UHC successfully deployed enhancements to its 835/Electronic Remittance Advice (ERA) on March 20, 2010. The enhancements apply to UnitedHealthcare Government and other lines of business and focused on changes to the reporting of Member Identification Numbers on 835s.
Previously, if a member identification number that was submitted on a claim was different from the member identification number that the claim adjudicated under, the 835 would report only the member ID number that the claim adjudicated under. The 16 digit member ID consisted of the group number, member's ID number, and proprietary patient relationship code, which were combined and reported in one element of the 835 transaction.
With the enhancements, the 835 now returns the original member ID that is submitted on the claim. This is reported in the Patient Name (NM1 with QC Qualifier) and Insured Name, if applicable, segment(s) (NM1 with IL Qualifier). If the submitted member ID is different than the adjudicated member ID, the nine digit corrected member identification number is returned in the Corrected Patient /Insured Name (NM1 with 74 Qualifier) segment.
The changes explained in this article apply to UnitedHealthcare government and other lines of business claims received by UnitedHealthcare on or after March 20, 2010. Claims received prior to this date report the 16 digit member ID with no corrected member ID (NM1*74). For full release details including 835 examples, please refer to the Update for Government and Other Business Completed notice in the News section of UnitedHealthcareOnline.com (post date April 5, 2010).