Oxford Health Plans

Oxford Health Plans - UHC

HIPAA 834 5010 Platform

*Please note: The carrier creates a company-specific companion guide for each client so a sample is not attached.

Client Level Configurations

Header

• ISA06/GS02: Interchange Sender ID-Usually the TAX ID of sender
• GS06: Group Control Number Assigned by Sender must match GE02 in footer (required to be 1-9 digits but cannot start with a zero)
• REF: Transaction Set Policy Number-This is a required segment. The carrier will provide the expected value

Loop 1000A

• N102:  Plan Sponsor Name
• N104:  Plan Sponsor Tax ID

Loop 1000C

• N102:  TPA or Broker Name
• N104:  TPA or Broker Tax ID
• This loop is optional and the carrier will indicate if it needs to be included on your setup

Loop 2000

• This carrier has most of the REF segments in the 2000 loop listed as optional. Carrier will advise if other REF segments should be included in the loop and what values they are requiring in those loops. Below is the required REF segment for this loop

• REF*1L will populate Group/Policy# and will be assigned by carrier

Loops 2100B-2200

• These loops are all optional. The carrier will advise if any of these loops are required for a specific setup

Loop 2300

• The below REF segments are reuired for Loop 2300. Other REF segments for this loop are considered optional.

• REF*1L (Group/Policy#) expected values will be assigned by carrier
• REF*ZZ (Mutually Defined) expected values will be assigned by carrier
  
  

Loop 2310 and 2320

• These are optional loops. The carrier will indicate if these are required

Footer

• GE02:  Group Control Number Assigned by Sender must be the same as GS06

Open Enrollment

This carrier has not provided details on their Open Enrollment process. This section will be updated once we have the carrier’s requirements for Open Enrollment files.

Transmission

Oxford-UHC uses a system called Post-n-Track to setup a transmission method for your file feed. Information regarding that program will be provided by the carrier. You will need to follow the instructions on the document provided to obtain the transmission credentials. The most recent Post-n-Track document provided by Oxford is attached.