Employee Navigator recommends, when possible, to avoid transmitting PCP's (Primary Care Physicians) on an 834 file.
Why? Well there are 2 main reason why we don't recommend sending PCPs:
1. Some carriers may reject the file in its entirety if even 1 PCP is blank or incorrectly entered (ex - Benefitfocus). Unfortunately, employees are notoriously slow at providing PCP's so this can be a big problem and slow down files.
Here's an example of this in practice:
- A carrier requires that you send the PCP loop on the 834 file.
- You configure the PCP value as required at the plan level, which forces the employee to enter the PCP number in the enrollment flow.
- The employee incorrectly enters the physicians phone number or name in this field.
- The file is transmitted but the carrier rejects the file in its entirety due to invalid PCP.
2. The carrier does not read PCP changes on the file. While Employee Navigators EDI engine sends the loop with the PCP value every time a file is transmitted, the carrier will only read it once. In this situation the carrier expects the employee to contact member services or the carrier's portal directly to update their PCP.
- From our experience, we have found that carriers are reading the PCP loop on a 1st time new hire record and at renewal.