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Frequently Asked Questions (FAQs) for 834 Transactions


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Q.

Will the new eMedNY 834 be posted on the same SFTP server as the NYSoH 834? Will we have to get it from a different folder path?

 

 

Published: 11/07/2019

|

Updated: 04/07/2020

|

QID: L2

 
 

A.

The NYSOH 834 and the eMedNY 834 are different files from different systems. eMedNY access details and business rules are published in both of the following documents on www.emedny.org in Transaction Instructions under the eMedNY HIPAA Support Tab:

  • The eMedNY Trading Partner Information Standard Companion Guide in the Connectivity/Communications section
  • The Managed Care Enrollment (MCE) 834 Companion Guide in the Payer Specific Business Rules and Limitations section
 
 

Q.

Where will the eMedNY 834 Client Enrollment file be delivered?

 

 

Published: 11/07/2019

|

Updated: 04/07/2020

|

QID: L3

 
 

Q.

Will the first file after go-live be an audit file?

 

 

Published: 11/25/2019

|

Updated: 11/25/2019

|

QID: L4

 
 

Q.

For support questions after go-live, who is the contact?

 

 

Published: 11/25/2019

|

Updated: 11/25/2019

|

QID: L5

 
 

Q.

Please advise the status of the various Maximus NYMC files (A, E, L, T, DU, Homeless etc.). What files will we continue to receive, and which will be discontinued?

 

 

Published: 12/10/2019

|

Updated: 12/10/2019

|

QID: L6

 
 

Q.

Does eMedNY/DOH expect to receive effectuations from Plans?

 

 

Published: 11/01/2019

|

Updated: 11/01/2019

|

QID: L8

 
 

Q.

Will there be any sort of error reporting for effectuations that are rejected by DOH? If so, what type of report will it be and how frequently will it be received?

 

 

Published: 11/01/2019

|

Updated: 11/01/2019

|

QID: L9

 
 

Q.

Will issuers be required to perform any sort of enrollment reconciliation with DOH?

 

 

Published: 11/25/2019

|

Updated: 01/03/2020

|

QID: L11

 
 

Q.

Will the submission of effectuations drive capitation payments?

 

 

Published: 11/01/2019

|

Updated: 11/01/2019

|

QID: L12

 
 

Q.

What is the QHP Policy ID referenced in 2000 REF - Member Supplemental Identifier noted in the 834 MCE Companion Guide, and does the value need to be stored within our system?

 

 

Published: 12/10/2019

|

Updated: 06/04/2020

|

QID: L13

 
 

Q.

If we have several different products (HARP, PACE etc.) will we receive one file?

 

 

Published: 11/01/2019

|

Updated: 11/01/2019

|

QID: L14

 
 

Q.

How can Plans determine in what order to process a client if the Plan receives different or overlapping information received over several different sources, i.e. both NYSOH and WMS?

 

 

Published: 04/01/2020

|

Updated: 04/01/2020

|

QID: L16

 
 

Q.

Currently, Plans get Retro disenrollment forms from the local districts (LDSS) to term a member based on a disenrollment reason code (i.e. 01 -  Incarceration, 02 Death). Should a Plan term the member prior to submitting a cancel transaction to the State?

 

 

Published: 01/16/2020

|

Updated: 02/25/2020

|

QID: L19

 
 

Q.

When the process is transitioned to the 834 format will clients be assigned new CIN numbers?

 

 

Published: 11/01/2019

|

Updated: 11/01/2019

|

QID: L20

 
 

Q.

How many RRE codes should we expect to receive?

 

 

Published: 11/07/2019

|

Updated: 06/04/2020

|

QID: L21

 
 

Q.

Will the 025 maintenance type transaction (reinstatement/re-enrollment) be sent on the 834 file? The companion guide only referenced 001, 021, 024 and 030 maintenance type transactions.

 

 

Published: 11/07/2019

|

Updated: 11/07/2019

|

QID: L24

 
 

Q.

Which date should the Plan use as the Plan enrollment date, 348 Benefit Begin Date or 356 Plan Eligibility Begin Date?

 

 

Published: 11/07/2019

|

Updated: 11/07/2019

|

QID: L25

 
 

Q.

Which date should the Plan use as the Plan disenrollment date, 349 Benefit End Date or 357 Plan Eligibility End Date?

 

 

Published: 11/07/2019

|

Updated: 11/07/2019

|

QID: L26

 
 

Q.

Will the Primary Care Physician be provided on the 834-enrollment file?

 

 

Published: 11/07/2019

|

Updated: 11/07/2019

|

QID: L27

 
 

Q.

Who should the Plan mail correspondences to, "member in care of name" or "responsible party"?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L28

 
 

Q.

Will the Expected Date of Confinement (EDC - Due Date) be provided on the 834-enrollment file?

 

 

Published: 11/07/2019

|

Updated: 11/07/2019

|

QID: L29

 
 

Q.

What would be the source of truth, eMedNY or the 834-enrollment file?

 

 

Published: 11/07/2019

|

Updated: 11/07/2019

|

QID: L32

 
 

Q.

Are Head of Household and/or Responsible Party going to be indicated on the eMedNY 834?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L33

 
 

Q.

Will Nursing Home members be on the MCE 834? If so, what details can we expect?

 

 

Published: 12/19/2019

|

Updated: 04/07/2020

|

QID: L45

 
 

Q.

Will the Monthly Nursing Home Residents specialty roster continue?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L46

 
 

Q.

Will the Health Commerce System (HCS) site still be used for any roster files?

 

 

Published: 11/25/2019

|

Updated: 01/03/2020

|

QID: L47

 
 

Q.

