Issued by: Centers for Medicare & Medicaid Services (CMS)

Issue Date: October 22, 2014

Program Area: Small Business Health Options Program (SHOP)

Question: How do the cancellation/termination reason codes discussed on a recent REGTAP call work with the codes listed in the 834 Companion Guide?

Answer: The maintenance reason code reported in INS04 is used in conjunction with the ADDL MAINT REASON sent in the 2750 loop. The ADDL MAINT REASON code is used to provide clarifying and/or additional maintenance reason information not covered by the code reported in INS04. For example, termination and cancellation transactions may report a maintenance reason code in INS04, but will also include an ADDL MAINT REASON to specify whether the transaction is meant to be a cancellation (no period of coverage) versus a termination.

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