Enrollment and Eligibility (ENR) FAQ
Guidance for FAQ regarding Transactions and Loops
Program Area: Enrollment and Eligibility (ENR)
Question: If an individual selects a medical and dental QHP from the same issuer, and the information is on a different 2000 loop in the ASC X12 834 enrollment transaction, is the premium amount owed going to total up to one amount and we only enroll the individual if the total (premium) amount is received?
Answer: No. Each QHP selection - medical and dental - will generate a separate enrollment and a separate payment Transaction ID. If a family selects a medical QHP and a separate dental QHP under the same issuer, the enrollments will be separate. The enrollee will be redirected once to the URL for the medical plan and then a separately to the URL for the dental plan. Issuers are expected to effectuate each enrollment independently once payment for the respective QHP selection is received.
Issued by: Centers for Medicare & Medicaid Services (CMS)
Issue Date: September 09, 2013
HHS is committed to making its websites and documents accessible to the widest possible audience, including individuals with disabilities. We are in the process of retroactively making some documents accessible. If you need assistance accessing an accessible version of this document, please reach out to the guidance@hhs.gov.
DISCLAIMER: The contents of this database lack the force and effect of law, except as authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically incorporated into a contract. The Department may not cite, use, or rely on any guidance that is not posted on the guidance repository, except to establish historical facts.