Will LDSS still notify the plan for a member roster change for the current month?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L48

 
 

Q.

Will the recert date for the upstate counties be included on the 834?

 

 

Published: 12/10/2019

|

Updated: 12/10/2019

|

QID: L49

 
 

Q.

With the new 834 process, what will the DOH Guidelines for Confidential Address be?

 

 

Published: 12/19/2019

|

Updated: 04/07/2020

|

QID: L50

 
 

Q.

Will there be a monthly correction file?

 

 

Published: 11/25/2019

|

Updated: 11/25/2019

|

QID: L54

 
 

Q.

Will there be mass/retro rate adjustments communicated in the 834?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L55

 
 

Q.

How will unborn/newborns be sent in the 834?

 

 

Published: 12/10/2019

|

Updated: 01/03/2020

|

QID: L57

 
 

Q.

Third Party Liability Coverage - will this be populated?

 

 

Published: 11/25/2019

|

Updated: 11/25/2019

|

QID: L58

 
 

Q.

How will the January test files be delivered?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L63

 
 

Q.

Will the values on the Verification file in the 348 (Benefit Begin Date) and 356 (Plan Eligibility Begin Date) dates show each member's original effective date, or will all members have the same date – the 1st of the month that the Verification file represents?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L64

 
 

Q.

If we have multiple ZIP files in a single day, with multiple 834s contained within each ZIP file, do we return a separate X12 999 Acknowledgement for each 834 within the zip file?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L65

 
 

Q.

What types of transactions can we receive on a single file for a single member?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L67

 
 

Q.

Can we get a breakdown of what the BGN02 value represents?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L68

 
 

Q.

Can we expect the "care name" or "guardian name" format in both downstate and upstate records to start being consistently first name first and last name last on the 834, or will it continue to be different from the 2 sources?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L71

 
 

Q.

There are a number of actions that HRA/LDSS does that brings Medicaid coverage down, E.g.: turning 65/ Pool/trust/CHHA. Will this impact the 834 transaction we receive, and, if so, how do we know HRA initiated this? How do we know if we have follow up?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L72

 
 

Q.

How will the plans be notified when a member loses or adds SSI?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L73

 
 

Q.

What is the plan regarding continued use of the supplemental files: RRE, NAMI, Disenrollments. If they are going to continue are the plans supposed to use this data to determine member benefit eligibility?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L76

 
 

Q.

It was mentioned that Maximus files will continue. Should these files be used for our source of eligibility?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L77

 
 

Q.

Maximus E files are daily and eMedNY 834s will be daily, so if Maximus enrolls a member and sends them on the E file and they don't appear on the daily eMedNY file should we enroll the member based on the E file or not?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L78

 
 

Q.

Maximus T files from Maximus are daily but eMedNY is only sending terms once a month. Should we term based on the Maximus T file or wait for eMedNY term file?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L79

 
 

Q.

Will all Rosters be replaced with 834 (MLTC, Medicaid Advantage & Medicaid Advantage Plus, MMC, HARP)? The Companion guide appears to only refer to MMC and MLTC?

 

 

Published: 12/19/2019

|

Updated: 01/03/2020

|

QID: L80

 
 

Q.

What will the eMedNY 834 file naming structures be for Production and Test files?

 

 

Published: 12/19/2019

|

Updated: 04/07/2020

|

QID: L81

 
 

Q.

Will Plans continue to get a new CIN assigned to a member when they move from/to NYC?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L82

 
 

Q.

We noticed that the disenrollment reason codes only had 2 in the companion guide and we would like the same level of detailed disenrollment's that NYSoH provides.

 

 

Published: 12/19/2019

|

Updated: 06/04/2020

|

QID: L83

 
 

Q.

How will newborns be enrolled retroactively to month of birth? Prospective Add with a retro change?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L85

 
 

Q.

What is the process when members move from one plan to another (ex. MMC to HARP)?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L86

 
 

Q.

If terms are only happening on the 25th of the month will we only get "adds" for a member moving from MMC to HARP after the term on the 25th?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L87

 
 

Q.

Where will we be able to find the original plan effective date for the member on the initial "030" maintenance "full file"?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L89

 
 

Q.

Will a Reinstate be sent as a 021 ADD transaction?
Will we receive a 024 Term transaction prior to receiving the 021?

 

 

Published: 12/19/2019

|

Updated: 12/19/2019

|

QID: L93

 
 

Q.

Will other HCS reports be replaced by the 834 (Fair Hearing, Newborns, TPHI, etc.)?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L94

 
 

Q.

With the C/O being replaced with a Resp Person loop in the 834, will there no longer be a 3rd address line with a 'C/O' reference?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L95

 
 

Q.

Currently, when Plans receive retroactive disenrollments from the LDSS, should the Plan cancel the member?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L101

 
 

Q.

When we receive a disenrollment from the LDSS, do we need to submit a cancel transaction to eMedNY?

 

 

Published: 01/16/2020

|

Updated: 02/25/2020

|

QID: L102

 
 

Q.

What will happen to the 270/271 Process?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L103

 
 

Q.

What will happen to the 277 Process?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L104

 
 

Q.

Is there any possibility to get the SFTP file transfer process set up so it's more automated like NYSoH?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L105

 
 

Q.

If we detect Level 1 compliance errors on the 834 validation, how should those be communicated back to eMedNY?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L107

 
 

Q.

What will be the process for the SDOH Retro disenrollments report?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L108

 
 

Q.

How do we handle 834 transactions received from eMedNY where we would be unable to send a 999 acknowledgement?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L111

 
 

Q.

