Blue Cross Blue Shield of Arizona

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