Change Request Detail
No.
1013
Date
10/13/2004
Submitter
Type of Request
Enrollment in a Health Plan
Status
DSMO Process Completed
Business Reason
Pre-existing condition applies to all new members and dependents enrolled in the Oklahoma State and Education Employees Group Insruance Board health plan. There are instances when Pre-EX needs to be waived but there is no indicator in the 834 for waiving pre-existing conditions.
Suggestion
1.  Implement an indicator which would waive pre-existing


or

2.  Recipient of 834 can use DTP at 2000 loop with '356' qualifier and waive pre-existing from this date forward
DSMO Category
B
Recommendation
Approve. The DSMO recommend that X12N verify the pre-existing information flows with the eligibility transaction as well as the requested 834.
Appeal Recommendation