BCBS of GA
HIPAA 834 file, 5010 format
- Anthem Blue Cross Platform, Spec Release 2.1 (May 2011)
Client Level Configuration
- ISA06/GS02: Senders Tax ID
- ISA08/GS03: Per the companion guide these values are based on your product and location. Your implementation contact at the carrier will provide the expected values. Some in use by this carrier are:
- GS06: Group Control Number Assigned by Sender must match GE02 in footer (required to be 1-9 digits)
- REF*38 is required. 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
- This is optional. Carrier client level structure will indicate if this is needed
- The below REF segment is required. All others for this loop are situational unless specifically asked to include by carrier
- REF1L: Group or Policy # populate for Employee and Dependents
- REF1L: Group or Policy # (Per spec, you can exclude the REF1L from the 2300 loop if you send it in the 2000 loop, you may want to ask your contact the preference 2000 vs. 2300)
- Both loops are optional and if required for your setup the carrier will advise.
- GE02: Group Control Number Assigned by Sender must be the same as GS06
- The carrier template is set to stop sending terminations once they are 14 days past the termination date.
- The PGP encryption key is saved at the carrier-level so you can use either transmission option: PGP with FTP or SFTP.
- Open enrollment file should include open enrollment elections only. The Carrier will terminate any members not re-enrolling by omission.
- After open enrollment file is sent, no further eligibility maintenance files for existing plan year should be sent until after plan year begin date.
- Open Enrollment files do NOT require a custom naming convention.
- Clients account membership representative should be notified when Open Enrollment file is transmitted.