of TN 834 files are full population files. As a result, sometimes vendors choose to replace the data each week. This replacement can cause problems if the DTP*348 effective date line is missing for members. In the case of terminating coverage, the state of TN 834 files do not provide both a DTP*348 line and a DTP*349 line for terminating members. The file only provides the

· DTP*349 line for terminating HOC’s and/or dependents

· The coverage term dates found on the DTP*349 line be the 1st of the month, however the actual date coverage ended is the last day of the previous month.

File extract example - This family is terminating coverage as of 5/01/2018.

REF*1L*FA06165*MSC Miscellaneous*ZZ:30401~ DTP*303*D8*20180401~ DTP*336*D8*20040901~ NM1*IL*1*Flowers*Walter*N***34*020202020~ PER*IP**HP*1111111111~ N3*6767 Rose Court~ N4*Verano*TN*111117777~ DMG*D8*19761005*M*M~

EC*08~ HLH*U~

HD*030**HLT*PRPV2B*FAM******~ DTP*348*D8*20180101~

INS*N*19*030*XN*A*E****N~ REF*0F*00939393~

REF*1L*FA06165*MSC Miscellaneous*ZZ:30401~ DTP*303*D8*20180401~ NM1*IL*1*Flowers*April*A***34*010101010~ PER*IP**HP*1111111111~ N3*6767 Rose Court~ N4*Verano*TN*111117777~ DMG*D8*20100401*F~

HLH*U~ HD*030**HLT*PRPV2B*******~ DTP*348*D8*20180101~

INS*N*01*030*XN*A*E****N~ REF*0F*00939393~

REF*1L*FA06165*MSC Miscellaneous*ZZ:30401~ DTP*303*D8*20180401~ NM1*IL*1*Flowers*May*R***34*030303030~ PER*IP**HP*1111111111~ N3*6767 Rose Court~ N4*Verano*TN*111117777~ DMG*D8*19800525*F~

HLH*U~

HD*030**HLT*PRPV2B*******~ DTP*348*D8*20180101~

HOC

INS*Y*18*030*XN*A*E**TE**N~ REF*0F*00939393~

REF*1L*FA06165*MSC Miscellaneous*ZZ:30401~ DTP*303*D8*20180501~ DTP*336*D8*20040901~ NM1*IL*1*Flowers*Walter*N***34*020202020~ PER*IP**HP*1111111111~ N3*6767 Rose Court~ N4*Verano*TN*111117777~ DMG*D8*19761005*M*M~

EC*08~ HLH*U~

HD*024**HLT*PRPV2B*FAM******~ DTP*349*D8*20180501~

INS*N*19*030*XN*A*E****N~ REF*0F*00939393~

REF*1L*FA06165*MSC Miscellaneous*ZZ:30401~ DTP*303*D8*20180501~ NM1*IL*1*Flowers*April*A***34*010101010~ PER*IP**HP*1111111111~ N3*6767 Rose Court~ N4*Verano*TN*111117777~ DMG*D8*20100401*F~

HLH*U~ HD*024**HLT*PRPV2B*******~ DTP*349*D8*20180501~

INS*N*01*030*XN*A*E****N~ REF*0F*00939393~

REF*1L*FA06165*MSC Miscellaneous*ZZ:30401~ DTP*303*D8*20180501~ NM1*IL*1*Flowers*May*R***34*030303030~ PER*IP**HP*1111111111~ N3*6767 Rose Court~ N4*Verano*TN*111117777~ DMG*D8*19800525*F~

HD*024**HLT*PRPV2B*******~ DTP*349*D8*20180501~

Scenario 8 - Removing one dependent and remaining family members keep coverage This scenario includes whenever a dependent is removed from coverage for various reasons such as aging off at 26yrs old, aging off at 65 years old, dependent is offered insurance elsewhere or a divorce as examples. This situation also occurs with the death of a dependent. Most often the file does not include a date of death for the deceased member. In these scenarios, the file will transmit:

· New date on DTP*348 line only for remaining HOC and dependents only

· No DTP*348 line sent for terminating dependent

· New DTP*349 line sent for terminating dependent

· (Sometimes) a new coverage level code on the HD* line for HOC and any dependents remaining on. A list of these coverage codes can be found on Table 8P: HD.

File extract example 1 - This family has Dep 2 terminating while the HOC and Dep 1 remain. There is a coverage level change on the HOC’s record.

