Fallon Community Health Plan
HIPAA 834 File, 4010 Format, Spec Revision 1.2 (September 2003)
Client Level Configurations
- ISA06 (sender ID): Carrier prefers Trading Partner Name
- GS02(sender ID): Client TAX ID
- GS06: Group Control Number must be 1-9 characters long and same value must also be populated in the GE02 in the footer. Cannot start with zero.
- N102: Group Name
- N104: Group Tax ID #
- N102: Insurer Name-Carrier will provide expected name
- N104: Carrier TAX ID #-Carrier will provide TAX ID they expect to see
Loop 1000C-This loop is optional and can be deselected. Carrier will communicate if they require this loop for your client setup.
- REF segments are situational and their requirements will depend on your client specific setup. The carrier will inform which REF segments to include. Common REF segments used by this carrier are:
- REF*1L: Group/Policy number
- REF*ZZ: Mutually defined field
- These loops are conditional and dependent upon the client/carrier requirements for a specific group. The carrier will communicate which loops are required for your setup
- REF*1L: Carrier requires Group/Policy number in this segment and will provide
- GE02: Group Control Number must be 1-9 characters long and match GS06 value in the Header. Cannot start with zero.
- Carrier requires a specific file naming convention. Please review the companion guide provided by the carrier for specific information on this topic.
- The carrier template is set to stop sending terminations once they are 14 days past the termination date.
- Open Enrollment requirements are not listed for this carrier in their guide. Please obtain the OE requirements from your carrier contact
- This carrier provides 2 sets of transmission credentials, one for testing and one for production. Please review the credentials the carrier has provided and make sure to update accordingly once your testing is complete and your file feed is approved for production transmission.
- There is no PGP encryption required for this carrier. Please make sure the carrier is using sFTP as a secure transmission and/or supply the PGP encryption key to Employee Navigator before sending FTP with PGP.