Platform: Anthem BCBS of CA
Client Level Configuration
- ISA06 & GS02: Sender Tax ID
- GS06: Unique group control number (must input this value in GE02 in the footer as well)
- ISA08 & GS03: Have multiple option, per guide we need to confirm with Business Analyst which of the following values to submit;
- REF: Policy Number
- N102: Client Name
- N104: Client Tax ID
- N101: TV for TPA or BO for Broker
- N104: Tax ID # for the partner in the N101
- REF1L: Group or Policy # populate for Employee and Dependents
- REF1L: Group or Policy # (Per spec, you can exclude the REF1L from the 2300 loop if you send it in the 2000 loop, you may want to ask your contact the preference 2000 vs. 2300)
- HD03: Value set at Plans tab, you will select the Insurance Line code based on the information provided to you by the business Analyst.
Loop 2310: Only required if client has a plan that requires a PCP be transmitted. Additionally, I believe this is optional and not requried as the employer can have the employees manage their PCP’s via the Anthem website. This is actually the Employee Navigator preferred method.
Loop 2320: Optional Loop loop and can excluded at client level
- Open enrollment file should include open enrollment elections only. The Carrier will terminate any members not re-enrolling by omission.
- After open enrollment file is sent, no further eligibility maintenance files for existing plan year should be sent until after plan year begin date.
- Open Enrollment files do NOT require a custom naming convention
- Clients account membership representative should be notified when Open Enrollment file is transmitted.