REF*1L*FA06165*CSA Central State Active*ZZ:32901~ DTP*303*D8*20180501~

DTP*336*D8*20050601~

NM1*IL*1*Cane*Michael*A***34*040404040~ PER*IP**HP*9999988888~ N3*904 Rush Ridge~ N4*Sweet Field*TN*111116666~ DMG*D8*19650901*F*M~

EC*08~ HLH*U~

HD*030**HLT*PRPV2N*FAM******~ DTP*348*D8*20180101~

INS*N*01*030*XN*A*E***N*N~ REF*0F*00929292~

REF*1L*FA06165*CSA Central State Active*ZZ:32901~ DTP*303*D8*20180501~ NM1*IL*1*Cane*Sugar*D***34*050505050~ PER*IP**HP*9999988888~ N3*904 Rush Ridge~ N4*Sweet Field*TN*111116666~ DMG*D8*19640420*F~

HLH*U~ HD*030**HLT*PRPV2N*******~ DTP*348*D8*20180101~

INS*N*19*030*XN*A*E****N~ REF*0F*00929292~

REF*1L*FA06165*CSA Central State Active*ZZ:32901~ DTP*303*D8*20180501~ NM1*IL*1*Cane*Kandi****34*060606060~ PER*IP**HP*9999988888~ N3*904 Rush Ridge~ N4*Sweet Field*TN*111116666~ DMG*D8*19971031*M~

HLH*U~

HD*030**HLT*PRPV2N*******~ DTP*348*D8*20180101~

HOC

INS*Y*18*030*XN*A*E**FT**N~ REF*0F*00929292~

REF*1L*FA06165*CSA Central State Active*ZZ:32901~ DTP*303*D8*20180501~

DTP*336*D8*20050601~

NM1*IL*1*Cane*Michael*A***34*040404040~ PER*IP**HP*9999988888~ N3*904 Rush Edge~ N4*Sweet Field*TN*372117028~ DMG*D8*19650901*F*M~

EC*08~ HLH*U~

HD*030**HLT*PRPV2N*ESP******~ DTP*348*D8*20180501~

INS*N*01*030*XN*A*E***N*N~ REF*0F*00929292~

REF*1L*FA06165*CSA Central State Active*ZZ:32901~ DTP*303*D8*20180501~ NM1*IL*1*Cane*Sugar*D***34*050505050~ PER*IP**HP*9999988888~ N3*904 Rush Ridge~ N4*Sweet Field*TN*111116666~ DMG*D8*19640420*F~

HLH*U~ HD*024**HLT*PRPV2N*******~ DTP*348*D8*20180501~

INS*N*19*030*XN*A*E****N~ REF*0F*00929292~

REF*1L*FA06165*CSA Central State Active*ZZ:32901~ DTP*303*D8*20180501~ NM1*IL*1*Cane*Kandi****34*060606060~ PER*IP**HP*9999988888~ N3*904 Rush Ridge~ N4*Sweet Field*TN*111116666~ DMG*D8*19971031*M~

HD*030**HLT*PRPV2N*******~ DTP*349*D8*20180501~

File extract example 2 - This family has Dep 3 removed and there is no coverage level change on the HOC’s record.

REF*1L*0717111*CSA Central State Active*ZZ:34902~ DTP*303*D8*20180601~

DTP*336*D8*20161003~

NM1*IL*1*Coon*TY*F***34*070707070~ PER*IP**HP*9999977777~ N3*23 Wall Street~ N4*Dinero*TN*111115555~ DMG*D8*19661125*M*M~

EC*08~ HLH*U~

HD*030**HLT*HSAV1B*FAM******~ DTP*348*D8*20180101~

INS*N*01*030*XN*A*E****N~ REF*0F*00919191~

REF*1L*0717111*CSA Central State Active*ZZ:34902~ DTP*303*D8*20180601~ NM1*IL*1*Coon*Rachel****34*080808080~ PER*IP**HP*9999977777~ N3*23 Wall Street~ N4*Dinero*TN*111115555~ DMG*D8*19590517*F~

HLH*U~ HD*030**HLT*HSAV1B*******~ DTP*348*D8*20180101~

INS*N*19*030*XN*A*E****N~ REF*0F*00919191~

REF*1L*0717111*CSA Central State Active*ZZ:34902~ DTP*303*D8*20180601~ NM1*IL*1*Coon*Daniel****34*090909090~ PER*IP**HP*9999977777~ N3*23 Wall Street~ N4*Dinero*TN*111115555~ DMG*D8*19980615*M~

HLH*U~ HD*030**HLT*HSAV1B*******~ DTP*348*D8*20180101~

INS*N*19*030*XN*A*E****N~ REF*0F*00919191~

REF*1L*0717111*CSA Central State Active*ZZ:34902~ DTP*303*D8*20180601~ NM1*IL*1*Coon*Manny****34*898989898~ PER*IP**HP*9999977777~ N3*23 Wall Street~ N4*Dinero*TN*111115555~ DMG*D8*19920629*M~

