Delta Dental of New Jersey
834 HIPAA 5010 format - Full File Companion Guide version 2.1 - last updated 10/23/2014*
Client Level Configurations
- ISA06/GS02: Uses client’s Tax ID. If different the carrier will indicate what they expect
- GS06: Group Control Number assigned by sender must match GE02 in footer. Cannot start with zero.
- N102: Group Name
- N104: Group Tax ID #
Loops1000C/1100C-These loops are optional. The carrier will communicate if they require this loop for your client setup.
- All REF segments in Loop 2000 are situational. The carrier will indicate if they require values and for which REF segment they want it reported in.
- These loops are situational. The carrier does not use some of the segments and will identify which ti include if any.
- The required DTP dates for this loop are below
- This carrier requires REF segments to be reported in either the 2000 OR the 2300 loop. Because of that requirement all REF segments are marked with a (s) for situationaland if they are required the carrier will indicate that on your group specific structure.
- GE02: Group Control Number must be 1-9 characters long and match GS06 value in the Header. Cannot start with zero.
*If you receive an updated version from your carrier contact, please share that with EN so we can compare the documents and update the configuration if required.