HIPAA 834, 5010 Platform
Last updated 1/31/2017
Client Level Configurations
- ISA06: Interchange Sender ID-Use sender's identification, usually the TAX ID
- GS02: Senders Tax ID
- GS06: Group Control Number Assigned by Sender must match GE02 in footer (required to be 1-9 digits)
- REF*38 is not used by this carrier
- N102: Plan Sponsor Name
- N104: Plan Sponsor Tax ID
- N102: TPA or Broker Name
- N104: TPA or Broker Tax ID
- This loop is optional
This is optional. Carrier client level structure will indicate if this is needed
- Exclude all REF segments except REF OF unless specifically asked to include by carrier
- This loop is optional and will be used based on the client requirements. See client level structure for details
- HD03-Insurance Line Code: This carrier used DEN or VIS for Vision and/or dental benefits
- HD04-Plan Coverage Description: The field is preset to the general carrier requirement of blank value. We expect Ameritas to provide specific values they want to see in the HD04 segment on your group structure; map these as indicated. If during the testing process they indicate that the HD04 is blank it is because you did not map the value.
Carrier can accept both of these loops and the client level structure will list the carrier requirements for that individual case
- GE02: Group Control Number Assigned by Sender must be the same as GS06
- Open Enrollment files should include ended and open enrollments.
- Ameritas will not accept eligibility maintenance files for the current plan year after the open enrollment file is transmitted. Any changes that occur from the time the open enrollment file is sent to the beginning of the plan year should be directed to your Ameritas Customer Support contact.
- The Open Enrollment file does NOT require a different naming convention (file name should remain the same)
- Ameritas Group has two platform options, Ameritas Group and Globalscape. Verify with your EDI analyst which platform is correct for your group.
- If transmitting with SFTP and the Ameritas Group platform, you want to make sure to select "Skip Encryption?" under the Transmission page.