BlueCross BlueShield of VT. Vermont
|
|
- Patrick Wells
- 5 years ago
- Views:
Transcription
1 BlueCross BlueShield of Vermont 834 Benefit Enrollment and Maintenance Companion Guide HIPAA/V4010X095A1 Version: 1.0 Company: BlueCross BlueShield of VT Publication: 12/19/2012 Blue Cross & Blue Shield of Vermont Version: 1.0
2 Table of Contents 1. Introduction Change versus Full File Audits Coverage Levels and Dependents Dates Connectivity Testing and Certification Production Processing Trading Partners BCBSVT Business Rules and Edits ISA & IEA: Interchange Control Header & Trailer GS & GE: Functional Group Header & Trailer ST & SE: Transaction Set Header & Trailer Header (BGN/REF/DTF) Sponsor, Payer and TPA Member Level Details Loop Member Name Loop 2100A Incorrect Member Name Loop 2100B Health Coverage Loop Provider Information Loop Miscellaneous Examples...17 Appendix A (Testing/Certification Scenarios)...25 Document Revision History:...26 Benefit Enrollment and Maintenance i X12V4010X095A1
3 1. Introduction This document is the property of Blue Cross Blue Shield of Vermont (BCBSVT) and is for use solely in your capacity as a Trading Partner of health care transactions with BCBSVT. This information is intended to serve only as a companion guide to the HIPAA ANSI X12N 834A1 and should be used in conjunction with the HIPAA Implementation Guide. The specifications contained within this Companion Guide define current functions and provide supplemental information specific to Blue Cross & Blue Shield of Vermont (BCBSVT). The implementation guides are available at Washington Publishing Company website at This Companion Guide is subject to change as new information is available. Please check the BCBSVT Web site, at for updated documents. Note: BCBSVT accepts 4010A1 version of 834 Benefit Enrollment and Maintenance. All Alpha Characters in the file must be Upper Case. 2. Change versus Full File Audits The 834 transaction set can be used to provide either updates to the membership database or full file audits against the membership database. An update is either a new add, termination or change request. This transaction only contains information about changed members. A full file audit lists all current members. This facilitates keeping the sponsor s and payer s systems synchronized. It is not intended to contain a history of all previous enrollments. BGN08 is used to indicate whether the transaction is a full file audit (4) or an update (2). When sending a full file audit, Loop 2000, INS03 must be 030. INS04 must be XN and Loop 2300, HD01 must be 030. When submitting full files, a single transaction set (ST/SE) must contain all of the enrollment transactions that belong to the BCBSVT group number that is specified in REF02 segment in the header, they cannot be submitted in multiple transaction sets. Separate full file must be submitted for each of the groups, if an employer has multiple group numbers with BCBSVT. For example, if an employer ABC has two group numbers and with BCBSVT, two full files must be submitted one for group number and one for Coverage Levels and Dependents Reporting of the coverage level code (e.g., individual, family, etc.) and benefit package information is reported at the employee level. Changes for the employee may need to be submitted with the addition or termination of a dependent or coverage level. Subscriber numbers are reported in the Loop 2000 REF (0F Identification Qualifier) Segment. BCBSVT requires the Subscriber s Social Security Number be sent in REF02. If the member is currently enrolled in a VT Blue 65 program, the one to two position suffix code must follow the Social Security Number with no spaces or hyphens. The Subscriber s group number is reported in Loop 2000 REF (1L Identification Qualifier) Segment. REF02 must be populated with the Subscriber s 5 or 6 position BCBSVT Group number which will be provided to you prior to testing. The Subscriber s Account Number is reported in Loop 2000 REF (DX Identification Qualifier) Segment. REF02 Benefit Enrollment and Maintenance X12V4010X095A1
4 must be populated with the Subscriber s 8 or 9 position BCBSVT Account number which will be provided to you prior to testing. Loop 2300 HD- Health Coverage, HD04 requires a concatenation of BCBSVT 4 position tier code plus a 4 position benefit package code. Prior to testing, a spreadsheet/grid will be provided defining the group number, account number, tier and benefit package that will need to be used. Student information should be sent when describing a non-employee/non-spouse dependent whose age requires a qualifying condition for enrollment (e.g., being a full time active student). Please contact your BCBSVT Account Manager for your student age requirements. Disability information should only be sent when enrolling a disabled member or when disability information about an existing member is added or changed. This information is reported in Loop 2000, INS10. Certain change/update transactions (BGN08 code value 2 ) must be submitted in a specific sequence in order for the membership database to be updated properly. Examples of these transactions, as well as others, are provided under the Examples section of this document. Change/update files can be transmitted as needed (daily, weekly). BCBSVT recommends that change/update files be transmitted not more than once a day, but should be sent daily if activity has been performed to ensure that all enrollment and maintenance activity is processed in the appropriate order. 4. Dates File effective date is required in full files only with 303 qualifier, and this date is used to cancel the members in BCBSVT system that are not present in full files for that master policy number identified in REF segment. Member level dates in loop 2000 are required to submit for member cancellation transactions with 357 qualifier in both change and full files. It is also required to submit member add and change transactions with 356 qualifier in full files. Health Coverage dates in loop 2300 is required with 348 qualifier for new member add transactions and with 303 for member change transactions in both change and full files as well. 5. Connectivity Trading Partners can access the BCBSVT secure FTP site in one of two ways, to submit x12 files. You will be provided HostName, UserName and Password upon receipt of completed Trading Partner Agreement. If you are logging in for the first time you will need to change your password and Method 1 will be the only way to do this. Once you have changed your password you can use either method. The SFTP User Guide is available on BCBSVT website that will provide more information. Our Secure FTP site requires password change every 90 days. Contact BCBSVT helpdesk at (800) option 1 or helpdesk@bcbsvt.com if password reset is needed. Method 1 Via the web interface Submitters will browse to and login to Method 2 Via FTP Client using FTP over SSL or FTP over SSH. Configure your ftp client to use one of the above protocols along with the hostname, username and password. After it is configured simply login to see your Home and Distribution folders. SFTP User Guide the Online Manual link from the website provides more information about supported clients. Benefit Enrollment and Maintenance X12V4010X095A1
