HIPAA 834 5010 Format, spec version last updated 5/29/2014
Please note: This carrier currently uses a transmission protocol that is NOT supported by Employee Navigator (FTPS). Due to that restraint, File transmission will not be automated for this carrier. A manual download and transmission is required by the licensee. Please work directly with the carrier to determine the best way to upload the file to their site.
Client Level Configurations
- ISA06: Interchange Sender ID-Use sender's identification, usually the TAX ID
- GS02: Senders Tax ID
- GS06: Group Control Number Assigned by Sender must match GE02 in footer (required to be 1-9 digits)
- REF*38 is situational. Refer to group structure to see if required for your setup
- N102: Plan Sponsor Name
- N104: Plan Sponsor Tax ID
- N102: TPA or Broker Name
- N104: TPA or Broker Tax ID
- Exclude all REF segments except REF OF and REF 1L unless specifically asked to include by carrier
- HD03-Insurance Line Code will be DEN for dental coverage. Carrier will assign if there are other benefits not listed in the companion guide
Loop 2310 and 2320
- Exclude from client level configuration unless carrier specifically asks to include.
- GE02: Group Control Number Assigned by Sender must be the same as GS06