HIPAA 834, 5010 Platform, Version 2.0
Last updated 7/8/2016
Client Level Configurations
- ISA06/GS02: Interchange Sender ID-Carrier assigned values
- GS06: Group Control Number Assigned by Sender must match GE02 in footer (required to be 1-9 digits)
- REF: Transaction Set Policy Number-This is required and the carrier will provide the expected value
- N102: Plan Sponsor Name
- N104: Plan Sponsor Tax ID
- N102: TPA or Broker Name
- N104: TPA or Broker Tax ID
- This loop is optional
- This loop is optional. The carrier will indicate if they require this loop on the file.
- REF*1L: Carrier uses this segment to report Policy Number and will provide the expected values
- REF*DX: Carrier uses this segment to report subgroup ID and will provide the expected values
- REF*ZZ: Carrier uses this to report Class ID and will provide the expected values
- All other loop segments for this loop are optional.
- These loops are all optional. The carrier will advise if any of these loops are required for a specific setup
- HD04-Carrier provided code they define as Class Plan ID.
- REF*1L-Optional for this loop
Loop 2310 and 2320
- These are optional loops. The carrier will inform if these are required via the group structure document
- GE02: Group Control Number Assigned by Sender must be the same as GS06
- Carrier template is set to stop sending terminated records 14 days after the termination date has passed
- EN has added Cigna's PGP to the carrier template.
- PGP encryption is used but not always required. When not required to use PGP encryption, the carrier still uses a secure transmission protocol (SFTP)
- Please note that Cigna has several options of secure transmission. EN recommends selecting FTP with PGP or SFTP with or without PGP.
- If choosing SFTP without PGP encryption, you will need to select the "Skip Encryption" option on File Settings>Transmitting in the EDI engine.
- Open Enrollment:
- Cigna expects the open enrollment file to include ended enrollments for the 2014 plan year with a end of the plan year term date and new enrollments for the renewing plan year.
- All updates for the existing plan year plan to include, adds, terms, and changes, must be sent to the clients Cigna account contact to be manually updated after the open enrollment file is sent. Regular eligibility maintenance files should resume at the beginning of the new plan year.
- Cigna does NOT require an alternate naming convention for the open enrollment file
- Notify the clients Eligibility Analyst when the open enrollment file has been sent