5 6. Testing and Certification Upon receipt of completed Trading Partner agreement and EDI enrollment forms, BCBSVT will provide the necessary information for you to start sending test files. It is required to submit a minimum of two test files that pass EDI validation and load into BCBSVT membership system successfully. Test files must be submitted with a usage indicator of T in ISA15. Test files received with usage indicator of P or Production files received with usage indicator of T will be rejected, and it will require resubmission of the files with correct usage indicator. We recommend you to submit the transactions for the scenarios that are outlined in Appendix A section. Upon successful completion of testing BCBSVT will communicate a plan for production processing of your files. 7. Production Processing Schedule: BCBSVT accepts transmissions 24 hours a day, 7 days a week. All 834 transactions received on a business day prior to 6:30PM will be processed in a batch mode that evening. Any transactions received after 6:30PM will be processed the following business day. Notifications regarding system upgrades and/or downtimes will be provided on our SFTP log in site. BCBSVT suggests separate transmissions for multiple clients (or employer). Any errors detected in a transaction set will result in the entire transmission being rejected. Interchange Control number (ISA13) must be unique within the sender/receiver relationship for each submission, not for each client when a clearinghouse is submitting for multiple clients. We highly suggest the use of the TA1 & 997 functional acknowledgement files. BCBSVT does not use the ISA14 element to identify the request of an acknowledgement. To request TA1 s & 997 s please request this option on the EDI Enrollment form and we will flag our system to provide TA1 s and 997 functional acknowledgements 8. Trading Partners A BCBSVT EDI trading partner is any business partner (provider, clearinghouse, billing service, software vendor, employer, etc.) who transmits to or receives electronic data from BCBSVT. In order to establish a trading partner relationship with BCBSVT, it is necessary to complete a Trading Partner Agreement. In addition, trading partners must also complete a copy of EDI enrollment form for certain EDI transaction types. Both documents are located on the BCBSVT Web site: Both documents must be completed and returned to: Blue Cross and Blue Shield of Vermont (BCBSVT) Attn: Channel Services (EDI Department) P.O. BOX 186 Montpelier, VT BCBSVT will only accept transactions from valid trading partners whose submitter/sender IDs are on file. It will reject transmissions if the submitter ID cannot be validated. Contact Information For more information or questions regarding this or other EDI transactions, you may contact us at: EDI Tech Support: Phone: (800) , select option 2 editechsupport@bcbsvt.com Fax: (802) Benefit Enrollment and Maintenance X12V4010X095A1
6 9. BCBSVT Business Rules and Edits This companion guide only addresses the business rules specific to BCBSVT, and do not send the information if it is not required by Implementation guide. The following are specific BCBSVT rules applicable to benefit enrollment and maintenance transactions: 9.1 ISA & IEA: Interchange Control Header & Trailer Interchange Control Header (ISA) Authorization Information Qualifier ISA01 BCBSVT require 00 Authorization Information ISA02 BCBSVT requires 10 spaces Security Information Qualifier ISA03 BCBSVT require 00 Security Information ISA04 BCBSVT requires 10 spaces Interchange ID Qualifier ISA05 BCBSVT require ZZ Interchange Sender ID ISA06 BCBSVT assigned 4 digit Sender ID followed by 11 spaces Interchange ID Qualifier ISA07 BCBSVT require ZZ Interchange Receiver ID ISA08 Must be BCBSVT followed by 6 spaces Interchange Date ISA09 Yymmdd Interchange Time ISA10 Hhmm Interchange Control Standards ISA11 U Identifier Interchange Control Version Number ISA Interchange Control Number ISA13 9 digit unique control number must match with IEA02 Acknowledgment Requested ISA14 0 BCBSVT do not use this value to generate Acknowledgement. Contact EDI department with your request for Acknowledgements. Usage Indicator ISA15 P for Production Files T for Test Files Component Element Separator ISA16 Use a valid HIPAA element separator Interchange Control Trailer (IEA) Number of Included Functional IEA01 Number of functional groups (GS/GE) Groups Interchange Control Number IEA02 9 digit unique control number must match with ISA13 Benefit Enrollment and Maintenance X12V4010X095A1
7 9.2 GS & GE: Functional Group Header & Trailer Functional Group Header (GS) Functional Identifier Code GS01 BE Application Sender's Code GS02 BCBSVT assigned 4 digit Sender ID Application Receiver's Code GS03 Must be BCBSVT Date GS04 Ccyymmdd Time GS05 Hhmm Group Control Number GS06 1 to 9 digit control number must match with GE02 Responsible Agency Code GS07 X Version / Release / Industry Identifier Code GS X095A1 Functional Group Trailer (GE) Number of Transaction Sets Included GE01 Number of Transaction sets (ST/SE) included. Group Control Number GE02 1 to 9 digit control number must match with GS ST & SE: Transaction Set Header & Trailer Transaction Set Header (ST) Transaction Set Identifier Code ST Transaction Set Control Number ST02 4 to 9 digit control number must match with SE02 Transaction Set Trailer (SE) Number of Included Segments SE01 Number of segments included in the transaction set. Transaction Set Control Number SE02 4 to 9 digit control number must match with ST02 Benefit Enrollment and Maintenance X12V4010X095A1
8 9.4 Header (BGN/REF/DTF) Specify the type of file that is being sent in BGN08, and send the REF and DTP segments appropriately for full files only. Do not send REF and DTP segments for change files. BGN - Beginning Segment Transaction Set Control Number BGN01 00 Original BCBSVT requires this code should be used for the first transmission, corrected transmission, and resending of a transmission that has been lost and never received by the Payer. Action Code BGN Change/Update Must be 2 for change files Resubmission BCBSVT require this code should only be submitted when the sender has contacted BCBSVT and the usage was agreed upon by the two entities. When using this option a new Interchange control number (ISA13) will need to be provided. 4 Verify Must be 4 for Verify/Full files. REF - Transaction Set Policy Number BCBSVT require this segment for full files (BNG08 = 4) only. Do not send this segment on change files. Reference Identification Qualifier REF01 38 Master Policy Number Reference Identification REF02 Must be five or six position BCBSVT Group Number and only in a verifying audit file. This Group Number will be provided to you after the Trading Partner Agreement is signed prior to begin testing. DTP - File Effective Date BCBSVT require this segment for full files (BNG08 = 4) only. Do not send this segment on change files. Date/Time Qualifier DTP Maintenance Effective Must be 303 Date Time Period DTP03 ccyymmdd DTP03 date must be the last day of the month ( , etc).this date will be used to terminate all active members in the BCBSVT system but not present in this full file, for the group identified in REF02. Benefit Enrollment and Maintenance X12V4010X095A1
9 9.5 Sponsor, Payer and TPA Sponsor Name Loop 1000A Identification Code Qualifier N103 FI Federal Taxpayer s Identification Number Identification Code N104 BCBSVT require your Federal Taxpayer s Identification Number using the format Do not use spaces, hyphens or special characters. Failure to provide the Federal Taxpayer s ID in the prescribed format will result in the rejection of the transmission. Payer Loop 1000B Identification Code Qualifier N103 FI Federal Taxpayer s Identification Number Identification Code N104 Must use TPA/Broker Name Loop 1000C Use this loop only when a Third Party Administrator (TPA)/Broker are involved. Do not send this loop when TPA/Broker is not involved. Entity Identifier Code N101 BO Broker or Sales office TV Third Party Administrator Identification Code Qualifier N103 FI Federal Taxpayer s Identification Number Identification Code N104 BCBSVT require TPA/Broker s Federal Taxpayer s Identification Number using the format Do not use spaces, hyphens or special characters 9.6 Member Level Details Loop 2000 Loop 2000 Member Level Details (INS) Individual Relationship Code INS02 Relationship Codes that are used by BCBSVT: 01 - Spouse Should also use this code for Partner/Party of a Civil Union Adopted Child 17 - Stepson or Stepdaughter 18 - Self Benefit Enrollment and Maintenance X12V4010X095A1
