Anthem 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 of the ANTHEM is a

CERIDIAN / COBRA Enrollment - EDI 834 Companion Document ANSI Version 4010 - IG LOOP ID SEG ID ELEMENT ID ELEMENT VALUES ELEMENT DESCRIPTION REQ (/O/C/S) ISA 01 Authorization Info Qualifier 00 = No Authorization Info 00 Present ISA 02 Authorization Information Blank ISA 03 Security Information 00 00 Qualifier ISA 04 Security Information Blank ISA 05 Interchange ID Qualifier 01 = Duns ZZ ISA 06 Interchange Sender ID VA00002E ISA 07 Interchange ID Qualifier ZZ ISA 08 Interchange Receiver ID VAWKMEMFUL ISA 09 Interchange Date Date format MMDD ISA 10 Interchange Time Time format HHMM ISA 11 Interchange Control U = U.S. EDI U Standards ID ISA 12 Interchange Control Version 00401 00401 Number ISA 13 Interchange Control Number Created by Sender Must be identical to IEA02 ISA 14 Acknowledgment 0 = No Acknowledgment 1 Requested Requested 1 = Acknowledgment Request ISA 15 Usage Indicator P = Production T = Test ISA 16 Component Element 7E ( ~ ) Separator GS 01 Functional ID Code BE = Benefit Enrollment BE and Maintenance (834) GS 02 Sender s Code VA00002E GS 03 Receiver s Code VAWKMEMFUL GS 04 Date Date format CCMMDD GS 05 Time Time format HHMM GS 06 Group Control Number Created by Sender Must be identical to GE02 GS 07 Responsible Agency Code X = Accredited Standards X Committee X12 GS 08 Version/Release Code 004010X095A1 HIPAA Compliant Version BGN 01- Transaction Set Purpose Code 00 = Original 00 = Original BGN 02- Reference Number COBRASERV BGN 03- Date Date 834 created CCMMDD BGN 04- Time Time 834 created HHMM BGN 08- Action Code 4 = Verify 4 = Full Population Audit 1000A N1 01- Entity Identifier Code P5 = Plan Sponsor N1 02- Name CERIDIAN N1 03- Identification Code Qualifier FI = Federal Tax ID N1 04- Identification Code 411981625 1000B N1 01- Entity Identifier Code IN = Insurer N1 02- Name ANTHEM HEALTH PLANS OF VIRGINIA INC Ceridian Companion Guide 2 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

N1 03- Identification Code Qualifier FI = Federal Tax ID N1 04- Identification Code 54-0357120 Ceridian Companion Guide 3 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

LOOP ID SEG ID ELEMENT ID 2000 INS 01- es/no Condition = es N = No INS 02- Individual Relationship Code ELEMENT VALUES 01 = Spouse 17 = Stepchild 18 = Self 19 = Child/Dependent 53 = Life Partner ELEMENT DESCRIPTION = Subscriber N = Dependent Relationship REQ (/O/C/S) INS 03- Maintenance Type Code 030 = Audit or Compare 030 = Full Population Audit INS 04- Maintenance Reason Code XN = Notification Only INS 05 Benefit Status Code C = COBRA Benefit Status Code S INS 07- COBRA Qualifying Event 1 = Termination COBRA Qualifying Event Code S 2 = Reduction in Hours 3 = Medicare 4 = Death 5 = Divorce 7 = Ineligible Child 8 = Bankruptcy of a Retired Employee INS 08 Employment Status Code FT = Active on COBRA TE = Terminated FT = Active on COBRA TE = Terminated INS 09 Student Status Code F = Full-time N = Not a Student P = Part-time INS 10 Handicap Indicator N = No = es REF 01- Reference Number Qualifier 0F = Subscriber Number 17 = Client Reporting Category DX = Department/Agency Number Q4 = Prior Id Number ZZ = Mutually Defined F = Full-time N = Not a Student P = Part-time N = No = es 0F = Subscriber SSN 17 = Division Code DX = Unit Code Q4 = Employee SSN ZZ = Ceridian Cancel Code REF 02- Reference Number Primary Subscriber s SSN Division Code Unit Code Employee SSN (if primary subscriber is a dependent) 2000 DTP 01 Date/Time Qualifier 301 = COBRA QE Date 357 = Eligibility End Date 340 = COBRA Begin Date 341 = COBRA End Date DTP 02 Date/Time Format D8 = CCMMDD Qualifier 301 = COBRA Qualifying Event 357 = Eligibility End Date 340 = COBRA Begin Date 341 = COBRA End Date DTP 03 Date/Time Period COBRA QE Date Eligibility End Date COBRA Begin Date COBRA End Date S S O O O O O O O S O S Ceridian Companion Guide 4 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

