Below are the loops, segments and elements that may need configured to support the VSP requirements. Each Loop is identified in a separate section below, and the segment and element are combined into one value.
Example, ISA is the Interchange Control Header Segment and it contains 16 elements. ISA06 is the 6th element within the ISA segment.
- ISA06 = Sender ID , recommend company Federal Tax ID
- GS02 = Sender ID (same value as ISA06)
- GS06 = Group Control Number. Note that some carriers indicate that the number cannot lead with a 0 and so EN recommends using the company Federal Tax ID. (same value as Footer GE02)
- REF02 = VSP assigned media ID - the Media ID is a 7-digit number, often included in the subject line of your EDI Implementation email
1000A Loop: Plan Sponsor Name
- N102 = Plan Sponsor/Company Name
- N104 = Plan Sponsor/Company Federal Tax ID
1000C Loop: TPA/Broker Name
- N101 = 'BO' if broker, 'TV' if TPA
- N102 = Broker or TPA Name
- N104 = Broker or TPA Federal Tax ID
2000 Loop: Member Level Detail
Data in this loop has mostly been configured automatically to pull member information. If group has Division codes, it will be programmed in this loop.
- INS06 = Medicare Plan Code. VSP may require transmission of Medicare information for those over 65. Use a Rule to send a Medicare code of 'E' for those age greater than or equal to 65, since Medicare details are not known.
- REF_DX : Department
- REF01 = 'DX'
- These loops are situational and rarely uses by the carrier. The carrier will indicate if these need to be included on the file
- This loop is optional. Carrier will notify if this loop needs to be included in the file.
2300 Loop: Health Coverage
- Data in this loop has mostly been configured automatically to pull member coverage information.
- HD04-(Plan Coverage Description) Carrier uses this database field to report account numbers. The client specific group structure from the carrier will provide the accepted values for this field
REF*1L-Carrier requires group/policy number in this REF segment. Will be provided with group structure
- These loops are situational and only included if carrier requires for your setup. The carrier will notify you if these loops are needed.
- GE02 = Group Control Number (same value as GS06 in Header)
- Refer to the VSP Open Enrollment FAQ's document attached below for VSP OE file expectations.
Other Helpful Information
1.Production Files Contact
EDI Enrollment Integration Team
2. Implementation Contact: Same as Production Contact
Plan Configuration/Setup Helpful Hints
- Contact to initiate the EDI process can be made through the VSP Account Manager or to EEI@vsp.com.
- The typical turnaround for VSP to assign an EDI Membership Coordinator is 5-7 business days.
- Once assigned, the Membership Coordinator will forward you the Electronic Enrollment Implementation Guide. It is required that the Appendix B: Forms Group Media Information/Pre Implementation EVR Recipient Forms are filled out. (Guide attached)
- Upon receipt of the completed forms, VSP will send the group structure and FTP Information.
- If you will need census data, the client will need to send an email to VSPEastern@VSP.com to request they grant access to the VSP eligibility management portal. VSP will in turn send you a username and password within 7-10 business days it can be sooner if the client requests that it be expedited.
- VSP does not typically house dependent data unless dependent tracking is turned on for the client. In the event it does not, the census you pull will house only employee data and the coverage tier.
VSP will send an Enrollment Verification Report (EVR) after each file via VSP secure email. During the implementation process you will be asked to assign an EVR recipient and Employee Navigator recommends assigning two. A Guide To Understanding the Enrollment Verification Report is attached below. The report will have an Current enrollment summary, in addition to listing the rejections.
If you have questions with regards to the rejections shown on the report or want to work with VSP to have them corrected prior to the next file being transmitted you may contact the EDI Enrollment Integration team firstname.lastname@example.org. Once your inquiry is received VSP will assign it to an EDI Coordinator to handle. Emails are typically assigned within 24-48 hours. If it is an urgent issue call 877-396-8940 as opposed to sending an email.
Last updated 3/22/2016