Blue Shield of NENY
BlueShield of Northeastern New York, a division of HealthNow New York Inc., is an independent licensee of the BlueCross BlueShield Association.
Client Level Configurations
- ISA06: Interchange Sender ID-Use sender's identification, usually the TAX ID
- GS02: Senders Tax ID. Should be the same value as the ISA06
- GS06: Group Control Number Assigned by Sender must match GE02 in footer (required to be 1-9 digits)
- REF_02: Master Policy # (Groups 8 digit assigned policy number)
- N102: Plan Sponsor Name
- N104: Plan Sponsor Tax ID
- N102: TPA or Broker Name-
- N104: TPA or Broker Tax ID
- This loop is optional and can be excluded at client level if carrier indicates not required.
The below REF segments are required and the values will be provided by carrier
- REF*1L will populate Group/Policy#
- REF*DX use subgroup assigned by carrier
- REF*ZZ Use to report employee’s personal ID with carrier
- REF*3H Will report Case number, provided by carrier
- REF*17 Use Class ID
- HD03-Insurance Line Code will be based on the benefit offered. Carrier has the following options and if they require more the carrier will provide:
Health Maintenance Organization=HMO
Exclusive Provider organization=EPO
Point of Service=POS
Preferred Provider Organization=PPO
Note: The HD03 value will be programmed via the plans tab, by using the selection option in the HD03 Insurance Line Code drop down.
- HD04: Plan coverage Description that will be provided by the carrier in the group structure
Loop 2310 and 2320
- Exclude from client level configuration unless carrier specifically asks to include as these are optional
- GE02: Group Control Number Assigned by Sender must be the same as GS06
- Open enrollment files should include open and ended enrollments as carrier does not terminate by omitting members that have dropped coverage from the file.
- All members should have a common effective date of the beginning for the plan year. Example: If the plan year begin date is January 1, each member should have a 01/01/2015 effective date. This can be set via the Plans link under the Common dates drop down.
- After Open Enrollment file is transmitted, carrier does not expect to receive any additional eligibility files until the renewing plan year begin date or later. Any changes for the existing plan year will need to be made manually with the dedicated Account Specialist for your account.
- The file naming convention for the Open Enrollment file should remain the same. (No changes need to be made)
- Notify Game_Support_Area_Analysts@healthnow.org when the open enrollment file has been transmitted