PacificSource Health Plans
HIPAA 834, 5010 Format
Company Configuration Details:
- ISA06: Enter client/company Tax ID
- GS02: Same as ISA06
- GS06: Only requirement is that it the same as the GE02. Recommend Broker ID.
- BGN02 - Unique control number under the carrier
- N102: Plan Sponsor/Company Name
- N104: Plan Sponsor/Company tax ID #
- N104: Carriers’ tax identification number
Loop 1000C - situational loop confirm with carrier if needed, if not can be excluded at client level
- N101: BO if broker or TV if third party administrator
- N102: Name of entity identified in N101
- N104: Tax ID of entity identified in N102
- REF_1L = Group Number (Employee and Dependent) Carrier will read from the 2000 loop OR the 2300. For the above reasons, we recommend using the 2300 loop to transmit this value.
- REF01 = '1L'
- REF02 = Group or Policy Number
- HD04: Plan ID for coverage
- GE02 must match GS06
Carrier Notes on Terminations:
- If a member is being sent for the first time on the file with a null coverage, we will create a record for them. The record will populate on the file with a termination date equal to the enrollment effective date and will automatically fall off the file 14 days from the termination date.
- Test files must be received two months prior to effective date.
- Production files must be received two weeks prior to the target “go live” date.