Anthem BCBS of Ohio
HIPAA 834 file, 5010 Platform, Spec Release 2.3 (November 2012)
Client Level Configuration
- ISA06/GS02: Senders Tax ID
- GS03 (Application Receiver’s Code):
- Per the companion guide these values are based on your product and location. Your implementation contact at the carrier will provide the expected values.
- If state is IN, KY, OH or MO use - FACETS
- If state is WI use - FACETSPR
- GS06: Group Control Number Assigned by Sender must match GE02 in footer (required to be 1-9 digits)
- REF*38 is required. Carrier will provide the expected value
- N102: Plan Sponsor Name
- N104: Plan Sponsor Tax ID
- N102: Carrier will provide expected name
- N104: Plan Sponsor Tax ID-Carrier provided TAX ID
- N102: TPA or Broker Name
- N104: TPA or Broker Tax ID
- 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
- REF*DX: Subgroup number reporting (This is optional)
- REF1L: Group or Policy # (Required in either Loop 2000 or Loop 2300)
- HD04-Plan Coverage Description (optional) Carrier will provide expected value if required for your configuration.
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.
- This carrier supports PGP encryption and the use of SFTP (Secure File Transfer Protocol). Currently, the configuration is only being used with the SFTP option. If PGP encryption is required for your configuration please request and forward that key to Employee Navigator.
- This carrier requires a specific file name and will provide details on that requirement
- Open Enrollment requirements are not currently listed in this carrier’s companion guide. If provided please forward to Employee Navigator so we can update this document.
- This carrier will not terminate a policy that is missing from the file feed. A cancel record with the termination date is required on the EDI file for all terminations.
- Please note: Per the Companion Guide, this configuration applies to multiple Anthem regions (OH, IN, KY, MO & WI). Employee Navigator's EDI engine will still require a carrier configuration for each state, however we will offer these other configurations are a reduced rate. Please submit the New Carrier Configuration ticket as normal with a copy of the CG and contact so we can compare the configuration. 11/5/2015