Premier Access

Premier Access

HIPAA 834 Format, 5010 Platform

Companion Guide Vs. 1.5

Client Level Configuration

Below are the loops, segments and elements that may need to be manually configured in order to support the Premier Access requirements.  Each Loop is identified in a separate section below, and the segment and element are combined into one value.  

Header Loop

• ISA06/GS02 = Sender ID provided by Carrier
• ISA08/GS03: (Receiver ID/Receiver’s Code) - Per the carrier’s companion guide the value should reflect 911857813
• GS06 = Group Control Number assigned by the sender (required to be 1-9 digits)- This is a generic value that must match the same field in the footer (GE02)
• REF02 = Customer Number (7 bytes) + HMO company code (2 bytes) + 6 digit group number (with leading 0).  If no customer number, prefill will 7 blank spaces.  Example:  0123456+US+0123456

1000A Loop:  Plan Sponsor Name

• N102 = Plan Sponsor/Company Name
• N104 = Plan Sponsor/Company Federal Tax ID

Loop 1000C (Optional) *If not using this loop you need to deselect or the blank segments will cause an error*

N102:  TPA or Broker Name

N104:  TPA or Broker Tax ID

Loop 2000:  Member Level Detail

Carrier has many optional REF and DTP segments that may be used for transmitting additional date elements, based on plan design. 

• Ref 1l: Group ID provided by Premier Access

Loop 2300

• This Loop uses multiple REF and Date Picker (DTP) segments and while most are optional below lists the required segments. All other segments not listed may still be required. The carrier’s companion will indicate those requirements
• The below segment is always included in this loop
• HD (Health Coverage)
  • HD*04-Plan Coverage Description-Optionally used to pass plan codes. Carrier will indicate if they require a value here
• Some commonly used DTP (Date Picker) segments are listed below. The carrier will indicate which you need to include/exclude
  • DTP_348/349 Benefit Begin/End Dates

 Footer

• GE02: Group Control Number Assigned by Sender (required to be 1-9 digits)- This is a generic value that must match the same field in the header (GS06)

 Companion guide used for configuration may be reviewed at https://employeenavigator.zendesk.com/attachments/token/eg6bCUTfFKfvpPIq13hSsEJQG/?name=Premier+Access+834-5010+Companion+Guide_Single_v1.5.pdf