10 19 - Child 38 - Collateral Dependent Valid only for specific group contracts. To verify the qualifications for your group policy contact your BCBSVT Account Manager Life Partner Use for Domestic Partner: This code should only be transmitted when this type of dependent coverage is applicable to your group coverage. Maintenance Type Code INS03 Valid Maintenance type codes for BCBSVT are: Change Addition Cancellation or Termination Do not send a cancellation or termination transaction when changing TIER/BENEFIT PACKAGE (HD04). Send a change transaction with a new TIER/BENEFIT PACKAGE (HD04) with new effective date in loop Our system will cancel/terminate the previous Tier/Benefit package with the date prior to the effective date of the new Tier/Benefit Package Reinstatement All of the above codes must only be used in change files Audit or Compare This code should only be used when the contract between the sponsor and the payer has agreed upon its usage. This code is required on full file processing (for add, change and cancellation transactions). Maintenance Reason Code INS04 A valid maintenance Reason Code from the below list is required to process transaction successfully into BCBSVT system Divorce 02 - Birth 03 - Death 04 - Retirement 05 - Adoption 07 - Termination of Benefits 08 - Termination of Employment 09 - Consolidation Omnibus Budget Reconciliation Act (COBRA) 14 - Voluntary Withdrawal 15 - Primary Care Provider (PCP) Change 22 - Plan Change Use this when the changing the Account, Tier Code or Benefit Package Change in Identifying Data Elements Benefit Enrollment and Maintenance X12V4010X095A1
11 Should be sent when a change to the Members First Name, Last Name, Date of Birth, or Gender is being made. If a change to the SSN is required, a termination transaction for the incorrect number should be sent, followed by an add transaction with the correct number Initial Enrollment 31 - Legal Separation 32 - Marriage 41 - Re-enrollment 43 - Change of Location AI - No Reason Given This code is not used unless agreed upon by both Trading Partners. XN - Notification Only This code should only be used when the contract between the sponsor and the payer has agreed upon its usage. This code must be submitted on full files. XT - Transfer A transfer is when a change to the BCBSVT Group Number is required. A termination transaction of the old Group must be sent, followed by an Add transaction with all of the new BCBSVT information. Benefit Status Code INS05 A - Active C - Consolidated Omnibus Budget Reconciliation Act (COBRA) Employment Status Code INS08 This is required for Subscriber Add and Change transactions only. Valid Employment Status Codes for BCBSVT are: AO - Active Military - Overseas AU - Active Military - USA FT - Full-time L1 - Leave of Absence PT - Part-time RT - Retired TE Terminated Loop 2000 Subscriber Number (REF) Reference Identification Qualifier REF01 0F Subscriber Number Reference Identification REF02 The Subscriber s Social Security Number must be sent (in REF02). If the member is currently enrolled/enrolling in VT Blue65, send the Subscribers Social Security Number with the one to two position Medicare assigned Suffix code(s) immediately following it (No spaces, hyphens or special characters should be sent). Benefit Enrollment and Maintenance X12V4010X095A1
12 Loop 2000 Member Policy Number (REF) This segment must be sent at member level with each transaction. Reference Identification Qualifier REF01 1L - Group or Policy Number Reference Identification REF02 REF02 must be sent with the Subscribers five or six position BCBSVT Group Number. Loop 2000 Member Identification Number (REF) This segment must be sent at member level with each transaction. Reference Identification Qualifier REF01 6O - Cross Reference Number DX - Department/Agency Number DX is the required minimum qualifier for this segment. Other qualifiers may be used in addition to the DX qualifier. F6 - Health Insurance Claim (HIC) Number Q4 - Prior Identifier Number Reference Identification REF02 REF02 must be a minimum of eight or nine position BCBSVT Account Number when REF01 equals DX. Loop 2000 Member Level Dates (DTP) Change File - Member Cancellation must be submitted with DTP01 = 357. Full file Member Add and Change transactions must be submitted with DTP01 = 356. Member Cancellation from a full file must be submitted with two DTP segments, DTP01 = 356 and DTP01 = 357 unless Term By Absence is requested. Date/Time Qualifier DTP01 Valid Date/Time qualifiers for BCBEVT are: 356 Eligibility Begin Required for Add and Change transactions in a full file only with member s eligibility start date Eligibility End Required for Cancellation Transactions. Send the last day that the member will have coverage in DTP03. If the Subscriber is sent, all members under the policy will be cancelled. If only a dependent is sent, only the individual dependent will be cancelled. Benefit Enrollment and Maintenance X12V4010X095A1
13 9.7 Member Name Loop 2100A Loop 2100A Member Name (NM1) Entity Identifier Code NM101 IL - Insured or Subscriber Entity Type Qualifier NM102 1 Person 74 Corrected Insured. Must only be submitted this code when Name, Date of Birth, Gender or Marital Status change is submitted along with the incorrect information in loop 2100B. Member Last Name NM103 BCBSVT allows 35 Characters. Member First Name NM104 BCBSVT allows 25 Characters. Member Middle Name NM105 BCBSVT allows 25 Characters. Name Suffix NM107 BCBSVT allows 10 Characters. Identification Code Qualifier NM Social Security Number Identification Code NM109 Nine digit member s Social Security Number. Loop 2100A - Member Demographics (DMG) Gender Code DMG03 Valid Gender Codes for BCBSVT are: F - Female M Male Marital Status Code DMG04 Marital Status Code must only be sent on Subscriber Transactions. Do not submit on dependent enrollment transactions. Valid Marital Status Codes for BCBSVT are: B - Registered Domestic Partner D - Divorced I - Single M - Married R - Unreported S - Separated U - Unmarried (Single or Divorced or Widowed) W - Widowed X - Legally Separated Benefit Enrollment and Maintenance X12V4010X095A1
14 9.8 Incorrect Member Name Loop 2100B This loop must be submitted only when there is a Name, Date of Birth, Gender or Marital Status change/correction is being requested in Loop 2100A with NM101 = 74. Loop 2100B Member Name (NM1) Submit with prior incorrect information. Entity Identifier Code NM Prior Incorrect Insured. Required only when Name, Date of Birth, Gender or Marital Status change is submitted along with the corrected information in loop 2100A. Entity Type Qualifier NM102 1 Person Member Last Name NM103 BCBSVT allows 35 Characters. Member First Name NM104 BCBSVT allows 25 Characters. Member Middle Name NM105 BCBSVT allows 25 Characters. Name Suffix NM107 BCBSVT allows 10 Characters. Identification Code Qualifier NM Social Security Number Identification Code NM109 Nine digit member s Social Security Number. Loop 2100B - Member Demographics (DMG) Submit with prior incorrect information. Gender Code DMG03 Valid Gender Codes by BCBSVT are: F - Female M Male Marital Status Code DMG04 Marital Status Code must only be sent on Subscriber Transactions. Do not submit on dependent enrollment transactions. Valid Marital Status Codes by BCBSVT are: B - Registered Domestic Partner D - Divorced I - Single M - Married R - Unreported S - Separated U - Unmarried (Single or Divorced or Widowed) W - Widowed X - Legally Separated Benefit Enrollment and Maintenance X12V4010X095A1
