Highmark

Highmark

HIPAA 834, 5010 Format

Companion Guide Version 4.0, December 2013

Client Configuration-Items to be completed at the client level

Header

• ISA06= Sender TAX ID 
• GS02=Senders name (The value to be populated in this segment will be discussed during your initial Implementation meeting with the carrier.  The value will be an alpha-prefixed value ranging in length from 2-8 characters with no special characters)
• GS06= Value created by sender (Can use tax id, set at client level same value must be populated in GE02 in footer set at client level)
• Does not use DTP or REF Segment, Exclude at client level

Loop 1000A

• N102=Client name (alpha-prefixed, 12 characters or less in length and value can optionally agree with the GS02 value.)
• N104=Client tax ID 

Loop 2000

• REF_1L 02=The 8 digit Group or Policy Number.  This will also be provided in the mapping codes provided by carrier.  This value should be populated at both the employee and dependent level.
• Does not use Ref_23, DX or 17, Exclude at client level unless otherwise advised by carrier

Loop 2100A

• Update DMG 06 to SELECT to unset the indicator 

Loop 2200

• Not typically used, Exclude at client level unless advised otherwise by carrier

Loop 2300

• DTP_303 not typically used, Exclude at client level unless otherwise advised by carrier
• Ref1_L 02=map the same as the Ref_1L in the 2000 Loop, set as determined in the mapping codes provided by carrier

Loop 2310

• Not typically used, Exclude at client level unless advised otherwise by carrier

Loop 2320

• Not typically used, Exclude at client level unless advised otherwise by carrier

Footer

• GE02= Should be same as ISA06 (Set at client level)

Open Enrollment

• Open and ended enrollments should be included in the open enrollment file as Highmark does not terminate by omission.
• Regular eligibility maintenance files should cease after the open enrollment file has been sent until the plan year begin date.
• Changes that need to be made to existing plan year enrollments and open enrollments after the open enrollment file has been sent, should be sent to the membership team to be keyed as manual.
• Highmark prefers to receive all open enrollment files by the 5th of the month prior to the plan year begin date.  (Example, January 1 renewal, you would send the open enrollment file by December 5th).
• When sending the open enrollment file notification should be sent to the clients assigned  Highmark Account Manager and Enrollment Coordinator.