HIPAA 834, 5010 Platform, spec version 1.2
Client Level Configurations
- ISA06/GS02: Interchange Sender ID-Usually the client Tax ID. Carrier will indicate what they prefer
- GS06:Group Control Number-Assigned by Sender must match GE02 in footer (required to be 1-9 digits)
- REF: (Transaction Set Policy Number)- Carrier requires this segment and expects a group/policy# that they will provide
- N102: Plan Sponsor Name-Usually Client name
- N104: Plan Sponsor Tax ID- Usually Client Tax ID
- This loop is optional. They can be excluded unless the carrier specifically asks to include them in the file.
- REF segments are situational and dependent on the carrier’s requirements. Below are the required REF segments in Loop 2000 per the carrier’s companion guide
- REF*DX: Department/Agency#-The carrier will provide the expected values.
- REF*IL: Group/Policy#- The carrier will provide the expected values
- REF*17: Division/Location#-The carrier will provide the expected values.
- REF*ZZ: Mutually defined value- Carrier uses this segment to report CIB (Certified Indian Blood) and will provide the expected values
- REF*QQ: Unit#-The carrier will provide the expected values.
- Please note: the carrier may list other REF segments as required but those are not currently supported by Employee Navigator
- These loops are optional and the carrier will indicate if they want them included or excluded in your configuration
- Most of the REF segments in this loop are optional. If CoreSource requires any of those segments to be included they will identify which they expect to see
- REF*IL: Group/Policy#- The carrier will provide the expected values (Required)
- HD04: Plan Coverage Description- Carrier uses this to report Plan#. They will provide the expected values in the group structure
Loop 2310 and 2320
- These loops are optional and used only if the carrier requires them
- GE02: Group Control Number Assigned by Sender must be the same as GS06
- Open Enrollment: The carrier has not provided their Open Enrollment requirements. Once that is provided this document will be updated. Please refer to the carrier if you have questions regarding their open enrollment/EDI process
- Carrier references Loop 2500 for FSA (CAFÉ) in their requirements. That loop is not supported. Medical, Dental and Vision benefits are the only lines of coverage supported via this feed
- Terminated records are set to drop from this carrier’s file feeds at 14 days past the termination date
- CoreSource did not provide their encryption/transmission requirements. Employee Navigator supports automated transmission via secure methods only (FTP w/PGP, SFTP)
- CoreSource provides a companion guide that will also have the group structure included