Can members change any demographic information through the plan or must they contact LDSS? How should these changes be reported to eMedNY if through the plan?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L112

 
 

Q.

Is there a separate document for what is expected in the "999 Interchange Acknowledgement" response file that is expected from the plans?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L113

 
 

Q.

How will temporary loss of Medicaid eligibility be indicated? Will temporary loss of Medicaid eligibility still require us to cover the member until they return to the roster or are disenrolled?

 

 

Published: 01/08/2020

|

Updated: 01/08/2020

|

QID: L115

 
 

Q.

Will the HIV SNP rate codes be provided in the 834 file?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L116

 
 

Q.

Will transgender/homeless/emancipated members be indicated on in the 834 file?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L118

 
 

Q.

How should we handle potential day-to-day changes to the elements involved in rate code calculation (age, sex, Aid Code, HIV status, transgender status, homeless status) and the downstream affect involving premium billing, claims payment and vendor services such as pharmacy and behavioral health that we might receive in the daily 834 file?

 

 

Published: 02/20/2020

|

Updated: 02/20/2020

|

QID: L119

 
 

Q.

Should the monthly RRE code file override any RRE code differences that might be sent in the daily 834 file?

 

 

Published: 01/08/2020

|

Updated: 03/23/2020

|

QID: L121

 
 

Q.

When we send an 834 Effectuation to eMedNY, what kind of response should we expect from eMedNY for the submission? Will we receive a 999 Acknowledgement or an 834 response in return?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L124

 
 

Q.

Will Plans receive mapping guidance from current Roster to the X12 834 format?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L125

 
 

Q.

When will testing begin for Non-Pilot Plans? How will Non-Pilots receive sample files?

 

 

Published: 02/20/2020

|

Updated: 02/20/2020

|

QID: L126

 
 

Q.

If a client is recertifying Medicaid and missed the verification file, will they come back as retro enrollment on a daily file?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L128

 
 

Q.

Can you clarify what the Renewal Date refers to? Is this the last day of coverage?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L130

 
 

Q.

How does a Plan react to the continuing current files (E, T, U etc.) and the 834? What if members show on these different files with different dates than the 834?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L131

 
 

Q.

If we get a retro Disenroll transaction on the 834 file for months for which the plan has received payment, can we use that transaction to initiate the refund, or will we need to wait for the formal retro term request asking for premiums back?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L132

 
 

Q.

When Roster file data definition differs from the data in the 834 files (e.g. - Ethnicity Code is 6 characters on a Roster and only 1 character on the 834), should we expect the Roster-specific definition to carry over to the new 834, or will it conform to the 834 specifications?

 

 

Published: 01/16/2020

|

Updated: 01/16/2020

|

QID: L133

 
 

Q.

If the Spend Down/Excess Income is updated, will the file include the effective date of the change?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L134

 
 

Q.

QHP ID - if plans do not send back effectuations, will this be a risk as it relates to the QHP ID/Plan Assigned Policy ID?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L136

 
 

Q.

If Marital Status is not included on the Roster file, will the eMedNY 834 file have Marital Status populated?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L137

 
 

Q.

Currently on the HARP roster, we receive either TANF or SSI rate codes. Will that continue with the 834, or will the Health Plan receive the HARP rate code?

 

 

Published: 01/29/2020

|

Updated: 01/29/2020

|

QID: L138

 
 

Q.

Currently, when a member switches from HIX to Roster and vice-versa, new CINs are bring created. Is there a plan to fix this?

 

 

Published: 02/20/2020

|

Updated: 02/20/2020

|

QID: L139

 
 

Q.

Will the data be sourced by the County, so we know where to go with inquiries?

 

 

Published: 02/20/2020

|

Updated: 04/07/2020

|

QID: L142

 
 

Q.

If we opt not to send Effectuations, would it be possible to send a unique file with address updates?

 

 

Published: 02/20/2020

|

Updated: 02/20/2020

|

QID: L143

 
 

Q.

In the 834 guide, the 2100A PER TE-telephone segment states "Member Local District's or Case Worker's Telephone (TE) number will be valued, when available." Will we be getting the member's phone number?

 

 

Published: 02/20/2020

|

Updated: 02/20/2020

|

QID: L144

 
 

Q.

From the 834 guide - "Member's County of Residence will be identified. When available, a 5-digit FIPS County Code will be sent, otherwise a 2-digit county code will be valued". What are the circumstances when we would get a 2-digit county code instead of a 5-digit FIPS county code?

 

 

Published: 02/20/2020

|

Updated: 04/07/2020

|

QID: L145

 
 

Q.

2300 REF*X9 (Policy Number) - What is this value and does it map to a value we currently get on the Roster?

 

 

Published: 03/18/2020

|

Updated: 03/18/2020

|

QID: L146

 
 

Q.

When a member turns 21, will we get a change record on the 834 with a new rate code?

 

 

Published: 02/20/2020

|

Updated: 02/20/2020

|

QID: L148

 
 

Q.

What are the expected file naming conventions for the 999 and the 834 Effectuation files we send to eMedNY?

 

 

Published: 02/25/2020

|

Updated: 02/25/2020

|

QID: L149

 
 

Q.

The State mentioned that in addition to the March pilot, there would be pilot testing opportunities in April and May. Will the March pilot testing requirements be the same requirements that will be used for the April and May pilots? Will plans be able to participate in either the April or the May pilot, or will plans be required to participate in both the April and May pilot opportunities?

 

 

Published: 03/18/2020

|

Updated: 03/23/2020

|

QID: L150

 
 

Q.