15 9.9 Health Coverage Loop 2300 Loop 2300 Health Coverage (HD) Maintenance Type Code HD01 Valid Maintenance Type codes for BCBSVT are: 001 Change 021 Addition 025 Reinstatement Can use to reinstate same TIER/BENEFIT PACKAGE (HD04) without a break in coverage. Send new TIER/BENEFIT PACKAGE (HD04) with original effective date of the TIER/BENEFIT PACKAGE Audit or Compare This code must be used for full files only. Insurance Line Code HD03 HLT Plan Coverage Description HD04 Send concatenated TIER/BENEFIT PACKAGE value. Value should be a fixed length: TIER CODE = 4; BENEFIT PACKAGE = 4. Example: 2001AB01 This information will be provided by BCBSVT Account Manager upon submission of Trading Partner Agreement. Coverage Level Code HD05 It is required for Subscriber transactions only, do not submit on dependent member transactions. Valid Coverage Level Codes for BCBSVT are: EMP - Employee Only ESP - Employee and Spouse ECH - Employee and Children FAM - Family E1D - Employee and One Dependent E2D - Employee and Two Dependents E3D - Employee and Three Dependents E5D - Employee and One or More Dependents E6D - Employee and Two or More Dependents E7D - Employee and Three or More Dependents E8D - Employee and Four or More Dependents E9D - Employee and Five or More Dependents Loop Health Coverage Dates (DTP) Date/Time Qualifier DTP01 Valid Date/Time qualifiers for BCBSVT are: Maintenance Effective Use this code for changes to an existing policy. Example: Account and/or Benefit Package or Tier has been changed Benefit Begin Benefit Enrollment and Maintenance X12V4010X095A1
16 Use this code for Add transactions. Loop 2300 Identification Card (IDC) Plan Coverage Description IDC01 BCBSVT requires use a single zero Identification Card Type Code IDC02 H - Health Insurance Action Code IDC04 Valid Action Codes for BCBSVT are: RX Replace 9.10 Provider Information Loop 2310 Loop 2310 Provider Name (NM1) Entity Identifier Code NM101 Valid Entity Identifier Codes for BCBSVT are: P3 - Primary Care Provider Physician that is selected by the insured to provide medical care. Entity Type Qualifier NM102 1 Person Identification Code Qualifier NM108 Valid Entity Identification Code qualifiers for BCBSVT are: XX - Health Care Financing Administration National Provider Identifier Identification Code NM109 Must be the Provider s 10 position PCP NPI Number. Entity Relationship Code NM110 Valid Entity Relationship Codes for BCBSVT are: 25 - Established Patient 26 - Not Established Patient 9.11 Miscellaneous Below are some additional segments that are used by BCBSVT for processing but not listed above. Member Communication Numbers (Loop 2100A) Member Mailing Address (Loop 2100C) PER NM1, N3 & N4 Use PER segment for submitting member communication phone number and or address. Member mailing address is required to process enrollment transactions into BCBSVT system. Use NM1, N3 & N4 segments to submit member Benefit Enrollment and Maintenance X12V4010X095A1
17 Custodial Parent (Loop 2100F) NM1, PER, N3 & N4 mailing address information Use this segment to submit custodial parent information. Valid Communication Number Qualifier in PER segment for Custodial Parent are: HP - Home Phone Number WP - Work Phone Number EX - Telephone Extension PCP Change Reason (Loop 2310) PLA Use this segment to report the reason and the effective date that a member changes primary care provider. Coordination of Benefits (Loop 2320) COB, REF, N1 & DTP Use COB, REF, N1 & DTP segments to submit Coordination of Benefits information. Benefit Enrollment and Maintenance X12V4010X095A1
18 10. Examples Subscriber Add INS*Y*18*021*28*A***FT*N*N~ REF*DX* ~ NM1*IL*1*LAST*FIRST*M**SR~ DMG*D8* *M*I~ HD*021**HLT*1001ABCD*EMP~ DTP*348*D8* ~ LX*1~ NM1*P3*1******XX* *25~ PLA*2*1P* **AI~ Benefit Enrollment and Maintenance X12V4010X095A1
19 Dependent Add Spouse INS*N*01*021*28*A***FT*N*N~ REF*DX* ~ NM1*IL*1*LAST*FIRST*M~ DMG*D8* *F~ HD*021**HLT*2001ABCD~ DTP*348*D8* ~ LX*1~ NM1*P3*1******XX* *25~ PLA*2*1P* **AI~ Child INS*N*19*021*28*A***FT*N*N~ REF*DX* ~ NM1*IL*1*LAST*FIRST*M**JR~ DMG*D8* *M~ HD*021**HLT*3001ABCD~ DTP*348*D8* ~ LX*1~ NM1*P3*1******XX* *25~ PLA*2*1P* **AI~ Benefit Enrollment and Maintenance X12V4010X095A1
20 PCP Change Send the new PCP provider number and the effective date. The benefit effective on the HD segment should be the current effective date for the member. INS*N*01*001*15*A***FT*N*N~ REF*DX* ~ NM1*IL*1*LAST*FIRST*M~ DMG*D8* *F~ HD*021**HLT*2001ABCD~ DTP*303*D8* ~ LX*1~ NM1*P3*1******XX* *25~ PLA*2*1P* **AI~ Address Change INS*Y*18*001*43*A***FT*N*N~ REF*DX* ~ NM1*IL*1*LAST*FIRST*M**SR~ DMG*D8* *M*I~ N3*110 MAIN STREET*APARTMENT A~ N4*CENTER CITY*VT* ~ HD*021**HLT*1001ABCD*EMP~ DTP*348*D8* ~ Benefit Enrollment and Maintenance X12V4010X095A1
21 Cancel Dependent No Downgrade Send the cancel date on the DTP 2000 loop. Normally the cancel date is the last day of the month. INS*N*19*024*14*A***FT*N*N~ REF*DX* ~ DTP*357*D8* ~ NM1*IL*1*LAST*FIRST*M**JR~ DMG*D8* *M~ Cancel Dependent with Downgrade The first transaction actually cancels the member. The second transaction will downgrade the subscriber s (or entire family s) tier. INS*N*01*024*01*A***FT*N*N~ REF*DX* ~ DTP*357*D8* ~ NM1*IL*1*LAST*FIRST*M~ DMG*D8* *F~ INS*Y*18*001*01*A***FT*N*N~ REF*DX* ~ NM1*IL*1*LAST*FIRST*M**SR~ DMG*D8* *M*I~ HD*001**HLT*1001ABCD*EMP~ DTP*303*D8* ~ Benefit Enrollment and Maintenance X12V4010X095A1
22 Add Dependent with Upgrade The first transaction upgrades the subscriber s (and family s) tier. The second transaction adds the new family member. INS*Y*18*001*32*A***FT*N*N~ REF*DX* ~ NM1*IL*1*LAST*FIRST*M**SR~ DMG*D8* *M*M~ HD*001**HLT*2001ABCD*ESP~ DTP*303*D8* ~ INS*N*01*021*32*A***FT*N*N~ REF*DX* ~ NM1*IL*1*LAST*FIRST*M~ DMG*D8* *F~ HD*021**HLT*2001ABCD~ DTP*348*D8* ~ LX*1~ NM1*P3*1******XX* *25~ PLA*2*1P* **AI~ Benefit Enrollment and Maintenance X12V4010X095A1
23 Account # Change (plan change) Only the account number and HD segment information will be changed, the new benefit effective date is reflected on the DTP segment. INS*Y*18*001*22*A***FT*N*N~ REF*DX* ~ NM1*IL*1*LAST*FIRST*M**SR~ DMG*D8* *M*M~ HD*001**HLT*2002ABCD*ESP~ DTP*303*D8* ~ INS*N*01*001*22*A***FT*N*N~ REF*DX* ~ NM1*IL*1*LAST*FIRST*M~ DMG*D8* *F~ HD*001**HLT*2002ABCD ~ DTP*303*D8* ~ Benefit Enrollment and Maintenance X12V4010X095A1
24 Group # Change/Plan Change If the group number changes, the family must be cancelled from the old group and each family member added to the new group. INS*Y*18*024*22*A***FT*N*N~ REF*DX* ~ DTP*357*D8* ~ NM1*IL*1*LAST*FIRST*M**SR~ DMG*D8* *M*M~ INS*Y*18*021*22*A***FT*N*N~ REF*1L*67890~ REF*DX* ~ NM1*IL*1*LAST*FIRST*M**SR~ DMG*D8* *M*M~ HD*021**HLT*2002ABCD~ DTP*348*D8* ~ LX*1~ NM1*P3*1******XX* *25~ PLA*2*1P* **AI~ INS*N*01*021*22*A***FT*N*N~ REF*1L*67890~ REF*DX* ~ NM1*IL*1*LAST*FIRST*M~ DMG*D8* *F~ HD*021**HLT*2002ABCD~ DTP*348*D8* ~ LX*1~ NM1*P3*1******XX* *25~ PLA*2*1P* **AI~ Benefit Enrollment and Maintenance X12V4010X095A1
25 Name and Birth Date Correction Always include the old demographics information when there is a change. INS*Y*18*001*25*A***FT*N*N~ REF*DX* ~ NM1*74*1*NEW LAST*NEW FIRST*M**SR~ DMG*D8* *M*I~ NM1*70*1*OLD LAST*OLD FIRST*M**SR~ DMG*D8* *M*I~ N3*110 MAIN STREET*APARTMENT A~ N4*CENTER CITY*VT* ~ HD*001**HLT*1001ABCD*EMP~ DTP*303*D8* ~ Benefit Enrollment and Maintenance X12V4010X095A1
