Self Service EDI FAQs
Can you send XYZ Carrier an EDI File?
The Self Service EDI Engine is a tool that our advanced users can utilize to create and transmit HIPAA ANSI 834 files securely to the carrier for medical, dental, and vision plans only. Any files outside of the standard 834 4010 or 5010 format are not supported (we call these proprietary files). We recommend all ancillary/voluntary lines be moved to self-bill or check the Data Exchange partners for our 2nd generation data transmission file.
Please note that after completing an Cost-Benefit Analysis of EDI file implementation, Employee Navigator does not generally recommend EDI files for groups under 100 eligible employees. In fact, we feel the best fit is for groups with 150+ eligible employees. This does not, however, mean you cannot establish a carrier feed for a group under 100, it is simply our recommendation.
What is a "pre-configured" carrier? And what do you mean by free re-use?
Our EDI engine has carrier hierarchy with carriers at the top and platforms attached to each carrier. Once a platform is configured by Employee Navigator, any user has the ability to "pull down" the carrier structure to a new company for no additional fee.
Our list of existing carriers that we are currently transmitting production files from our Self Service EDI engine are listed on the Support Site > EDI Preconfigured Carrier List and is updated often. We recommend subscribing to this article to keep abreast of the new carriers added.
How do I request a new carrier be added to the list?
Requesting a new carrier be added to the list, can be completed by submitting the New Carrier Set-up Request Form located with instructions here. You will email the completed form to firstname.lastname@example.org along with a copy of the 834 5010 Companion Guide and carrier contact for the carrier you are requesting be set up.
What type of files can be transmitted using the SS EDI product?
The Self Service EDI product is designed to transmit HIPAA 834 files for medical model plans only (medical, dental, vision)
Why would I want to implement & manage 834 files for my clients?
The Self-Service EDI option is ideal when an HR or broker wants end to end control of the set-up process, or they want a low-cost option to provide electronic data interchange files to their clients. Self-Service EDI should only be undertaken if you have the talent, time and resources to devote to the operation of EDI files. Licensees will need to commit a resource to learning about 834 file standards, transmission, testing and error reporting. Cost-savings may be significant when placing additional clients on the same carrier platform.
How long does the 834 EDI implementation process take?
The Implementation process typically ranges from 4-10 weeks upon receipt of all of the necessary items needed from the carrier to configure the file. This time frame is contingent upon the complexity of the group structure and carrier response time during the testing process.
What type of training and support will Employee Navigator provide for its Self Service EDI Product?
One 1:1 EDI training will be offered at no fee to the agency premier user. You must complete the pre-training requirements prior to scheduling the training. During the training call, an EDI Analyst will provide a detailed overview of the EDI Engine and walk through a single new file implementation. For all subsequent files, you will be able to pull down your own carrier configuration, access documentation resources on the Knowledge Base and subsequent questions can be directed email@example.com .
Please note that the Self Service model does not provide unlimited 1:1 support. The most successful EDI users read the Carrier documentation and Employee Navigator's Knowledge Base. If you require dedicated support, you should consider outsourcing this to a Employee Navigator EDI Partner. If you are interested, please ask our support team for recommendations.
PLEASE NOTE: Due to volume, Employee Navigator has a Q4 black-out period for new EDI Training from approximately 12/1 - 1/15 each year. If you intend to implement an enrollment & eligibility transmission for a plan year beginning 1/1/2016 and you have not completed training, please establish another method of transmission for open enrollment records with the carrier and schedule training in the new year.
Help! Our dedicated EDI user has left and we need additional training session?
If you have completed your free 1:1 EDI Training session, but, for whatever reason, need another one, you can request an additional training at the cost of $250 per hour.
When should "Managed EDI" be used?
The Managed EDI is ideal for licensees who are comfortable configuring plans, but the number of changes are too large to manually key into carrier systems, you do not have sufficient resources to devote to carrier maintenance. If you would like to consider outsourcing EDI implementation and renewal support to one of our valued partners, their contact information is here.
What is Employee Navigator's position on Self Billing?
Self-billing is a preferred method of handling ancillary benefits such as group life, long term disability or short term disability. Eliminating carrier file feeds will reduce both hard and soft costs associated and eliminates the time consuming process of bill reconciliation. The standard Reporting Tool can provide the necessary data to self-bill many insurance products.
My carrier has indicated that Employee Navigator already has a transmission credentials established and would like to re-use it, is that ok?
The carrier is referring to the secure method in which an 834 EDI file is transmitted to them. While Employee Navigator may have secure transmission protocols established for our own direct clients, for security purposes, it is imperative that each licensee establishes their own protocol with the carrier directly. If a carrier attempts to require all files originating from Employee Navigator's server to use the same credentials/protocols, please send in a support ticket so we can assist.
Does the Self Service EDI product support COBRA files?
The EDI engine is designed to transmit 834 files only. If you are interested in a COBRA data feed, we began offering a COBRA plug & play option through our Data Exchange. More information is available here.
A carrier is requesting that we pass term REASON on the 834 EDI file - how do I turn that "on"?
Employee Navigator does not support QE reason codes on the 834 file. If a carrier requires a termination reason, it is most often because the carrier is transforming the 834 file to be used for another purpose - generally COBRA administration and for that reason we recommend using the COBRA XML file to capture the term reason value.
Has there been discussion with carriers to request the carriers pull the eligibility data from the Employee Navigator system versus using an 834 EDI file transmission?
While Employee Navigator is making an effort to reach out to carriers to discuss data integration; we are enlisting assistance from our clients in reaching out to the carriers to encourage the carriers to contact Employee Navigator regarding data integration. The text below will assist you in positioning the conversation with any carriers and who they can use at EN as a contact.
Our agency uses Employee Navigator as a front end benefit enrollment system for our clients which is cost effective, provides an excellent enrollment experience for employees and is very easy to configure. As we move more of our clients onto Employee Navigator’s online platform, we will need to improve the scalability of the data flows, first and foremost is the interchange of enrollment between ______ (carrier) and Employee Navigator. While their system supports HIPAA 834 file formats, we, and Employee Navigator, feel this is not a scalable long term solution for carriers or our agency. Employee Navigator has more efficient solutions and I’d like to encourage (carrier) to explore how they could better integrate the 2 systems. While I am not techie, their “plug and play” approach would benefit us in the long term and help us sell more product while saving carriers money on retroactivity. The quality of their system is exception and the fact there are no monthly employee fees means it’s a solution I can use for my whole book. You can reach out to their CEO, George Reese @ 240-599-1115 to discuss how to proceed with an integration.
last updated 4/27/2017