Platform: 834 5010
- ISA06: Sender Tax ID #
- GS02: Sender’s Code (Senders Tax ID)
- GS06: Group control number assigned by group must be a minimum of 1 character, maximum of 9 characters
Note: REF Segment in Header can be excluded at company level
- N102: Plan Sponsor Name (Client Name)
- N104: Plan Sponsor Identifier (Client Tax ID #)
Loop 1000C : Optional loop and can be excluded at client level if the client level.
- N102: Name of entity sending the file (TPA name or Broker name if broker sending file)
- N104: Tax ID number of named entity sending the file.
- REF_1L_02: Group Number
- The following REF Segments are Situational the carrier will advise what values should be populated in these segments if they are needed.
- DX: Used when the group is department billed
- HD03: Select under plans, from insurance line code drop down one of the following codes based on the plan type
- DEN: Dental
- HLT: Health
- VIS: Vision
- HMO: Health Maintenance Organization
- HD04: (Situational, carrier will advise if needed and provide codes. Typically required when additional information is needed to describe the exact type of coverage being provided.
- REF_1L_02: If needed will be provided by carrier
- GE02: Group control number (input same value that is in GS06 in the header)