The exchange (NYSoH) 834s have a "Request Submit Timestamp" in Loop ID 2750. We notice this will not be on the eMedNY 834s. Will the eMedNY 834s have an equivalent time stamp?

 

 

Published: 03/18/2020

|

Updated: 03/18/2020

|

QID: L151

 
 

Q.

Currently we receive daily E-flies for all approved members. Per the FAQ on 834 NYS website, it is mentioned that the 834 should be considered as the source of truth. What will the future state be after 834 go-live?

 

 

Published: 03/18/2020

|

Updated: 03/23/2020

|

QID: L152

 
 

Q.

If a member is approved on the 2/13/2020 E-file for a 3/1/2020 enrollment date, will this member also appear on the 834 file on the same day as 2/13/2020 or the next day?
Will there be any delay between the members appearing on the E-file vs. the 834 file?

 

 

Published: 03/23/2020

|

Updated: 03/23/2020

|

QID: L153

 
 

Q.

Will the 834 carry the same Aid Categories as the WMS roster?

 

 

Published: 03/18/2020

|

Updated: 04/07/2020

|

QID: L154

 
 

Q.

Will the 834 file have fields that can have repeating contents? The current NYS Roster file fields have singular content. For example, the current Health Exchange EDI 834 record can have multiple phone numbers in a phone number field, but the NYS Roster has just one number in a phone number field. In these scenarios, how should we determine which number is the primary phone number?

 

 

Published: 03/18/2020

|

Updated: 03/18/2020

|

QID: L157

 
 

Q.

Understanding that the Maximus E files are not to be used as source of eligibility, should they be used for any kind of differences between them and the eMedNY 834 that is received? Should we be using the 834 ONLY for all member information?

 

 

Published: 04/14/2020

|

Updated: 04/14/2020

|

QID: L158

 
 

Q.

In the set of sample transactions published in January 2020, the REF01 WMS ENROLL/DISENROLL REASON CODE on the sample files has both "17" and "ZZ". The Companion Guide only has "ZZ". Is there a discrepancy between the Samples and the CG?

 

 

Published: 06/04/2020

|

Updated: 06/04/2020

|

QID: L159

 
 

Q.

Please confirm the data value that should be populated within the 2300 Loop REF01 = 1L and REF02. According to the 834 manual, REF01 = 1L and REF02 are reserved for the group number and the issuer assigned policy ID which are already provided within the 2000 Loop. Is the expectation to provide it once again in the 2300 Loop as well?

 

 

Published: 03/18/2020

|

Updated: 03/18/2020

|

QID: L161

 
 

Q.

We need further clarity regarding the REJECT REASON and EXCEPTION from the ADDL MAINT REASON under the 2750 Loop on the Effectuation. Is the REJECT REASON mandatory for all EXCEPTIONS? If so, what is considered an acceptable REJECT REASON and in what format should it be provided (i.e., free-form text, character limit, etc.)?

 

 

Published: 03/18/2020

|

Updated: 03/18/2020

|

QID: L162

 
 

Q.

In the INS04 (Loop-ID 2000), we noted it does not appear to be valued, except on an 024 record with an 03 (Death). Is this the only value that will be populated?

 

 

Published: 03/23/2020

|

Updated: 03/23/2020

|

QID: L164

 
 

Q.

Would there ever be more than one disenrollment reason sent for a TERM (024)? The sample test data shows reason codes could be valued under two different reporting categories ("WMS ENROLL/DISENROLL REASON" and "DISENROLL RSN"). If both of these reporting categories are valued on a TERM (024), which reason code should be used by the Plan?

 

 

Published: 04/14/2020

|

Updated: 04/14/2020

|

QID: L165

 
 

Q.

In the MCE 834 Companion Guide, Loop ID 2750, DTP - Reporting Category Date, the comments state, "Effective Dates associated with several of the Member Reporting Categories will be sent, when applicable. To see when date(s) may be sent refer to Section 4.1.1 Table A - Member Reporting Category (Loop 2700) Iterations. End date will be populated only on TERM transactions". This seems incorrect; the Companion Guide has end dates for other types of transactions.

 

 

Published: 03/23/2020

|

Updated: 04/06/2020

|

QID: L166

 
 

Q.

What types of transactions would we see an "RD8" Date Qualifier on a record, other than TERM transactions?

 

 

Published: 03/23/2020

|

Updated: 03/23/2020

|

QID: L167

 
 

Q.

If we have MEDICAID, LTC, MAP and HARP Plans, to which Line of Business (Product) would the EXCESS and NAMI segments (see examples below) apply
N1*75*EXCESS~REF*9V*240.75~
N1*75*NAMI~REF*9V*0~.

 

 

Published: 03/18/2020

|

Updated: 08/24/2020

|

QID: L168

 
 

Q.

When is the go-live date for implementation of this Roster Project?

 

 

Published: 03/18/2020

|

Updated: 08/24/2020

|

QID: L169

 
 

Q.

Regarding FAQ L138, does this mean ALL HARP transactions will have a 7580 in the Rate Code Reporting Category? On the HARP Roster files today, were are receiving the normal (ex: 2201, 2205,2209) Rate Codes.

 

 

Published: 03/18/2020

|

Updated: 03/18/2020

|

QID: L170

 
 

Q.

Could you outline the timing/frequency of the daily 834 Roster Replacement file?

 

 

Published: 03/18/2020

|

Updated: 03/18/2020

|

QID: L171

 
 

Q.

Will plans receive transactions created on the same day which negate one another or will these be suppressed in the eMedNY system?
For example:
02/28/2020 Addition 04/01/2020
02/28/2020 CancelTerminate 04/01/2020-04/01/2020

 

 

Published: 03/23/2020

|

Updated: 03/23/2020

|

QID: L172

 
 

Q.

Will the transition to the eMedNY 834 prevent duplicate member enrollments into two MCOs?

 

 

Published: 04/01/2020

|

Updated: 04/01/2020

|

QID: L174

 
 

Q.

If Third Party Liability Coverage is on the file, will that always be included on a CancelTerminate transaction, or will the plan be required to notify DSS to have the member disenrolled for TPHI?

 

 

Published: 03/23/2020

|

Updated: 03/23/2020

|

QID: L175

 
 

Q.

Are Managed Care Coordinators prepared to assist Plans with eligibility discrepancies related to the eMedNY 834 transactions? Will they continue to correspond with Plans using email, mail and fax?

 

 

Published: 03/30/2020

|

Updated: 04/07/2020

|

QID: L176

 
 

Q.

What will the process be to request the Verification/Audit Files two times per year?

 

 

Published: 04/01/2020

|

Updated: 06/04/2020

|

QID: L177

 
 

Q.

If a Plan opts to not send Effectuations, as they are not required, the Plan Assigned Policy Identifier would not be reported by that Plan.
Is reporting the Plan Assigned Policy Identifier optional for plans choosing to effectuate?

 

 

Published: 04/01/2020

|

Updated: 04/01/2020

|

QID: L178

 
 

Q.

Plans currently receive an Excel spreadsheet uploaded through our HCS account that we download and manually key to our eligibility/claims systems. This allows us the opportunity to review and possibly appeal.
Will this process now be incorporated into the 834 process? If so, will there be Maintenance Reason Codes used to identify these members for other downstream workflow processes, or will this process remain outside of the 834 transactions?

 

 

Published: 03/23/2020

|

Updated: 03/23/2020

|

QID: L179

 
 

Q.

Will an edit be created to prevent members from being added to our plan if they have active TPHI in WMS?
Should a plan accept an 834 transaction for a member with TPHI or reject it back, so that the member can be disenrolled under the terms of our contract?

 

 

Published: 03/23/2020

|

Updated: 03/23/2020

|

QID: L180

 
 

Q.

It was indicated the current COB file we receive would be going away since this information will now be received on the 834. Will the current Carrier Codes be sent in the 2330 loop or will another identifier be used?

 

 

Published: 04/07/2020

|

Updated: 04/07/2020

|

QID: L183

 
 

Q.

Are the change transactions going to have all the information for the member in each change transaction? Or only the elements that changed?

 

 

Published: 04/01/2020

|

Updated: 04/01/2020

|

QID: L185

 
 

Q.

If an add transaction has excess income but the change does not have any amount at all (meaning an empty income loop in the change file), would this mean the excess income is removed? Can this be a case?

 

 

Published: 04/01/2020

|

Updated: 04/01/2020

|

QID: L186

 
 

Q.

Assuming there was no excess income in the add transaction, can the change transaction for the same member have an excess income?

 

 

Published: 04/01/2020

|

Updated: 04/01/2020

|

QID: L187

 
 

Q.

If an add transaction has excess income but the change has a zero amount, currently, we will consider the member went from excess income to no excess income. Is this correct?

 

 

Published: 04/01/2020

|

Updated: 04/01/2020

|

QID: L188

 
 

Q.

During Pilot testing, we are seeing the FAM IND on our daily Medicaid transactions that were sent this week.

N1*75*FAM IND
REF*17*F
LX*3

However, according to the companion guide this should only be present on MLTC. Can you confirm if this will now be passed on all members or if this is an error in the file?

 

 

Published: 04/07/2020

|

Updated: 06/04/2020

|

QID: L189

 
 

Q.

Health Plans have been receiving communications from NYS that will require plans to send the HIOS ID on all encounter submissions to the All Payer Claims Database. On these 834 files from eMedNY, there seems to be no HIOS ID. Are you aware of the requirements with NYS that issuers and vendors supply the HIOS ID on submissions, and will you be working on a plan to send a HIOS ID?

 

 

Published: 04/01/2020

|

Updated: 04/01/2020

|

QID: L190

 
 

Q.

In eMedNY eXchange, there is no option to upload a 999. What should we use?

 

 

Published: 04/07/2020

|

Updated: 06/04/2020

|

QID: L191

 
 

Q.

The Race Ethnicity had a 6 byte field length in the roster, but this field will have 834 standard code, which is one byte. Can we please get a crosswalk? We are converting the 834 file to a roster format for one of our applications and need the reference for this new code.

 

 

Published: 04/14/2020

|

Updated: 06/04/2020

|

QID: L193

 
 

Q.

The Local DSS office code field is not available on 834 as per the crosswalk. How do we know what the LDSS code is?

 

 

Published: 04/07/2020

|

Updated: 04/07/2020

|

QID: L194

 
 

Q.

Category Code position 279 – 280 on the current roster file: these values are N/A on the 834. Specifically, the Medicaid buy-in codes 70 and 71 that are currently passed on the roster. Please let us know how to look for this information in the 834.

 

 

Published: 04/27/2020

|

Updated: 04/27/2020

|

QID: L195

 
 

Q.

Capitation Code does not seem to be populated anywhere on the 834. Will this be in the 834, or should we assume it is always '03'?

 

 

Published: 04/07/2020

|

Updated: 04/07/2020

|

QID: L196

 
 

Q.

Guarantee date: this field is not populated. Is there another field that should be referred to?

