Delta Dental of Idaho Carrier Overview and EDI Configuration Details

EDI Configuration

Below are the loops, segments and elements that may need configured to support the Delta Dental of Idaho 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. 

Header Loop

• ISA06 = Federal Tax ID of sender
• GS02 = Federal Tax ID of sender
• GS06 = Group Control Number - recommend broker Federal Tax ID
• REF = Carrier doesn't accept this segment.  Exclude this segment.
• DTP = Carrier doesn't accept this segment.  Exclude this segment.

1000A Loop:  Plan Sponsor Name

• N101 = 'P5'
• N102 = Plan Sponsor/Company Name
• N103 = 'FI'
• N104 = Plan Sponsor/Company Federal Tax ID

1000C Loop:  TPA/Broker Name

• N101 = 'BO' if broker, 'TV' if TPA
• N102 = Broker or TPA Name
• N103 = 'FI'
• 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.  Carrier will provide a spreadsheet with group specific account structure that will be included in the REF segments, which needs to be added to both Employee and Dependents.

REF_1L = Group Number (Employee and Dependent)

• REF01 = '1L'
• REF02 = Group Number provided on group structure
• Hint:  If only one group number provided, insert group number into the Value option.
• REF_ZZ : Alternate ID
• REF01 = 'ZZ'
• REF02 = Alternate ID
• Situational:  If not used, exclude this segment

2100ALoop:  Member Name

Data in this loop has mostly been configured automatically to pull member demographic information.

2100C Loop:  Member Mailing Address

Situational loop, can be excluded since member address is sent in the 2100A Loop.

2300 Loop:  Health Coverage

Data in this loop has mostly been configured automatically to pull member coverage information.  Group specific information needed on the following segments.   

• HD04 = Plan Coverage Description (Situational) Details provided by carrier when needed. 
• REF_1L = Group Number
• REF01 = '1L'
• REF02 = Group Number provided on group structure

Footer Loop

• GE02 = Group Control Number (same value as GS06 in Header)

 

 

Other Helpful Information

Plan Configuration/Setup Helpful Hints:

 Errors: