Blue Cross Blue Shield of Arizona 5010 Platform
Client Level Configurations
Header
- ISA06/GS02: Interchange Sender ID-Carrier assigned value
- GS06: Group Control Number Assigned by Sender must match GE02 in footer (required to be 1-9 digits)
- REF: Transaction Set Policy Number-This is required and the carrier will provide the expected value
Loop 1000A
- N102: Plan Sponsor Name
- N104: Plan Sponsor Tax ID
Loop 1000B
- N102: Plan Sponsor Name-Carrier name
- N104: Plan Sponsor Tax ID-Carrier Tax ID
Loop 1000C
- N102: TPA or Broker Name
- N104: TPA or Broker Tax ID
- This loop is optional
Loop 1100C
- This loop is optional. The carrier will indicate if they require this loop on the file.
Loop 2000
- REF*1L will populate Group/Policy# and will be assigned by carrier. It is a required segment for this carrier
- REF*DX will populate department/agency number. This carrier uses this segment to report the employee location code
- REF*ZZ is a mutually defined value. Per the companion guide this carrier uses this to report employee IDs instead of SSN#s when applicable. This is a optional segment and the carrier will advise when they require it
*All other loop segments for this loop are optional.
Loops 2100B-2200
- These loops are all optional. The carrier will advise if any of these loops are required for a specific setup
Loop 2300
- HD03-HLT
- HD04-Carrier requires plan descriptions for this field. Per carrier if the values are not unique then they will also require the AMT segment in the 2300 loop
- REF*1L-Optional for this loop
Loop 2310 and 2320
- These are optional loops. The carrier will inform if these are required via the group structure document
Footer
- GE02: Group Control Number Assigned by Sender must be the same as GS06
Open Enrollment: The carrier will notify you of their Open Enrollment requirements
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