HLH*U~ HD*030**HLT*HSAV1B*******~

HOC

Dep 3

INS*Y*18*030*XN*A*E**FT**N~ REF*0F*00919191~

REF*1L*0717111*CSA Central State Active*ZZ:34902~ DTP*303*D8*20180701~

DTP*336*D8*20161003~

NM1*IL*1*Coon*TY*F***34*070707070~ PER*IP**HP*9999977777~ N3*23 Wall Street~ N4*Dinero*TN*111115555~ DMG*D8*19661125*M*M~

EC*08~ HLH*U~

HD*030**HLT*HSAV1B*FAM******~ DTP*348*D8*20180701~

INS*N*01*030*XN*A*E****N~ REF*0F*00919191~

REF*1L*0717111*CSA Central State Active*ZZ:34902~ DTP*303*D8*20180701~ NM1*IL*1*Coon*Rachel****34*080808080~ PER*IP**HP*9999977777~ N3*23 Wall Street~ N4*Dinero*TN*111115555~ DMG*D8*19590517*F~

HLH*U~ HD*030**HLT*HSAV1B*******~ DTP*348*D8*20180701~

INS*N*19*030*XN*A*E****N~ REF*0F*00919191~

REF*1L*0717111*CSA Central State Active*ZZ:34902~ DTP*303*D8*20180701~ NM1*IL*1*Coon*Daniel****34*090909090~ PER*IP**HP*9999977777~ N3*23 Wall Street~ N4*Dinero*TN*111115555~ DMG*D8*19980615*M~

HLH*U~ HD*030**HLT*HSAV1B*******~ DTP*348*D8*20180701~

INS*N*19*030*XN*A*E***N*N~ REF*0F*00919191~

REF*1L*0717111*CSA Central State Active*ZZ:34902~ DTP*303*D8*20180701~ NM1*IL*1*Coon*Manny****34*898989898~ PER*IP**HP*9999977777~ N3*23 Wall Street~ N4*Dinero*TN*111115555~ DMG*D8*19920629*M~

HLH*U~ HD*024**HLT*HSAV1B*******~

DTP*349*D8*20180701~

Scenario 9 - Death of the head of contract/HOC (medical benefit only) The State of TN offers a six month extension of medical benefits to the surviving dependents of an HOC if they were enrolled in coverage at the time of the HOC’s death. The State of TN’s 834 file most of the time does not include a date of death. The HOC’s coverage and any enrolled dependents remain on the file with DTP*349 lines for the next six months (or sooner if the dependents choose to end coverage sooner). The file will transmit the HOC record as long as the remaining dependents stay enrolled. Indicators on the file would be:

· New DTP*349 lines sent for deceased HOC and for the dependents with an end date (usually) six months in the future.

· However it is no definite way to tell this is a deceased HOC situation.

File extract example 1 - This HOC passed away on 01/24/2018. Normally the coverage end date transmitted would have been 02/1/2018. However this HOC and enrolled dependents have a coverage end (DTP*349) of 08/01/2018 which is six months later.

REF*1L*FA06165*RCS Retiree Central State*ZZ:71500~ DTP*303*D8*20180201~

DTP*336*D8*20121201~

NM1*IL*1*Dente*Al*E***34*838383838~ PER*IP**HP*9999966666~ N3*PO Box 52~ N4*Rome*TN*111114444~ DMG*D8*19350704*M*M~

EC*08~ HLH*U~

HD*030**HLT*PPOV2N*ESP******~ DTP*348*D8*20170801~

INS*N*01*030*XN*A*E****N~ REF*0F*00909090~

REF*1L*FA06165*RCS Retiree Central State*ZZ:71500~ DTP*303*D8*20180201~ NM1*IL*1*Dente*Allie*M***34*848484848~ PER*IP**HP*9999966666~ N3*PO Box 52~ N4*Rome*TN*111114444~ DMG*D8*19351221*F~

HLH*U~ HD*030**HLT*PPOV2N*******~

DTP*348*D8*20170801~

HOC

INS*Y*18*030*XN*A*E**TE**N~ REF*0F*00909090~

REF*1L*FA06165*RCS Retiree Central State*ZZ:71500~ DTP*303*D8*20180301~

DTP*336*D8*20121201~

NM1*IL*1*Dente*Al*E***34*838383838~ PER*IP**HP*9999966666~ N3*PO Box 52~ N4*Rome*TN*111114444~ DMG*D8*19350704*M*M~

EC*08~ HLH*U~

HD*024**HLT*PPOV2N*ESP******~ DTP*349*D8*20180801~

INS*N*01*030*XN*A*E****N~ REF*0F*00909090~

REF*1L*FA06165*RCS Retiree Central State*ZZ:71500~ DTP*303*D8*20180501~ NM1*IL*1*Dente*Allie*M***34*848484848~ PER*IP**HP*9999966666~ N3*PO Box 52~ N4*Rome*TN*111114444~ DMG*D8*19351221*F~

HLH*U~ HD*024**HLT*PPOV2N*******~

DTP*349*D8*20180801~

File extract example 2 - Occasionally, the date of death will appear on the file for the HOC. If it is present, it will be on the INS line with a D8* indicator. The date of death would appear for dependents on the INS line too and only occasionally.