 

 

Published: 04/01/2020

|

Updated: 04/01/2020

|

QID: L197

 
 

Q.

In the Companion Guide Crosswalk, the Authorization Date field is not valued in the eMedNY 834. Is this field not available?

 

 

Published: 05/04/2020

|

Updated: 05/04/2020

|

QID: L198

 
 

Q.

Transaction date: this field is not available on the eMedNY 834. Is it because the 834 files are daily and the date of the file refers to the transaction date?

 

 

Published: 04/14/2020

|

Updated: 04/14/2020

|

QID: L199

 
 

Q.

New Indicator: in the WMS roster, this field had an asterisk (*) symbol. Should we assume that any member with 'Add' maintenance code, i.e. 021, is a new member on the file?

 

 

Published: 04/01/2020

|

Updated: 04/01/2020

|

QID: L200

 
 

Q.

We are loading indicators in our source system for auto-assignment for subsequent reporting. Can you please verify the WMS Enroll/Disenroll Reason Codes below are the appropriate values to identify auto assignment to us?

05 ENROLLMENT MANDATORY VIA AUTO
06 AUTO ASSIGNMENT LOCAL DISTRICT
07 ENROLLMENT/NEWBORN AUTO ENROLL

 

 

Published: 04/01/2020

|

Updated: 04/01/2020

|

QID: L201

 
 

Q.

Since there is no effective date for the RRE Codes on the eMedNY 834, how will a change from one RRE code to another be processed, as we must know the effective date for the updated code?

 

 

Published: 04/14/2020

|

Updated: 04/14/2020

|

QID: L202

 
 

Q.

How many sets of COB (Coordination of Benefits) data should plans expect?

 

 

Published: 04/07/2020

|

Updated: 04/07/2020

|

QID: L204

 
 

Q.

Will the Case Number always be the same if there is more than one member related to a Case Name? If there are multiple people under the same Case Name, will they also have the same Case Number?

 

 

Published: 04/14/2020

|

Updated: 04/14/2020

|

QID: L205

 
 

Q.

We are having some challenges with loading the Case name as it's being presented in the 2100G loop NM103. Is there any way to parse the name into last and first so that we get NM103 and NM104?

 

 

Published: 04/20/2020

|

Updated: 06/04/2020

|

QID: L206

 
 

Q.

When the Case Name is valued in Loop 2100G, can eMedNY also pass the mailing address within the same loop?

 

 

Published: 05/04/2020

|

Updated: 05/04/2020

|

QID: L207

 
 

Q.

Care-of Name: it states in the Companion Guide that it's being sent in the 2100A. However, in the daily files, we have noted that it also appears in 2100C. Does the guide just need to be updated to show the different locations?

 

 

Published: 04/27/2020

|

Updated: 06/04/2020

|

QID: L208

 
 

Q.

We noticed that there are a lot of white spaces in the client addresses. Is it possible to remove all of this extra white space?

 

 

Published: 04/27/2020

|

Updated: 06/04/2020

|

QID: L209

 
 

Q.

If we have an SSI case in a TA or MA household, will it be grouped with the same case name/number? If not grouped together, will the case name be the Parent if it's a child SSI case?

 

 

Published: 04/14/2020

|

Updated: 04/14/2020

|

QID: L210

 
 

Q.

How will plans receive rate codes for the SNP population?

 

 

Published: 04/14/2020

|

Updated: 04/14/2020

|

QID: L211

 
 

Q.

Please summarize the flow of eligibility information between eMedNY, Maximus, and the MCO.

 

 

Published: 04/14/2020

|

Updated: 04/14/2020

|

QID: L212

 
 

Q.

The Business Processing Rules in the Companion Guide state: "Plan needs to maintain the coverage by source (WMS, NYSoH, Maximus, etc)." This does not align with many other FAQs that state the Maximus files are to be used as supplemental only. Can you please clarify why this is in the Business Rules?

 

 

Published: 04/20/2020

|

Updated: 06/04/2020

|

QID: L216

 
 

Q.

When the Companion Guide references 834, does this refer to 834 files from eMedNY and 834 files from Maximus (e.g. E and T files), or do these refer only to the eMedNY 834 files?

 

 

Published: 04/20/2020

|

Updated: 04/20/2020

|

QID: L217

 
 

Q.

We see members appearing with Nursing Home Rate Codes on the test 834. How can we find out the effective date of the Rate Code change?

 

 

Published: 04/14/2020

|

Updated: 04/14/2020

|

QID: L221

 
 

Q.

We plan on using the (030) Verification files to reconcile the membership prior to the initial daily incremental files going "live". Does this align with how the Department of Health thinks that this file should be used?

 

 

Published: 04/27/2020

|

Updated: 04/27/2020

|

QID: L222

 
 

Q.

When the daily eMedNY 834 is sent to a Plan, if we receive a change, term or cancel for a member that we do not have active/enrolled in our system, we will generate an error report. If we send this report to eMedNY, how will that be handled?

 

 

Published: 04/27/2020

|

Updated: 04/27/2020

|

QID: L223

 
 

Q.

How do we determine if a member has been auto-assigned to our Plan?

 

 

Published: 04/27/2020

|

Updated: 04/27/2020

|

QID: L224

 
 

Q.

As a Plan, we would like a listing of our Rate Codes; how can we do that?

 

 

Published: 05/04/2020

|

Updated: 05/04/2020

|

QID: L226

 
 

Q.

When the MCO sends the U file to Maximus, does Maximus confirm eligibility with eMedNY the same day that the U file is received, or the following day?

