HIPAA 834 5010 Platform, Spec v 1.0
*Please note that this carrier has some configuration requirements that are non-standard so some of our advanced functionality will need to be used when setting up this carrier feed.
Client Level Configurations
- ISA06/GS02: Interchange Sender ID=TAX ID
- GS03:Application Receiver’s code- Should equal ISA08
- GS06: Group Control Number Assigned by Sender must match GE02 in footer (required to be 1-9 digits)
- REF02-Transaction Set Policy Number (REF*38)-Carrier requires group/policy # here and will provide with group structure
- N102: Plan Sponsor Name
- N104: Plan Sponsor Tax ID
- This loop is optional. The carrier will indicate if they require this loop on the file.
- REF*OF (Subscriber Identifier) - Carrier requires a value other than member SSN. You will need to work with the carrier to determine what value will be sent. Once that is determined you need to navigate to REF*OF, Element 02 and change the DB field name to where the pre determined value should be mapped to. For example: If the agreement with the carrier is to send all Social Security numbers with a leading zero, select *SSN (padded to 10) from the DB Field Name. The same option needs to be selected for the Dependent tab
- REF*1L-This is required and will populate the Group/Policy#. Carrier will provide with the companion guide. All other REF segments are optional for this loop.
- These loops are all optional. The carrier will advise if any of these loops are required for a specific setup
- REF*1L-This is required and populate the Group/Policy#. Carrier will provide with the companion guide.
- HD04: Plan Coverage Description - This field will populate a carrier assigned code to identify the benefit package the member has elected.
- Whenever there is a medical plan transmitted, this carrier requires a prescription plan wrapped with the medical. This can be done by navigating in the export engine to Plans tab > Plan Bundles and adding the additional “wrapped” plan there. There are limitations to the Plan Bundles and the help text on that page will list what is supported along with examples.
Loop 2310 and 2320
- Optional loops that can be removed from the feed if the carrier doesn’t require them for your case.
- GE02: Group Control Number Assigned by Sender must be the same as GS06