North American Administrators

North American Administrators

HIPAA 834, 5010 Platform, Spec Effective Date 1/1/2016

Client Level Configurations

Header

• 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) –Optional segment. Carrier will provide expected values if it is required for your setup

Loop 1000A

• N102:  Plan Sponsor Name-Usually Client name
• N104:  Plan Sponsor Tax ID- Usually Client Tax ID

Loops 1000C-1100C

• These loops are optional. They can be excluded unless the carrier specifically asks to include them in the file.

Loop 2000

• Most REF segments in this loop are optional. Below are the required REF segments for this carrier
• REF*1L: Group/Policy#-The carrier will provide the expected values.
• REF*DX: Division/Office/Location#-The carrier will provide the expected values.

Loops 2100B-2200

• These loops are optional and the carrier will indicate if they want them included or excluded in your configuration

Loop 2300

• Most REF segments in this loop are optional. The carrier will indicate if they require any to be included or excluded

• HD04: Plan Coverage Description- NAA requires a plan number here and will provide it

Loop 2310 and 2320

• These loops are optional and used only if the carrier requires them

 
Footer

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

File Transmission

• This carrier’s specifications indicate they cannot accept an incoming file feed. Due to this limitation you will need to transmit the files to NAA using an alternative method other than Employee Navigator’s transmission tool. If the carrier does accept incoming feeds in the future, they can be sent via our automated process in the export engine

Carrier Notes

• 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
• NAA does not have specific requirements for a lot of the loops and segments. They may ask to include some that are marked as optional.
• No PGP encryption key was provided. If provided please forward to [e-mail]
• Terminated records are set to drop from this carrier’s file feeds at 14 days past the termination date
• NAA requires a separate HD loop for each medical record that is passed and also requires the HD04 element to be different. Due to this requirement the “plan bundle” option in Employee Navigator will not support this. You will need to setup a stand-alone plan to pass the required PDG code for NAA. The carrier will indicate if they can make an exception for that requirement.
• Café accounts are noted as optional in the carrier’s companion guide. Employee Navigator does not support reporting Café accounts (FSA, DCA, PRK) in 834 formatted files as they are intended for Medical, Dental and Vision reporting.
• DTP356 (Eligibility Begins) date to send only once for the earliest date (5/25/18).