HIPAA 834 format, 5010 Platform
- ISA06/GS02: Interchange Sender ID-Use sender's identification, usually the TAX ID
- ISA08/GS03: Senders Tax ID-Carrier requires a unique ID that is provided with the companion guide.
- GS06: Group Control Number Assigned by Sender must match GE02 in footer (required to be 1-9 digits)
- N102: Plan Sponsor Name-required only when the carrier specifies the name.
- N104: Plan Sponsor Tax ID-carrier uses TAX ID for this value
- 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
- This loop is optional and not usually used by the carrier. The carrier will advise if field value is required to be sent in this loop..
- 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
- The REF segment used by this carrier in this loop is listed below.
- REF_1L (Member Policy Number)- Carrier requires this to be sent here or in Loop 2300 2300
- 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
- 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)