Updated January 24, 2017
HIPAA 834, Format 5010
BCBSTX is part of Health Care Service Corporation(HCSC). HSCS is a for-profit company health insurance company, and is the licensee of the Blue Cross and Blue Shield Association for 5 states, including Texas.
Client Level Configurations
- ISA06: Interchange Sender ID-Use sender's identification. Carrier has specific required values that they will provide.
- GS02, GS03: Carrier provided values
- GS06: Group Control Number Assigned by Sender must match GE02 in footer (required to be 1-9 digits)
- REF*38 is optional and carrier will provide required values if needed.
- N102: Plan Sponsor Name
- N104: Plan Sponsor Tax ID
This Loop is optional. Carrier client level structure will indicate if this is needed
Most REF segments except REF*OF are listed as optional in this loop for this carrier. The carrier will indicate when they require an optional loop
These loops are optional and will be used based on the carrier requirements. See client level structure for details
- HD04-Plan Coverage Description: Carrier requires this and the required values are case based. Refer to client level group structure for exact requirements
- REF*1L-This is required. Carrier will provide group specific structure with required values.
Loops 2310, 2320
These loops are optional. Carrier client level structure will indicate if this is needed
GE02: Group Control Number Assigned by Sender must be the same as GS06
Timely Notifications Requirement
- With the 2005 passage of the Texas Senate Bill 51, Group Premium Payment and Employee Termination; BCBSTX requires Timely Notifications of terminations; attached is their SB 51 Termination Guidelines. In summary, BCBSTX requires a timely notification, defined as notification of a termination within 3 business days from the end of subsequent month to cancel coverage at the end of the month during which the employee was terminated, otherwise they will terminate at the end of the following month and the employer is responsible for the premium.
- During file implementation, please establish a process to manage timely notifications of coverage.
Additional Carrier Notes
- Carrier requests Loop2700 (Reporting Loop) but that is not currently supported by Employee Navigator
- No PGP encryption key was provided. Carrier uses a SFTP protocol for transmission (Secure)
- Terminated records are set to drop from this carrier’s file feeds at 14 days past the termination date
- Open Enrollment: the carrier has not provided their Open Enrollment requirements. Please coordinate with your contact directly to manage this process.