1. HIP Member Debt Process
February 2012

2. Agenda Overview of HIP member debt How it’s reported How it’s cleared
How the 834 responds
PRF layout
834 sample
Q&A

3. Overview of HIP member debt
For members terminated from HIP before their POWER Account is fully funded, the MCE may register and collect any debt owed by the member to the MCE.
The MCE registers the debt with the State fiscal agent using the PRF Termination transaction.
The State fiscal agent documents the debt owed and the MCE to whom the debt is owed.
Neither DFR nor ICES receives or stores this information.
Time passes and the former HIP member reapplies for the program.

4. HIP member debt continued
A conditional 834 record generates to the debt plan with an INS03 value of 025 and an INS04 value of 27.
The MCE must send a letter to the individual explaining that until his or her debt is paid, the individual cannot participate in HIP and has 60 calendar days to clear the debt and pay his or her first POWER Account contribution.
If the MCE collects the debt, it must notify the State fiscal agent that the debt is cleared. This allows an 834 conditional record to generate to the receiving plan, for the member to follow through the reenrollment process.
MCEs should clear the debt using the PRF “D” Debt transaction. Debt clear date must be specified in a CCYYMMDD format.
If the member does not pay or clear their debt after 60 days, the MCE must submit a no-pay response on the daily Pay/No-pay file. This will terminate the conditional eligibility process for the member.

6. Member Rollover Same plan or different plan Claims Only Reporting CAT
HIP PRF excerpts
Field
Defaults
Type
Length
Start
Finish
Format
Description/Values
Member Plan Change
Member Termination
Member Rollover Same plan or different plan
Claims Only Reporting CAT
Member Debt Cleared
Debt Incurred Amount
NUMBER 10
119
128
9.2
N/A
The TOTAL amount of debt incurred by member as of the 180th day. (If the termination is NOT due to non-payment or member requests termination, then use the default for this field.)
Date Debt Amount is sent to HP
zeros 8
129
136
CCYYMMDD
Date the debt transaction was created. (If the termination is NOT due to non-payment or member requests termination, then use the default for this field.)
Debt Cleared Date
137
144
Plans will report this only on "D" type transaction. Default is zeros.
Date debt was cleared

7. PRF field descriptions for debt
Debt Incurred Amount NUMBER The TOTAL amount of debt incurred by member as of the 180th day. (If the termination is NOT due to non-payment or member requests termination, then use the default for this field.)
Date Debt Amount is sent to HP zeros NUMBER CCYYMMDD Date the debt transaction was created. (If the termination is NOT due to non-payment or member requests termination, then use the default for this field.)
Debt Cleared Date zeros NUMBER CCYYMMDD Plans will report this only on "D" type transaction. Default is zeros. Date debt was cleared.

8. 834 transaction – Maintenance Code
INS Maintenance Type Code O ID 3/3 Required 1
Description: Code identifying the specific type of item maintenance
IHCP HIP NOTE
Maintenance Type Code
001 – Change
021 – Addition
024 – Cancellation or Termination
025 - Reinstatement
030 – Audit or Compare
1. The monthly audit file consists of only 030.
– A change to the member demographic data, power account amounts, eligibility dates, or capitation category.
– A new conditionally eligible member, a member who has moved from conditionally to fully eligible, or a member who has moved from one plan to another. Type of eligibility will be sent in INS04.
– A member who is being removed from the HIP plan. Can be conditionally or fully eligible. Reason for removal will be sent in INS04.
– A conditional member who has an outstanding debt from a previous HIP enrollment. Notification sent to debt plan only.
CodeList Summary (Total Codes: 123, Included: 5)
Code Name
001 Change
021 Addition
024 Cancellation or Termination
025 Reinstatement
030 Audit or Compare

9. 834 transaction – Maintenance Reason Code
INS Maintenance Reason Code O ID 2/3 Situational 1
Description: Code identifying the reason for the maintenance change
IHCP HIP NOTE
This code clarifies the type of change and distinguishes a change from a deletion.
The following codes will be used in the 834 file for conditionally eligible members:
Maintenance Reason Code
03 - Death
14 – Voluntary Withdrawal
22 – Plan Change
25 – Change in Identifying Data Elements
27 – Pre-Enrollment
33 – Personnel Data
43 – Change of Location
XN – Notification Only
03 – Will be sent along with INS03 = 024 to indicate a member who has
passed away. Member date of death will be sent in INS12.
14 – Will be sent along with INS03 = 024 to indicate a member who withdrew
from HIP prior to making an initial POWER account contribution.
22 – When sent with INS03 = 024, indicates a member no longer eligible for
this plan due to a plan change to ESP or another HIP plan. When sent with
INS03 = 021, indicates a member coming from the ESP plan or another HIP
plan.
25 – Indicates a change has been made to the member’s name, SSN, date of
birth, or RID.
27 – When sent with INS03 = 021, indicates a new conditionally eligible HIP
member. When sent with INS03 = 025, indicates a conditionally eligible HIP
member who was previously on HIP and has an outstanding member debt.
33 – Indicates a change to the member’s POWER account contribution
amount.
43 – Indicates the member’s address, phone number, secondary phone
number, case number, companion case number, address and /or PMP
directory indicator has changed.
XN – Sent along with INS03 = 030 for all monthly audit records.

10. 834 conditional record sample
INS*Y*18*025*27*A***FT**Y~
REF*0F*XXXXXXXXXXXX~
REF*1L*HIP~
REF*23*102XXXXXXX~
REF*ZZ*XXXXXXXXXXXX~
DTP*300*D8* ~
NM1*IL*1*SMITH*XXX*A***34*305XXXXXX~
N3*1 W COUNTY ROAD 1 S~
N4*ANYWHERE*IN*XXXXX~
DMG*D8* *M**7~
AMT*C1*348.04~
AMT*D2*207~

11. Questions?