REF*1L*0717111*CSA Central State Active*ZZ:32732~

DTP*303*D8*20180401~ DTP*336*D8*19911201~

NM1*IL*1*Bacon*Chris*P***34*818181818~ PER*IP**HP*9999955555~ N3*2396 Forest Trail~ N4*Woodfield*TN*111113333~ DMG*D8*19480207*M*I~

EC*08~ HLH*U~

HD*030**HLT*PRPV1B*EMP******~ DTP*348*D8*20180101~

REF*1L*0717111*CSA Central State Active*ZZ:32732~ DTP*303*D8*20180401~

DTP*336*D8*19911201~

NM1*IL*1*Bacon*Chris*P***34*818181818~ PER*IP**HP*9999955555~ N3*2396 Forest Trail~ N4*Woodfield*TN*111113333~ DMG*D8*19480207*M*I~

EC*08~ HLH*U~

HD*024**HLT*PRPV1B*EMP******~

DTP*349*D8*20180401~

Scenario 10 - Future-dated benefit end - (potentially present up to four times) Similar to an HOC death, where the termination of coverage is in the future, there are other times when a “future-dated termination” is present on the file. Terminations in the future can be from an upcoming retirement or from the aging off of dependents reaching 26 yrs or 65 yrs old for examples. One common characteristic among future terms is

· The date on the new DTP*349 line (benefit-ending entry) will be after the date on the current DTP*303 line (file maintenance date) File extract example - The maintenance date on DTP*303 is in May 1 2018. The date on DTP*349 is June 1 2018. The records remain on the file until the DTP*303 date reaches something after June 1, 2018

REF*1L*0717111*RTE Loc Ed Retiree Teacher*ZZ:99105~ DTP*303*D8*20180501~ DTP*336*D8*20160301~ NM1*IL*1*Storm*Gail*S***34*797979797~ PER*IP**HP*9999944444~ N3*PO Box 819~ N4*Weathertown*TN*111112222~ DMG*D8*19590803*F*M~

EC*08~ HLH*U~

HD*024**HLT*PRPV2B*EMP******~ DTP*349*D8*20180601~

After DTP*303*D8*20180602~: Not present on file

Scenario 11 - Reinstatement of benefits Sometimes members who were previously terminated appear again on the file and it will look like they never ended coverage in the first place. These reinstatements can be within a month or two or cross over several months or even a year or two depending on the reinstatement reason. Some indicators of a reinstatement situation on a file will be:

· A previously sent DTP*349 date for the HOC and any enrolled dependents at the time

· Any DTP* 348 dates from before will reappear with the date they had before the DTP*349 line was sent

· No new DTP*348 date File extract example - This member was terminated on the May 2018 file but then returned within a calendar month on the June 2018 file. The DTP*348 is dated before the DTP*349 line.

REF*1L*0717111*GA1 Local Gov Active Prem Level 1*ZZ:51295~

DTP*303*D8*20180501~ DTP*336*D8*20150101~

NM1*IL*1*Wood*Chuck*N.***34*787878787~ PER*IP**HP*9999933333~ N3*13432 Timber Ridge~ N4*Green House*TN*222223333~ DMG*D8*19791017*M*M~

EC*08~ HLH*U~

HD*024**HLT*PPLV1B*ECH******~ DTP*349*D8*20180501~

INS*N*19*030*XN*A*E****N~ REF*0F*00858585~

REF*1L*0717111*GA1 Local Gov Active Prem Level 1*ZZ:51295~

DTP*303*D8*20180501~

NM1*IL*1*Wood*Holly*E***34*767676767~ PER*IP**HP*9999933333~ N3*13432 Timber Ridge~ N4*Green House*TN*222223333~ DMG*D8*20130731*F~

HLH*U~ HD*024**HLT*PPLV1B*******~

DTP*349*D8*20180501~

H O C

INS*Y*18*030*XN*A*E**FT**N~ REF*0F*00858585~

REF*1L*0717111*GA1 Local Gov Active Prem Level 1*ZZ:51295~

DTP*303*D8*20180601~ DTP*336*D8*20150101~

NM1*IL*1*Wood*Chuck*N.***34*787878787~ PER*IP**HP*9999933333~…