Client Specific Fields
- ISA06: Sender ID (Tax ID # of Sender)*
- GS02: Sender ID (Tax ID # of Sender)*
- GS06: Group control Number (this is a required value and is assigned by the sender, the value populated must match the GE02 in the Footer)
- REF: Master Policy Number
* EN recommends using the Sender Tax ID# for the ISA06/GS02/N104; the carrier may provide other instructions to you directly, please follow their instructions.
- N102: Client Name
- N104: Client Tax ID #
- N101: BO for broker or TV for Third Party Admin (If managed)
- N102: Name of party identified in N101
- N104: Tax ID of named TPA/Broker in the N102
- REF: REF1L: Group Number (Please add for both employee and dependents)
- Could potentially need REF17, REF23, and REFDX I would expect carrier to provide you with detail as to whether these fields are needed when they provide group structure.
- HD03: VIS (This setting while exported in the 2300 loop, it is set at the Plan level on the client configuration. by Selecting Plans from the Plans drop down and then selecting VIS from the Insurance Line Code (HD03) drop down on the far right hand side of the screen )
- HD04: Plan Coverage Descritpion, per spec this is provided by Eyemed
- REF: REF_17 and REF_ZZ may be used, if needed Eyemed will provide you with the values in the group structure
- GE02: Group control number, should be the same value as input into the GS06 in the header
- Open enrollment file should include open enrollments only
- Eyemed will terminate any members that did not elect for renewing plan year by omission
- Timelines (Note the timelines below are based on plan years that begin as of the 1st of the month)
- Cards: To ensure cards are issued by the renewing plan year begin date, Eyemed requires clean open enrollment file by 5th of the month. (Example, if plan year begins January 1, file must be received by December 5th)
- Billing: To ensure billing is updated with accurate renewal plan enrollments, Eye med requires clean open enrollment file by the 15th of the month.
- Eligibility: To ensure member eligibility for the renewing plan year is in the system by the renewing plan year begin date, Eyemed requires a clean open enrollment file by the 24th of the month.
- The open enrollment file should contain OE at the end of the file name.
- Eyemed does NOT require notification when the open enrollment file is sent.
File Naming Conventions
- Test files: test_834Clientname_MMDDYYYY
- Production files: 834Clientname_MMDDYYYY
- Open Enrollment Files: OE_834Clientname_MMDDYYY
NOTE: While testing the file, the file name MUST contact 'Test' in the naming convention.
Carrier Contact Information
If you have any questions/concerns on the file layout, please send inquiries to firstname.lastname@example.org
last updated 4/1/2015