 

 

Published: 05/11/2020

|

Updated: 05/11/2020

|

QID: L227

 
 

Q.

When a member moves from one product to another, where do we find the effective date of the change, and in what order do we need to process files, when we get multiple MMIS ID files on the same day?

 

 

Published: 05/26/2020

|

Updated: 05/26/2020

|

QID: L228

 
 

Q.

When a member changes their case number, where do we find the effective date of the change, and what happens if the change occurs mid-month?

 

 

Published: 05/26/2020

|

Updated: 05/26/2020

|

QID: L229

 
 

Q.

When a member changes rate code, where do we find the effective date of the change?

 

 

Published: 05/26/2020

|

Updated: 05/26/2020

|

QID: L230

 
 

Q.

Will the 030-audit file include Adds, Changes, and Terms that we haven't already received from a previous roster? Should we expect that any of the prospective enrollment on the 030 file will be on the subsequent daily files as new Adds?

 

 

Published: 05/26/2020

|

Updated: 05/26/2020

|

QID: L231

 
 

Q.

If there are no member records to send on a given daily eMedNY 834 file, will a blank file be sent?

 

 

Published: 05/26/2020

|

Updated: 05/26/2020

|

QID: L232

 
 

Q.

Is eMedNY planning on sending any sort of daily notification indicating that the eMedNY 834 file was successfully posted to the eMedNY eXchange portal?

 

 

Published: 05/26/2020

|

Updated: 05/26/2020

|

QID: L233

 
 

Q.

Will there be a way for DOH to implement data entry standards with LDSS offices in order to normalize entries in fields such as Case Name, C/O Name and Address entries for City and Street?

 

 

Published: 06/08/2020

|

Updated: 06/08/2020

|

QID: L234

 
 

Q.

Will unborns and newborns be issued a default rate code?

 

 

Published: 06/04/2020

|

Updated: 06/04/2020

|

QID: L237

 
 

Q.

Will Term transactions be sent only once a month (on the 25th), or will Terms be sent on a daily basis?

 

 

Published: 06/08/2020

|

Updated: 06/08/2020

|

QID: L238

 
 

Q.

If a newborn has a missing date of birth and/or gender, can eMedNY populate a default rate code?

 

 

Published: 06/08/2020

|

Updated: 06/08/2020

|

QID: L240

 
 

Q.

If a rate code is missing due to incorrect/mismatched data from WMS, can eMedNY populate a default rate code?

 

 

Published: 06/08/2020

|

Updated: 06/08/2020

|

QID: L241

 
 

Q.

Will the eMedNY 834 send any transactions with a maintenance reason code of "41- Re-enrollment" to indicate renewals, like is currently received on the NYSOH 834?

 

 

Published: 07/08/2020

|

Updated: 07/08/2020

|

QID: L242

 
 

Q.

Today, our Plan utilizes the PCP Error Rosters from HCS to determine members who lose Medicaid eligibility due to a lapse in coverage.

FAQ # L94 advises that the PCP Error Rosters will no longer be distributed to plans. Can you please advise how we will be able to identify these members within the 834? Will there be a certain code we should be on the lookout for?

 

 

Published: 06/30/2020

|

Updated: 06/30/2020

|

QID: L243

 
 

Q.

During today's call, one of the plans had a question regarding receiving a change transaction on a rate code for their member. He asked what should be the effective date of rate code change and, I believe, the answer was the date of the change file received. My followup question to this is, what if the change file was received mid-month…say today? Current state, all WMS changes are effective the first of a given month. Please advise when possible.

 

 

Published: 06/30/2020

|

Updated: 06/30/2020

|

QID: L245

 
 

Q.

Can you provide the Loop and Segment on the eMedNY 834 that we should be utilizing to determine the "Care-Of Person" effective date?

Our system requires this data in order to determine when one "Care-Of Person" ends and the other begins, should the role ever change to a different person.

 

 

Published: 07/20/2020

|

Updated: 07/20/2020

|

QID: L247

 
 

Q.

Our plan received an 834 TERM transaction, with a Maintenance Reason Code: 03-DEATH and a Date of Death as "99991231". What date do we use as the actual date of death?

 

 

Published: 08/24/2020

|

Updated: 08/24/2020

|

QID: L249

 
 

Q.

Currently, there is not an indicator on the roster that identifies veteran members; will there be an indicator on the new 834 roster for MAP? If no indicator exists on the roster, what resource should the health plan utilize to identify the population?

 

 

Published: 08/24/2020

|

Updated: 08/24/2020

|

QID: L253

 
 

Q.

When a member has a gap in coverage, the current WMS roster maintains their original Effective Date, but the eMedNY 834 does not. Why is that?

 

 

Published: 08/24/2020

|

Updated: 08/24/2020

|

QID: L254

 
 

Q.

Can you please advise if the HCBS K codes will be included with all other RRE codes in the eMedNY 834 file?

 

 

Published: 08/24/2020

|

Updated: 08/24/2020

|

QID: L255

 
 

Q.

What is the correct process to follow when a member overlaps between WMS and NYSOH?

 

 

Published: 09/22/2020

|

Updated: 09/22/2020

|

QID: L256

 
 

Q.

Will all Medicaid Advantage and Medicaid Advantage Plus members (both deemed and non-deemed) be included on the new Medicaid 834 file and identified by rate code?

 

 

Published: 08/24/2020

|

Updated: 08/24/2020

|

QID: L257

 
 

Q.

Please confirm if we will see NAMI/EXCESS MSG in conjunction with, or instead of, a valid NAMI and/or EXCESS dollar amount. What are the possible combinations per member record?

 

 

Published: 08/24/2020

|

Updated: 08/24/2020

|

QID: L258

 
 

Q.

Previously, we received an enroll/disenroll source on the E or T file such as P = Phone Transfer, 6 = Auto Transfer or X = Regular. How do these code tie to INS04 Maintenance Reason Codes?

 

 

Published: 08/17/2020

|

Updated: 08/17/2020

|

QID: L259

 
 

Q.

If we get a newborn update directly from mom, or the newborn report, and we have the Unborn pre-enrollment in our system, should we update that baby per the MMC contract manually in our systems, or wait for the 834 transaction to arrive?

 

 

Published: 08/31/2020

|

Updated: 08/31/2020

|

QID: L260

 
 

Q.

We understand we may receive Adds prospectively (HARP to MMC, or MMC to HARP) before we get a Term on the 25th for the old plan. However, how will this translate with retroactive enrollments or retroactive terms?

 

 

Published: 09/08/2020

|

Updated: 09/10/2020

|

QID: L261

 
 

Q.

How are plans expected to use the name eMedNY sends in the 2100G Responsible Person/Responsible Party loop?

Based on previous FAQ responses (L28 & L33), we were not expecting a Responsible Person.

 

 

Published: 10/05/2020

|

Updated: 10/05/2020

|

QID: L262

 
 

Q.

Currently, MCOs receive 1st and 2nd pulldown Rosters on a schedule. Enrollments, reenrollments, and reinstatements of members can be performed by the caseworker in the WMS system up until 2nd pulldown. Late enrollments, reenrollments and reinstatements of members after 2nd pulldown has already been received/processed can be denied by the MCO.

For the Future State, will the DSS MCO's reach out and request approval from the health plans for late enrollments, reenrollments and reinstatements once we move to the eMedNY 834 transaction process?

 

 

Published: 09/08/2020

|

Updated: 09/10/2020

|

QID: L264

 
 

Q.

Will there be a specified time each day the 834 files will be available for Plans to retrieve when we go live in January?

Is there any way that we can agree on a plan that we would get our files daily by "X" time and that if we have not received them on our site by that time:
1. Who do we reach out to?
2. Can we just process those files in the next day's run?

 

 

Published: 09/08/2020

|

Updated: 09/10/2020

|

QID: L265

 
 

Q.

Is there any opportunity to retrieve the first Production Verification file before the 15th of January to give Plans ample time to analyze and process?

 

 

Published: 09/22/2020

|

Updated: 09/22/2020

|

QID: L266

 
 

Q.

If the plan does not receive an eMedNY 834 file, how do we determine if we really are not supposed to get a file that day, or if there is a technical issue causing a delay?

 

 

Published: 10/05/2020

|

Updated: 10/05/2020

|

QID: L267

 
 

Q.

Will multiple transactions for a single member always be sequential within the file?

 

 

Published: 09/28/2020

|

Updated: 09/28/2020

|

QID: L268

 
 

Q.

Is there a list of all possible multiple transaction scenarios and their usage?
Does a Term followed by an Add signify a break/gap in coverage?

 

 

Published: 09/22/2020

|

Updated: 09/22/2020

|

QID: L269

 
 

Q.

How are plans expected to process retroactive enrollments which are received outside of the current NYS DOH Roster Pulldown Schedule?

 

 

Published: 09/28/2020

|

Updated: 09/28/2020

|

QID: L273

 
 

Q.

How will multiple births (twins, triplets, etc.) be submitted on the 834 file?

 

 

Published: 09/28/2020

|

Updated: 09/28/2020

|

QID: L274

 
 

Q.

When a Unborn becomes Born (New born), will the Effective date (DTP*348) be sent over as the DOB on the Change transaction? If not, what date would be populated there?

 

 

Published: 10/05/2020

|

Updated: 10/05/2020

|

QID: L275

 
 

Q.

If the member is currently active and we get a RATE CODE change, what is the effective date for that change?

 

 

Published: 09/28/2020

|

Updated: 09/28/2020

|

QID: L276

 
 

Q.

If the eMedNY 834 file fails EDI Validation on the side of the Plan and is rejected, would a corrected file be submitted the same day?

If not, how do plans accommodate sequencing multiple transactions on multiple files for membership?

 

 

Published: 10/05/2020

|

Updated: 10/05/2020

|

QID: L277

 
 

Q.

Loop 2320 COB Segment (Coordination of Benefits) - The companion guide states COB02 will contain an 11- digit MBI or 16-digit Other Payer Policy Sequence Number.

Can you provide more information on what the Other Payer Policy Sequence Number is, and will it always be 16 digits?

 

 

Published: 10/05/2020

|

Updated: 10/05/2020

|

QID: L278

 
 

Q.

WMS Enroll/Disenroll Reason Codes – eMedNY sends WMS Reason Codes on all Transaction Types.

Can you provide additional information on how this is used? More specifically, how this is used in conjunction with INS04, which is used to report Maintenance Reason Code for Changes, Additions, Cancellations or Terminations?

Which value should be used as the true source of enrollment/disenrollment reason?

 

 

Published: 09/28/2020

|

Updated: 09/28/2020

|

QID: L280

 
 

Q.

Will there be a change to how plans send known Third Party Liability (TPL) reports to DOH, or are we supposed to continue our current processes?

 

 

Published: 10/19/2020

|

Updated: 10/19/2020

|

QID: L282

 
 

Q.

After the 834 Go-Live, will OMIG still send the Restricted Recipients File twice a month the way they currently do?

 

 

Published: 10/19/2020

|

Updated: 10/19/2020

|

QID: L283