26 Appendix A (Testing/Certification Scenarios) BCBSVT recommends that you include the enrollment transactions but not limited to the scenarios that are outlined in this section below, to complete successful testing as a new trading partner submitting enrollment transactions. BCBSVT will work with you on how to submit test files and status of the test files validation and loading into BCBSVT membership system. Upon completion of successful testing we will start processing your production files. Membership Adds: 1. Enrolling a new subscriber only policy. 2. Enrolling subscriber and spouse policy. 3. Enrolling a new family (subscriber, spouse and child dependents) policy. 4. Enrolling a new family (subscriber, and dependent children) policy. 5. Adding a new dependent member to a family policy, without a benefit or tier change to the policy. 6. Enrolling subscriber and a domestic partner policy. 7. Enrolling a new family policy with one of the children as a student status. 8. Enrolling a new family policy with twins. 9. Enrolling a new member with phone number and address. 10. Enrolling a new member with a Primary Care Physician. 11. Enrolling a new subscriber with COB. Membership Cancels: 12. Cancel subscriber only policy. 13. Cancel subscriber and spouse policy. 14. Cancel a family policy. 15. Cancel a dependent member of a family remaining at a family policy. Subscriber Upgrades with dependent member add. 16. Subscriber upgrade from a single to two people by adding a spouse 17. Subscriber upgrade from a single to two people by adding a dependent child 18. Subscriber upgrade from a single to family by adding spouse and dependent child 19. Subscriber upgrade from a single to family by adding dependent children 20. Subscriber upgrade from two people (subscriber & spouse) to a family by adding and dependent child 21. Subscriber upgrade from two people (subscriber & child) to family by adding spouse. Subscriber Downgrades with dependent member cancel. 22. Subscriber downgrade from two people (subscriber & spouse) to a single by cancelling spouse. 23. Subscriber downgrade from two people (subscriber & child) to single by cancelling dependent child. 24. Subscriber downgrade from family to a single by cancelling spouse and dependent children. 25. Subscriber downgrade from family (subscriber & children) to single by cancelling dependent children. 26. Subscriber downgrade from family to two people by cancelling dependent children. 27. Subscriber downgrade from family to two people (subscriber & child) by cancelling spouse. Membership Changes. 28. Subscriber s Address change 29. Subscriber s Last name change 30. Subscriber s phone number change 31. Subscriber s address change 32. Subscriber s PCP change 33. Dependent member s PCP change 34. Subscriber s DOB correction Benefit Enrollment and Maintenance X12V4010X095A1
27 Document Revision History: Version Number Date Modified By Comments/Revision Details /19/2012 Anantha Boppana Initial version Benefit Enrollment and Maintenance X12V4010X095A1
834 Benefit Enrollment and Maintenance
Companion Document 834 834 Benefit Enrollment and Maintenance This Companion Document serves as supplementary material to the primary resources, ASC X12 Standards for Electronic Data Interchange Technical
More informationHIPAA Transaction Standard Companion Guide. ASC X12N Version X220A1 834 Benefit and Enrollment Maintenance
HIPAA Transaction Standard Companion Guide ASC X12N Version 005010X220A1 834 Benefit and Enrollment Maintenance Guide Version 1.2 September 2, 2018 Preface This Companion Document to the ASC X12N Implementation
More information834 Benefit Enrollment and Maintenance
Companion Document 834 834 Benefit Enrollment and Maintenance This companion document is for informational purposes only to describe certain aspects and expectations regarding the transaction and is not
More information270/271 Health Care Eligibility, Coverage, or Benefit Inquiry and Response
Companion Document 270/271 270/271 Health Care Eligibility, Coverage, or Benefit Inquiry and Response Basic Instructions This section provides information to help you prepare for the ANSI ASC X12.281 Eligibility,
More informationAnthem Blue Cross and Blue Shield. 834 Companion Guide
Anthem Blue Cross and Blue Shield 834 Companion Guide for ANSI ASC X12N 834 Benefit Enrollment and Maintenance Transactions Incoming to the Electronic Enrollment System (EES) Anthem Blue Cross and Blue
More informationAnthem Blue Cross and Blue Shield. 834 Enrollment Companion Guide. For. CERIDIAN / COBRA Enrollment
Anthem Blue Cross and Blue Shield 834 Enrollment Companion Guide For CERIDIAN / COBRA Enrollment Ceridian Companion Guide 1 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee
More informationStandard Companion Guide
HealthSmart Benefit Solutions, Inc. Standard Companion Guide Refers to the Implementation Guide Based on X12 Version 00X220A1 Benefit Enrollment and Maintenance () January 2012 Companion Guide Version
More informationAttachment-F FSCJ Current System Technical Specifications
Attachment-F FSCJ Current System Technical Specifications The College utilizes PeopleSoft HCM 9.2 for Benefits Administration. The below describes the process currently utilized that may potentially have
More informationWest Virginia HMO Rosters Companion Guide 834
West Virginia HMO Rosters Companion Guide 834 Version 1.8 Created Modified March 09, 2015 March 09, 2015 I TABLE OF CONTENTS Record of change... 3 Companion Guide Purpose... 3 Overview... 3 Scope... 4
More informationAdministrative Services of Kansas (ASK)
Administrative Services of Kansas (ASK) HIPAA 834 005010X220A1 Health and Dental Standard Companion Guide Refers to the Implementation Guides Based on ASC X12 version 005010 Last reviewed July 2018 1 Disclosure
More informationIntegration Guide for Data Originators of Claim Status. Version 1.1
Integration Guide for Data Originators of Claim Status Version 1.1 December 23, 2010 Integration Guide for Data Originators of Claim Status Revision History Date Version Description Author November 25,
More informationCareFirst BlueCross BlueShield CareFirst BlueChoice, Inc.
CareFirst BlueCross BlueShield CareFirst BlueChoice, Inc. 834 Benefit Enrollment and Maintenance Inbound and Outbound Companion Guide (Version 2) Reference Guidelines HIPAA X12 Implementation Guide (Version
More informationHIPAA 276/277 Companion Guide Cardinal Innovations Prepared for Health Care Providers
Cardinal Innovations Prepared for Health Care Providers, February 2017 Table of Contents Preface... 4 1. Transaction Instruction (TI) Introduction... 5 1.1 Scope... 5 1.2 Overview... 5 1.3 References...
More informationRefers to the Technical Reports Type 3 Based on ASC X12 version X /277 Health Care Claim Status Inquiry and Response
HIPAA Transaction Standard Companion Guide For Availity Health Information Network Users Refers to the Technical Reports Type 3 Based on ASC X12 version 005010X212 276/277 Health Care Claim Status Inquiry
More informationC:\EDIdEv\Examples\HIPAA\5010\VbNet\vbNet_Tran834X220A1\Form1.vb Imports Edidev.FrameworkEDI
Imports Edidev.FrameworkEDI 1 Public Class Form1 Private Sub btntranslate_click(byval sender As System.Object, ByVal e As System.EventArgs) Handles btntranslate.click Dim oedidoc As edidocument Dim oschemas
More informationStandardized Membership Eligibility Customized Companion Guide
Standardized Membership Eligibility Customized Companion Guide HEALTH CARE SERVICE CORPORATION (HCSC) 834 Companion Document BLUESTAR ASC X12N Benefit Enrollment and Maintenance Version 005010 Version
More information/277 Companion Guide. Refers to the Implementation Guides Based on X12 version Companion Guide Version Number: 1.1
5010 276/277 Companion Guide Refers to the Implementation Guides Based on X12 version 005010 Companion Guide Version Number: 1.1 November 26, 2012 1 Disclosure It is the sole responsibility of the provider/vendor
More informationSHARES 837P Companion Guide
SHARES 837P Companion Guide Contents Introduction... 2 SHARES 837 Guidelines... 2 SHARES Interchange Requirements... 2 Transaction Segment Delimiters and Terminators... 2 Claim Matching... 2 Service Line
More information837 Dental Health Care Claim
Companion Document 837D 837 Dental Health Care Claim Basic Instructions This section provides information to help you prepare for the ANSI ASC X12N 837 Health Care transaction for dental claims. The remaining
More information276/ /277 Health Care Claim Status Request and Response Real-Time. Basic Instructions. Companion Document
Companion Document 276/277 276/277 Health Care Claim Status Request and Response Real-Time Basic Instructions This section provides information to help you prepare for the ANSI ASC X12.316 Health Care
