HIPAA 834, 5010 Platform, Spec Version 4.0
Please note: Some Anthem proprietors require a separate file feed for Dental only. This document addresses those requirements.
Client Level Configuration:
- ISA06/ GS02: Uses client TAX ID
- GS03/ISA08: Uses Senders Tax ID #
- GS06: Group Control number this is a numeric value that is assigned by the sender. The group control number should be a minimum of 1 character a maximum of 9 characters. (This number should be identical to the number input in the GE02 segment of the footer)
- REF_02: Master Policy Number- This segment is situational. The carrier will indicate if it is required for your configuration
- N102: Plan Sponsor Name (Company)
- N104: Plan Sponsor Tax ID
- N102: Insurer Name (Carrier)- Carrier will provide the expected name they require
- N104: Insurer Identification Code- Usually Carrier’s TAX ID. They will provide
Loop 1000C-This loop is optional
- N101: Populate with BO if Broker is sending or TV is TPA is sending
- N102: Input name of entity identified in N101
- REF*1L (Member Policy#)-This is a required REF segment and the carrier will provide the expected values
- All other REF segments are situational for this loop. The carrier will indicate if any should be included for your configuration
- HD03: Insurance Line Code- Carrier will provide. Usually Den or DCP for this carrier
- REF Segments 17, 1L, and ZZ are situational for this loop. If they are used in Loop 2000 n the carrier will not require them in Loop 2300
Loops 2310/2320-These loops are optional and can be excluded from your company configuration. The carrier will advise if it is required for your file feed
- GE02: Group Control number, must be the same as the GS06 in the header
- Carrier requires scenario testing. As a result you will be required to add dummy employees that can later be deleted and should be sent on baseline test file. Please see Test Cases document attached to this article.
- If your companion guide received from the carrier differs from the requirements in this document please alert Employee Navigator so we can update the carrier template.