LOOP ID SEG ID ELEMENT ID ELEMENT VALUES ELEMENT DESCRIPTION REQ (/O/C/S) 2100A NM1 01- Entity Identifier Code IL = Insured or Subscriber IL = Insured or Subscriber NM1 02- Entity Type Qualifier 1 = Person NM1 03- Name Last Last Name NM1 04- Name First First Name NM1 05- Name Middle Middle Name or Initial O NM1 08- Identification Code 34 = SSN Qualifier NM1 09 Identification Code Member s SSN N3 01- Address Line 1 Address Line 1 S N3 02- Address Line 2 Address Line 2 S N4 01- City City S N4 02- State State S N4 03- Zip Zip + 4 S N4 04 Country Code Country Code (If other than US) S DMG 01- Date/Time Format Qualifier D8 = CCMMDD DMG 02- Date/Time Period Date of Birth DMG 03- Gender Code M = Male Gender F = Female 2300 HD 01- Maintenance Type Code 030 = Audit or Compare Maintenance Type Code 024 = Termination HD 03- Insurance Line Code DEN = Dental Insurance Line Code HLT = Health HD 04- Plan Coverage Description HD 05- Coverage Level Code IND = Individual FAM = Family E1D = Employee + 1 ECH = Emp + Children ESP = Emp + Spouse Coverage Code DTP 01- Date/Time Qualifier 348 = Begin 349 = End 543 = Last Premium Paid DTP 02- Date/Time Format D8 = CCMMDD Qualifier Benefits Begin Date Benefits End Date Last Premium Paid Date DTP 03- Date/Time Period Benefits Begin Date Benefits End Date Last Premium Paid Date REF 01- Reference Identification 1L = Group or Policy Qualifier Number REF 02- Reference Identification Group or Policy Number C O O C Ceridian Companion Guide 5 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Requirement Legend: = es, always sent on all records. O = Optional, sent when relative to the record. C = Carrier specific, sent to carrier when applicable. S = Subscriber, always sent on subscriber record. BGN Segment Element Descriptions BGN 01 Transaction Set Purpose Code 00 = Original BGN 02 Reference Number Sender Organization name. BGN 03 Date File creation date. Format CCMMDD BGN 04 Time File creation time. Format HHMM BGN 08 Action Code 4 = Verify Loop 1000A N1 01 Entity Identifier Code P5 = Plan Sponsor N1 02 Name (Required by N1 01) Client s Name N1 03 Identification Code Qualifier FI = Federal Tax ID Number N1 04 Identification Code Client s Federal Tax ID Number Ceridian Companion Guide 6 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Loop 1000B N1 01 Entity Identifier Code IN = Insurer N1 02 Name (Required by N101) Carrier s Name N1 03 Identification Code Qualifier FI = Federal Tax ID Number N1 04 Identification Code Carrier s Federal Tax ID Number Loop 2000 INS 01 es/no condition Used to indicate Subscriber vs. Dependent. = Subscriber N = Dependent. INS 02 Individual Relationship Code Used to identify relationship 01 = Spouse 17 = Stepson or Stepdaughter 18 = Self 19 = Child / Dependent 53 = Life Partner INS 03 Maintenance Type Code 030 = Audit or Compare INS 05 Benefit Status Code Used to identify COBRA Coverage C = COBRA (Sent on subscriber record) INS 07 COBRA Qualifying Event (Sent on subscriber record) Identifies the Qualifying Event which resulted in the loss of coverage 1 = Termination 2 = Reduction in Work Hours 3 = Medicare 4 = Death 5 = Divorce 7 = Ineligible Child 8 = Bankruptcy of a Retired Employee INS 08 Employment Status Code FT = Active on COBRA TE = Terminated (Sent on subscriber record) INS 09 Student Status Code (Sent on dependent record) Ceridian Companion Guide 7 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