More informationHIPAA Transaction Standard Companion Guide. Refers to the Implementation Guides Based on ASC X12 version CORE v5010 Companion Guide
Gold Coast Health Plan CORE Companion Guide 270-271 HIPAA Transaction Standard Companion Guide Refers to the Implementation Guides Based on ASC X12 version 005010 CORE v5010 Companion Guide August 2018
More informationAlameda Alliance for Health
Alameda Alliance for Health HIPAA Transaction Standard Companion Guide Refers to the Implementation Guides Based on ASC X12 version 005010 CORE v5010 Companion Guide October 2015 October 2015 005010 Version
More informationANSI ASC X12N 837 Healthcare Claim (Version X222A1-June 2010) Professional Companion Guide
ANSI ASC X12N 837 Healthcare Claim (Version 005010X222A1-June 2010) Pruitt Health Premier Missouri Medicare Select Signature Advantage September 2015 TABLE OF CONTENTS AT A GLANCE II CHAPTER 1: INTRODUCTION
More informationFlorida Blue Health Plan
FLORIDA BLUE HEALTH PLAN COMPANION GUIDE Florida Blue Health Plan ANSI 276/277- Health Care Claim Status Inquiry and Response Standard Companion Guide Refers to the Technical Report Type Three () of 005010X212A1
More informationASC X X220A1)
HIPAA Transaction Standard EDI Companion Guide Benefit Enrollment and Maintenance (834) (Refers to the Implementation Guides based on ASC X12 005010X220A1) 2 Disclosure Statement: This Companion Guide
More informationUSVI HEALTH ELIGIBILITY/BENEFIT INQUIRY 5010 Companion Guide 270
USVI HEALTH ELIGIBILITY/BENEFIT INQUIRY 5010 Companion Guide 270 Date of Publication: 12/04/2012 Version: 1.1 DISCLAIMER The DXC Technology Companion Guide for USVI Medicaid is subject to change prior
More informationBLUE CROSS AND BLUE SHIELD OF LOUISIANA PROFESSIONAL CLAIMS COMPANION GUIDE
BLUE CROSS AND BLUE SHIELD OF LOUISIANA Table of Contents I. Introduction...3 II. General Specifications...4 III. Enveloping Specifications...5 IV. Loop and Data Element Specifications...7 V. Transaction
More informationFlorida Blue Health Plan
FLORIDA BLUE HEALTH PLAN COMPANION GUIDE Florida Blue Health Plan ANSI 270/271- Health Care Eligibility and Benefit Inquiry and Response Standard Companion Guide Refers to the Technical Report Type Three
More informationELECTRONIC ENROLLMENT GUIDE TO SENDING ELIGIBILITY FILES TO BML. Standard HIPAA 834V5010
ELECTONIC ENOLLMENT GUE TO ENDING ELIGIBILITY FILE TO BML tandard HIPAA 834V5010 DECIPTION DECIPTION IA 01 Authorization Info 00 No Auth Info IA 02 Authorization Info BLANK IA 03 ecurity Info Qualifer
More informationHIPAA X 12 Transaction Standards
HIPAA X 12 Transaction Standards Companion Guide 837 Professional/ Institutional Health Care Claim Version 5010 Trading Partner Companion Guide Information and Considerations 837P/837I June 11, 2012 Centene
More information< A symbol to indicate a value is less than another. For example, 2 < 3. This symbol is used in some BCBSNC proprietary error messages.
Glossary < A symbol to indicate a value is less than another. For example, 2 < 3. This symbol is used in some BCBSNC proprietary error messages. > A symbol to indicate a value is greater than another.
More informationHIPAA X 12 Transaction Standards
HIPAA X 12 Transaction Standards Companion Guide 837 Professional/ Institutional Health Care Claim Version 5010 Trading Partner Companion Guide Information and Considerations 837P/837I September 19, 2014
More informationBLUE CROSS AND BLUE SHIELD OF LOUISIANA INSTITUTIONAL CLAIMS COMPANION GUIDE
BLUE CROSS AND BLUE SHIELD OF LOUISIANA Table of Contents I. Introduction...3 II. General Specifications...4 III. Enveloping Specifications...5 IV. Loop and Data Element Specifications...7 V. Transaction
More informationMedical Associates Health Plans and Health Choices
Medical Associates Health Plans and Health Choices 270/271 HIPAA Transaction Companion Guide HIPAA V5010X279A1 VERSION: 2.0 DATE: 06/21/2016 1 Disclosure Statement This material contains confidential,
More informationElectronic Transaction Manual for Arkansas Blue Cross and Blue Shield FEDERALEMPLOYEEPROGRAM (FEP) DentalClaims
Electronic Transaction Manual for Arkansas Blue Cross and Blue Shield FEDERALEMPLOYEEPROGRAM (FEP) DentalClaims HIPAA Transaction Companion Document Guide Refers to the X12N Implementation Guide: 005010X224A2:
More informationHIPAA Transaction Health Care Claim Acknowledgement Standard Companion Guide (277CA, X214)
(underwritten by Dean Health Plan) HIPAA Transaction Health Care Claim Acknowledgement Standard Companion Guide (277CA, 005010X214) Instructions related to Transactions based on ASC X12 Implementation
More informationRefers to the Technical Reports Type 3 Based on ASC X12 version X223A2
HIPAA Transaction Standard Companion Guide For Availity Health Information Network Users Refers to the Technical Reports Type 3 Based on ASC X12 version 005010X223A2 837 Health Care Claim Institutional
More information834 Companion Document to the 5010 HIPAA Implementation Guide
Published: 1/3/2012 Updated: 12/15/2014 834 Companion Document to the 5010 HIPAA Implementation Guide Version 3.00.00 Virtual Benefits Administrator Companion Document Audience Companion documents are
More informationIt is recommended that separate transaction sets be used for different patients.
ASC X12N 278 (004010X094A1) Health Care Services Request For Review And Response Companion Guide Notes The ISA segment terminator, which immediately follows the component element separator, must consist
More informationWest Virginia HEALTH ELIGIBILITY/BENEFIT INQUIRY Companion Guide 270
West Virginia HEALTH ELIGIBILITY/BENEFIT INQUIRY Companion Guide 270 Date of Publication: 01/01/2014 Document Number: Version: 2.0 DISCLAIMER The Molina Healthcare Companion Guide for West Virginia is
More informationElectronic Enrollment User Guide MAKING ELECTRONIC ENROLLMENT EFFICIENT AND EASY ERC
Electronic Enrollment User Guide MAKING ELECTRONIC ENROLLMENT EFFICIENT AND EASY ERC-0198-0817 Contents Purpose 3 Key Terms 3 Enrollment File Formats 4 Enrollment File Types 4 Enrollment File Record Requirements
More information837 Health Care Claim Professional, Institutional & Dental Companion Guide
837 Health Care Claim Professional, Institutional & Dental Companion Guide 005010X222A1 & 005010X223A1 V. 1.2 Created 07/18/14 Disclaimer Blue Cross of Idaho created this companion guide for 837 healthcare
More information270/271 Benefit Eligibility Inquiry/Response Transactions Companion Guide ANSI ASC X12N 270/271 (Version 4010A)
270/271 Benefit Eligibility Inquiry/Response Transactions ANSI ASC X12N 270/271 (Version 4010A) State of Washington Department of Social & Health Services Prepared by: CNSI 3000 Pacific Avenue S.E. Suite
More information837 Health Care Claim Companion Guide. Professional and Institutional
837 Health Care Claim Companion Guide Professional and Institutional Revised December 2011 Table of Contents Introduction... 3 Purpose... 3 References... 3 Additional information... 4 Delimiters Supported...
More informationStandard Companion Guide
Standard Companion Guide Refers to the Implementation Guide Based on X12 Version 005010X224A2 Health Care Claim Dental (837D) Companion Guide Version Number 2.0 September 25, 2018 Page 1 of 15 CHANGE LOG
More informationHIPAA Transaction 278 Request for Review and Response Standard Companion Guide
FLORIDA BLUE HEALTH PLAN COMPANION GUIDE HIPAA Transaction 278 Request for Review and Response Standard Companion Guide Refers to the Technical Reports Type 3 Based on ASC X12 version 005010X217 Companion
More informationVendor Specifications 270/271 Eligibility Benefit Inquiry and Response ASC X12N Version for. State of Idaho MMIS
Vendor Specifications 270/271 Eligibility Benefit Inquiry and Response ASC X12N Version 5010 for State of Idaho MMIS Date of Publication: 7/27/2017 Document : TL419 Version: 8.0 Revision History Version
More informationIt is recommended not to exceed 99 patient requests per Information Receiver Loop (2000B).
