Insurance Management Services (IMS)
HIPAA 834, 5010 Platform, Spec dated August 2006
Client Level Configurations
- ISA06/GS02: Uses client’s Tax ID
- GS06: Group Control Number assigned by sender must match GE02 in footer. Cannot start with zero.
- REF*02: Master Policy Number-This segment is required by IMS
- N102: Sponsor Name- Client name
- N104: Sponsor ID #- TAX ID of client
- N102: Insurer Name- Carrier name. The carrier will inform you what name they want to use for this field
- N104: Insured ID #-TAX ID from carrier
These loops are optional. The carrier will communicate if they require this loop for your client setup.
- Carrier uses multiple REF segments for this loop and will provide the expected values for each. Below are the common REF segments used in this loop:
- REF*1L Member Policy Number- Not required
- REF*DX Department/Agency Number-Carrier uses this to report division codes and they will provide the client specific codes they expect
- REF*ZZ Mutually defined-Not required
- REF*17 Member Identification Number-Not required
- IMS requires the below member level dates to be included:
- DTP*336- Hire date
- DTP*356-Eligibility Date
- DTP*357-Eligibility End Date
- These loops are situational. The carrier does not use some of the segments and will identify which ti include if any.
- REF segments are optional for this loop. The carrier will indicate if they require use of any in this loop
- HD03-Insurance Line Code: Medical=HLT Vision=VIS Dental=DEN
- HD04-Listed as required by the carrier. They will provide the expected values
- Dates-Carrier uses the following dates to begin/end benefits
- DTP*348-Benefit Begin Date
- DTP*349-Benefit End Date
Loops 2310-2320 - Optional
- GE02: Group Control Number must be 1-9 characters long and match GS06 value in the Header. Cannot start with zero.
- There is no reference to Open Enrollment in the carrier’s documentation. Once its is provided this document will be updated
- The “drop terminated record” option is set to drop terminated records from this feed 14 days after the date of termination has passed.
- There is no PGP encryption key on file as the carrier since the carrier uses a secure transmission protocol during transmission (SFTP). If the carrier does require PGP encryption in the future please obtain and provide the secure key to Employee Navigator.