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Employee Navigator created a self service tool that allows our users to configure and transmit ANSI 834 files to carriers on a schedule.
ANSI 834 files were born out of the HIPAA regulations which created a national standard to electronically communicate health enrollment and eligibility information from the plan sponsor (employer) to the health insurance carrier. There is a limitation to 834 files in that the only supported plan or product types for the 834 file are medical model plans - health, dental & vision plans. While some carriers try to use 834 files to communicate other plan types such as ancillary, FSA or HSA enrollments, the federal format was not created to support these plan types and trying to do so may cause unexpected errors or simply fail.
Our users often referred to these files as "EDI files", however EDI is a generic term that means Electronic Data Interchange and 834 file feeds are simply one method or format of transmitting information electronically. Other methods to electronically communicate health insurance information include but are not limited to Employee Navigator's Data Exchange, an API, or even a third party app connection.
If you do not use an 834 file or other electronic method to communicate adds, terms and changes to a carrier, another manual method must be used. Employee Navigator offers options for our users to manually manage enrollment and eligibility data, however, depending on the option chosen, it can be quite cumbersome.
How do I access the 834 EDI tool?
The tool is often referred to as our "export engine" and can only be accessed if you have the Enhanced Plus license or above. It is located on the Benefits tab and then on the left navigation panel, under "Advanced" select the link for Carrier Feeds. Once you navigate to the export engine, you land on the exports page which provides an overview of carrier feeds that are being transmitted and/or tested for a specific client. Selecting the edit link next to the corresponding carrier feed will direct you to the carrier feed setup page. Below is a short summary of each page within the tool that needs to be touched during the file configuration process:
The carrier feed setup page provides an overview of the carrier feed to include the type of file, carrier name, carrier platform, transmission status, and Employee Navigator service level.
The plans tab is an advanced configuration menu where you can control which plans are to be included in the carrier feed, the Insurance line code (also commonly known as the HD03 segment) is set, the logic for common employee eligibility dates, the HD04 (plan coverage description), plan bundles and transaction sets.
The loops page is the heart of building a carrier file feed. This is where loops and segments can be included or excluded from the Carrier file. Carriers are generally very consistent about how they utilize the segments within a file. Employee Navigator has configured the basic carrier configuration and removed loops/segments the carrier has indicated they don't read. The Employee Navigator Support site contains documentation specific to each carrier.
The file settings page is where the file naming convention, file transmission frequency, file notification, and ftp credentials are configured and stored.
The generation page allows for file generation outside of the normal file transmission frequency as set on the file settings page. Files are typically generated from the generation page during file testing, open enrollment, or if an off-cycle manual file needs to be transmitted to the carrier.
The history page is where historical files (test or automatically generated) are saved for historical reference. It is here where you can also see a snap shot of the number of records