Tufts Health Plan
834 Benefit Enrollment Companion Guide
Version 1.5: June 2016
- Security Protocol: Utilizes Secure File Transfer Protocol (SFTP using SSH Keys), with PGP encryption.
- It typically takes 2-4 months to complete the testing cycle
and begin implementation
- The trading partner prepares the programming necessary to create the
- 834 5010 transaction in accordance with the 834 5010
- Guide, Errata and the Plans’ specific requirements defined in the
- 834 5010 Companion Guide. The EDI Analyst is then notified
when the file is ready for testing.
Client Level Configurations
- ISA06/GS02: Interchange Sender ID-Use sender's identification, usually the TAX ID
- GS06: The Control Group Number in GS06 must be identical to the associated group trailer GE02
- REF 02: Unique Reference ID code
- N102: Plan Sponsor Name-required only when the carrier specifies the name.
- N104: Plan Sponsor Tax ID-carrier uses TAX ID for this value
- N104: Insurer Identification Code
- N102: Plan Sponsor Name-required when the carrier needs the name
- N104: Plan Sponsor Tax ID-carrier will provide value to use if different from preconfigured value
- REF*1L-Member/Group Policy number-Carrier will provide required values
- These loops are all optional. The carrier will advise if any of these loops are required for a specific setup
- HD03-Insurance Line Code will be based on the mapped benefit plans.
- HD04-Plan Coverage Description: This is required for plan mapping when applicable. Tufts will provide the values when they require the use of this field
- GE02: Group Control Number Assigned by Sender must be the same as GS06
Open Enrollment-You will need to work directly with the carrier to identify their Open Enrollment requirements and limitations