Carrier Processing System:
- Gateway deliver to clearing house then loaded to one of the following back end Systems (WGS, ACES, CS90, Facets)
1.Production Files Contact
2.Implementation Contact: Client assigned Sales Contact
Plan Configuration/Setup Helpful Hints
- Reach out to your sales contact who will in turn reach out to EDI. After EDI receives the set up request from sales, EDI will send out enveloping and gateway connectivity information.
- Anthem requires that the client complete the attached BMS registration form. Once this form is completed an received by Anthem, they will in turn send the file specifications, group structure, census data if requested, and set you up with a user name and password to their BMS site. (copy of BMS form attached and instructions to complete form)
- Anthem requires multiple transaction sets. The transition set detail is comprised of two main sections with subsections with the main sections. While some carriers will not require this, Anthem requires multiple transaction sets for each plan/eligible class.
- Production: PCP data is required for all HMO Plans
834 Benefit Enrollment and Maintenance Companion Document: . http://www.anthem.com/wps/portal/ahpculdesac?content_path=edi/noapplication/f5/s0/t0/pw_b157465.htm&na=edi_va&rootLevel=2&label=5010
File Receipt Acknowledgements
Acknowledgements will be delivered to trading partner based on acceptance/rejection of the inbound 834. Below is a quick summary of the reports produced and their naming conventions. The first four numbers after the two letter prefix is the date of the file. For example: TX012915494035809.834.zip is the Level 2 report for a file sent 01/29.
RP**** General information only - like an information bulletin. Occurs only occasionally.
RJ**** If the file you sent can't be read, is not in ANSI format.
TA**** If the file cannot be processed, such as enveloping errors, the file is incomplete or it failed on the FA.
FA**** HIPAA 999 Level 1 acknowledgement report. This is a file pass/fail report. If it fails, no further reports.
TX**** If it passes the FA 999, this second report Level 2 is produced. This report is an individual member check.
- Anthem will send secure email to notify of file processing and that errors are available
- You are able to access the errors via the Anthem BMS site using the link below. During set up, Anthem will provide you with your username and password.
- Review any unresolved errors and add comments as to how Anthem should resolve directly in the BMS site
- Anthem will often have two columns one that will reflect the information on the our File which is labeled Customer File and a Column titled payer file which is the information that is housed in Anthem’s system.
- Rejection due to PCP error will prevent employee eligibility from being updated. Example, if the file has a change in coverage tier from EE Only to EE+Spouse, if the record errors due to PCP error, the coverage change will not be applied until the PCP error has been resolved unless you request a manual update.