ASC X12N 270/271 (004010X092A1) Health Care Eligibility Benefit Inquiry and Response Companion Guide Notes The ISA segment terminator, which immediately follows the component element separator, must consist
More informationUnsolicited 277 Trading Partner Specification
Unsolicited 277 Trading Partner Specification Revision Summary: Revision Date Summary of Changes Number 1.0 3/20/2007 NPI changes in loop 2100C AmeriHealth U277 Unsolicited Health Care Claim Status Notification
More informationAdministrative Services of Kansas (ASK)
Administrative Services of Kansas (ASK) HIPAA 276/277 005010X212 Standard Companion Guide Refers to the Implementation Guides Based on ASC X12 version 005010 January 2016 1 Disclosure Statement This document
More information837 Healthcare Claim Companion Guide ANSI ASC X12N (Version 4010A) Professional, Institutional, and Dental
837 Healthcare Claim Companion Guide ANSI ASC X12N (Version 4010A) Professional, Institutional, and Dental State of Washington Department of Social & Health Services Prepared by: CNSI 3000 Pacific Avenue
More informationAssurant Health HIPAA Transaction Standard Companion Guide
Assurant Health HIPAA Transaction Standard Companion Guide Refers to the Implementation Guides Based on ASC X12 version 005010 270/271 Health Care Eligibility Benefit Inquiry and Response CORE v5010 Master
More information837 Companion Guide. October PR.P.WM.1 3/17
837 Companion Guide Refers to the Implementation Guides based on the HIPAA Transaction ASC X12N. Standards for Electronic Data Interchange X12N/005010x222 Health Care Claim: Professional (837P) and ASC
More informationPartnership HealthPlan of California
Partnership HealthPlan of California HIPAA Transaction Companion Guide CORE: 276/277 Health Care Claim Status Request and Response ASC X12 version 005010 Disclosure Statement This document is subject to
More informationBlue Cross Blue Shield of Louisiana
Blue Cross Blue Shield of Louisiana Health Care Claim Payment/Advice (835) Standard Companion Guide Refers to the Implementation Guides Based on ASC X12N version: 005010X221A1 October 1, 2013 Version 1.0
More informationDentaQuest HIPAA Transaction Standard Companion Guide
DentaQuest HIPAA Transaction Standard Companion Guide 837D 005010X224A2 Version 1.0 January 2016 January 18, 2016 1 Disclosure Statement 2015 DentaQuest, LLC. All rights reserved. This document may be
More information835 Health Care Claim Payment and Remittance Advice Companion Guide X091A1
835 Health Care Claim Payment and Remittance Advice Companion Guide 004010 X091A1 Version 1.3 March 1, 2008 1-March-2008 TABLE OF CONTENTS 1 Introduction... 1 1.1 Purpose... 1 2 Transmission and Data Retrieval
More informationC:\EDIdEv\Examples\HIPAA\5010\VbNet\vbNet_Gen834X220A1\Form1.vb Imports Edidev.FrameworkEDI
Imports Edidev.FrameworkEDI 1 Public Class Form1 Private Sub btngenerate_click(byval sender As System.Object, ByVal e As System.EventArgs) Handles btngenerate.click Dim oedidoc As edidocument Dim oschemas
More informationCabinet for Health and Family Services Department for Medicaid Services
KyHealth Choices 277 Health Care Payer Unsolicited Claim Status (ASC X12N 277) Companion Guide Version 2.3 Version 003070 Cabinet for Health and Family Services Department for Medicaid Services August
More informationStandard Companion Guide. Refers to the Implementation Guide Based on X12 Version X212 Health Care Claim Status Request and Response (276/277)
Standard Companion Guide Refers to the Implementation Guide Based on X12 Version 005010X212 Health Care Claim Status Request and Response (276/277) Companion Guide Version Number 4.0 June 12, 2018 Change
More informationMaryland Health Insurance Exchange (MHBE) Standard Companion Guide Transaction Information
A service of the Maryland Health Benefit Exchange Maryland Health Insurance Exchange (MHBE) Standard Companion Guide Transaction Information 999 Implementation Acknowledgments for Health Care Insurance
More informationCompanion Guide Benefit Enrollment and Maintenance 834
Companion Guide Benefit Enrollment and Maintenance 834 Private Exchanges X12N 834 (Version 5010) X12N 834 (Version 5010)Healthcare Services Review Benefit Enrollment and Maintenance Implementation Guide
More informationX A1 ADDENDA COMPANION DOCUMENT PROFESSIONAL (004010X098A1)
X12 837 4010A1 ADDENDA COMPANION DOCUMENT PROFESSIONAL (004010X098A1) Updated February 2006 Submission of the National Provider Identifier (NPI) IN ADDITION to the Empire assigned provider Number (EPIN)
More informationEMBLEMHEALTH HIPAA Transaction Standard Companion Guide
EMBLEMHEALTH HIPAA Transaction Standard Companion Guide Refers to the X12N Implementation Guide 005010X222A1: 837P Health Care Claim Professional Transaction HIPAA Readiness Disclosure Statement The Health
More informationSpecialty Benefits Dental. Standard Companion Guide
Specialty Benefits Dental Standard Companion Guide Refers to the Technical Report Type 3 (TR3) (Implementation Guide) Based on X12N (Version 005010X220A1) Companion Guide Version [EDI - 834] Benefit Enrollment
More information837 Professional Health Care Claim
Section 2A 837 Professional Health Care Claim Basic Instructions This section provides information to help you prepare for the ANSI ASC X12N 837 Health Care transaction for professional claims. The tables
More informationKentucky HIPAA HEALTH CARE PAYER UNSOLICITED CLAIM STATUS Companion Guide Unsolicited 277. Version 1.1
Kentucky HIPAA HEALTH CARE PAYER UNSOLICITED CLAIM STATUS Companion Guide Unsolicited 277 Version 1.1 Released August 4, 2004 RECORD OF CHANGE VERSION NUMBER DATE REVISED DESCRIPTION OF CHANGE PERSONS
More information276 Health Care Claim Status Request Educational Guide
276 Health Care Claim Status Request Educational Guide June 2010 - Version 1.1 Disclaimer INGENIX is still under development stages and frequent changes within this document are expected. This documentation
More informationHealth Care Claims: Status Request and Response (Version 1.12 January 2007)
PacifiCare Electronic Data Interchange 276/277 Transaction Companion Guide Health Care Claims: Status Request and Response (Version 1.12 January 2007) 276/277 ANSI ASC X12 276/277 (004010X093) ANSI ASC
More informationMississippi Medicaid Companion Guide to the X279A1 Benefit Inquiry and Response Conduent EDI Solutions, Inc. ANSI ASC X12N 270/271
Mississippi Medicaid Companion Guide to the 005010X279A1 Benefit Inquiry and Response Conduent EDI Solutions, Inc. ANSI ASC X12N 270/271 OCT 2017 TABLE OF CONTENTS AT A GLANCE II CHAPTER 1: INTRODUCTION
More information276/277 Health Care Claim Status Request/ Response Real-Time. Section 1 276/277 Claim Status Request/Response: Basic Instructions
Companion Document 276/277 276/277 Health Care Claim Status Request/ Response Real-Time This companion document is for informational purposes only to describe certain aspects and expectations regarding
More informationExpress permission to use X12 copyrighted materials within this document has been granted.
837 Companion Guide Refers to the Implementation Guides based on the HIPAA Transaction ASC X12N. Standards for Electronic Data Interchange X12N/005010x222 Health Care Claim: Professional (837P) and ASC
More informationBlue Cross and Blue Shield of Kansas BCBSKS Proprietary 834 Acknowledgment HIPAA X220A1Health Care Benefits Enrollment and Maintenance
Blue Cross and Blue Shield of Kansas BCBSKS Proprietary 834 Acknowledgment HIPAA 834 51X22A1Health Care Benefits Enrollment and Maintenance 7/1/217 The BCBSKS Proprietary 834 Acknowledgement was created
More information837 PROFESSIONAL CLAIMS AND ENCOUNTERS TRANSACTION COMPANION GUIDE
837 PROFESSIONAL CLAIMS AND ENCOUNTERS TRANSACTION COMPANION GUIDE OCTOBER 19, 2012 A S C X 1 2 N 8 3 7 (0 0 5 0 10 X 222A1) VERSION 3.0 TABLE OF CONTENTS 1.0 Overview 3 2.0 Introduction 4 3.0 Data Exchange
More informationKentucky HIPAA HEALTH CARE CLAIM: DENTAL Companion Guide 837
Kentucky HIPAA HEALTH CARE CLAIM: DENTAL Companion Guide 837 Version 1.4 Final RECORD OF CHANGE VERSION NUMBER DATE REVISED DESCRIPTION OF CHANGE PERSONS INVOLVED 1.0 10/25/02 Creation and first view by
More informationBlue Cross Blue Shield of Delaware
Highmark Standard Companion Guide Blue Cross Blue Shield of Delaware Instructions related to Employer/Sponsor Transactions based on ASC X12 Implementation Guides, version 005010 Companion Guide Version
More information837 Superior Companion Guide
837 Superior Companion Guide Refers to the Implementation Guides based on the HIPAA Transaction ASC X12N. Standards for Electronic Data Interchange X12N/005010x222 Health Care Claim: Professional (837P)
More informationEMBLEMHEALTH. HIPAA Transaction Standard Companion Guide
EMBLEMHEALTH HIPAA Transaction Standard Companion Guide Refers to the X12N Implementation Guide 005010X220A1: 834 Benefit Enrollment and Maintenance Transactions EMBLEMHEALTH COMPANION GUIDE HIPAA Readiness
More informationPresbyterian Enrollment Standard Flat File (SFF) Layout Specification Version 1.7
Presbyterian Enrollment Standard Flat File (SFF) Layout Specification Version 1.7 1 Specification Overview: PHP Enrollment Standard Flat File Layout (SFF) Specification The goal of this standard flat file
More informationInland Empire Health Plan
Inland Empire Health Plan HIPAA Transaction Standard Companion Guide Refers to the Implementation Guides Based on ASC X12 version 005010 CORE v5010 Companion Guide March 2016 March 2016 005010 Version
More informationStreamline SmartCare Network180 EHR
Last modified 8/28/2016 Network180-Streamline837CompanionGuide20160818.doc Page 1 of 8 Streamline SmartCare Network180 EH HIPAA 837 Companion Guide for Direct Submitters (V 1.0 Updated 08/28/2016) Last
More information278 Health Care Service Review and Response
278 Health Care Service Review and Response Overview 2 Blue Card Inquiries (Blue Exchange) 2 Health Care Services Review Processing 2 Frequency of Data Exchange 2 Acknowledgements 2 Data Retention 3 Batch
More informationElectronic Transaction Manual for Arkansas Blue Cross Blue Shield
Electronic Transaction Manual for Arkansas Blue Cross Blue Shield HIPAA Transaction Companion Document Guide Refers to the X12N Implementation Guides: 004010X092A1: (270/271) Health Care Eligibility Benefit
More informationX A1 Addenda Companion Document - Institutional (004010X096A1) - EFFECTIVE 05/23/07
Companion Document 837I++ X12 837 4010A1 Addenda Companion Document - Institutional (004010X096A1) - EFFECTIVE 05/23/07 Introduction The Federal Department of Health and Human Services has adopted regulations,
More informationStandard Companion Guide
Response (278) Standard Companion Guide Refers to the Implementation Guides Based on X12 version 005010X217E2 Health Care Services Review Request for Review and Companion Guide Version Number: 2.0 October
More information276/277 Claim Status Request and Response
276/277 Claim Status Request and Response 276 & 277 Health Care Claim Status Request and Response 2 Overview 2 Connectivity Transmission Options 2 System Availability 3 Frequency of Data Exchange 3 Claim
More information276/277 Health Care Claim Status Request/ Response Real-Time. Section 1 276/277 Claim Status Request/Response: Basic Instructions
Companion Document 276/277 276/277 Health Care Claim Status Request/ Response Real-Time This companion document is for informational purposes only to describe certain aspects and expectations regarding
More informationBlue Shield of California
Blue Shield of California HIPAA Transaction Standard Companion Guide Section 1 Refers to the Implementation Guides Based on X12 version 005010 Companion Guide Version Number: 1.0 June 6,2011 [OCTOBER 2010
More informationStandard Companion Guide
Standard Companion Guide Refers to the Implementation Guide Based on X12 Version 005010X212 Health Care Claim Status Request and Response (276/277) Companion Guide Version Number 3.0 September 28, 2018
More informationX A1 Addenda Companion Document - Professional (004010X098A1) - EFFECTIVE 05/23/07
Companion Document 837I++ X12 837 4010A1 Addenda Companion Document - Professional (004010X098A1) - EFFECTIVE 05/23/07 Introduction The Federal Department of Health and Human Services has adopted regulations,
More information270/271 Companion Document ASC X12N. Health Care Eligibility and Benefit Inquiry and Response Version 4010A1 Addenda October 2002
Purpose of This Document 270/271 Companion Document ASC N Health Care Eligibility and Benefit Inquiry and Response Version 4010A1 Addenda October 2002 This companion guide has been written to assist those
More informationX A1 ADDENDA COMPANION DOCUMENT INSTITUTIONAL (004010X096A1)
X12 837 4010A1 ADDENDA COMPANION DOCUMENT INSTITUTIONAL (004010X096A1) Updated February 2006 Submission of the National Provider Identifier (NPI) IN ADDITION to the Empire assigned provider number (EPIN)
More informationCOMMONWEALTH CARE ALLIANCE CCA COMPANION GUIDE
COMMONWEALTH CARE ALLIANCE CCA 5010 837 COMPANION GUIDE PREFACE This Companion Guide is v5010 and ASC X12N compatible and adopted under HIPAA clarifies and specifies the data content when exchanging electronically
More informationHIPAA X 12 Transaction Standards
HIPAA X 12 Transaction Standards Companion Guide 837 Professional/ Institutional Health Care Claim Version 5010 Trading Partner Companion Guide Information and Considerations 837P/837I March 1, 2012 Centene
More information834 Benefit Enrollment and Maintenance Companion Guide ANSI ASC X12N (Version 4010A1) State of Washington Department of Social & Health Services
834 Benefit and ANSI ASC X12N (Version 4010A1) State of Washington Department of Social & Health Services Prepared by: CNSI 3000 Pacific Avenue S.E. Suite 200 Olympia, Washington 98501 April 16, 2009 834
More informationEligibility Gateway Companion Guide
Eligibility Gateway Companion Guide Conduent EDI Solutions, Inc. ASC X12N 270/271 ASC X12N 276/277 All Payers May 10, 2017 2017 Conduent Business Services, LLC. All rights reserved. Conduent and Conduent
More informationOverview. Express permission to use X12 copyrighted materials within this document has been granted.
837 Companion Guide Refers to the Implementation Guides based on the HIPAA Transaction ASC X12N. Standards for Electronic Data Interchange X12N/005010x222 Health Care Claim: Professional (837P) and ASC
More informationGuide to the X214 Claim Acknowledgement Conduent EDI Solutions, Inc.
Mississippi Medicaid Companion Guide to the 005010X214 Claim Acknowledgement Conduent EDI Solutions, Inc. ANSI ASC X12N 277CA October 2017 TABLE OF CONTENTS AT A GLANCE II CHAPTER 1: INTRODUCTION 3 Audience
More information270/271 Eligibility Inquiry/Response
270/271 Eligibility Inquiry/Response Overview... 1 Connectivity Transmission Options... 1 System Availability... 2 BlueCard and Federal Employee (FEP) Inquiries... 2 Eligibility Inquiry Processing... 2
More informationHIPAA X 12 Transaction Standards
HIPAA X 12 Transaction Standards Abbreviated Companion Guide 837 Institutional Health Care Claim Version 004010X096A1 Trading Partner Companion Guide Information and Considerations 837I 1. General Transaction
More information