F = Full-time N = Not on record P = Part-time Ceridian Companion Guide 8 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Loop 2000 INS 10 Handicap Indicator N = No = es REF 01 Reference Number Qualifier Used to indicate type of value contained in REF 02 0F Subscriber SSN 17 Division Code DX Unit Code Q4 Employee SSN ZZ Ceridian Cancel Code (Sent on dependent record) (Sent on relative records) REF 02 Reference Number (Sent on relative records) Subscriber SSN Sent on all records. Will be used to tie Dependents and Subscribers Division Code Sent only on the subscriber records if applicable Unit Code Sent only on the subscriber record if applicable Employee SSN Sent only on the subscriber record when the COBRA subscriber is a dependent of the Employee DTP 01 Date/ Time Qualifier Used to indicate type of date being sent. 301 = Date that the COBRA Qualifying Event occurred 357 = Eligibility End Date 340 = COBRA Begin Date 341 = COBRA End Date DTP 02 Date and Time Format D8 = CCMMDD DTP 03 Date/Time Period COBRA Qualifying Event Date Eligibility End Date COBRA Begin Date COBRA End Date (Sent on subscriber record) (Sent if DTP 01 is sent) (Sent on subscriber record) Loop 2100A NM1 01 Entity ID Code IL = Insured or Subscriber NM1 02 Entity Type Qualifier 1 = Person NM1 03 Last Name (Always Sent) Ceridian Companion Guide 9 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Last name of the individual NM1 04 First Name First name of the individual (Always Sent) Ceridian Companion Guide 10 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Loop 2100A NM1 05 Middle Name or Initial Middle name or initial of the individual NM1 08 Identification Code Qualifier 34 = SSN NM1 09 Identification Code Member s SSN PER 01 Contact Function Code IP = Insured Party N3 01 Address Line 1 N3 02 Address Line 2 N4 01 City N4 02 State N4 03 Zip N4 04 Country Code (Only used if member resides outside of US) DMG 01 Date/Time Format Qualifier D8 = CCMMDD DMG 02 Date/Time Period Date of Birth of Individual (Sent if on file) (Always Sent) (Always Sent) (Sent if on file) (Sent if on file) (Sent on subscriber record) (Always Sent) (Always Sent) DMG 03 Gender Code M = Male F = Female (Always Sent) Loop 2300 HD 01 Maintenance Type Code Indicates type of transaction. 030 = Audit or Compare 024 = Termination HD 03 Insurance Line Code Used to indicate type of insurance product. DEN = Dental HLT = Health HD 04 Plan Coverage Description Used to identify the exact type of coverage (Always sent if HD loop is sent) (Always sent if HD loop is sent) (Always sent if HD loop is sent) Ceridian Companion Guide 11 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Loop 2300 HD 05 Coverage Level Code Used to indicate coverage level. IND = Individual FAM = Family E1D = Employee + 1 ECH = Employee + Child(ren) ESP = Employee + Spouse DTP 01 Date/ Time Qualifier Used to indicate type of date being sent. 348 = Begin 349 = End 543 = Last Premium Paid Date DTP 02 Date and Time Format D8 = CCMMDD (Always sent if HD loop is sent) (Sent if DTP 03 is sent) (Sent if DTP 01 is sent) DTP 03 Date/Time Period 348 Benefits Begin Date (Always sent if HD loop is sent) 349 Benefits End Date (Sent on termination of coverage) 543 Last Premium Paid Date REF 01 Reference Identification Qualifier 1L = Group or Policy Number REF 02 Reference Identification Group or Policy Number Ceridian Companion Guide 12 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Additional notes on the EDI feed: (1) In all cases, the SSN field (NM1-08 = '34', NM1-09 = SSN) will represent SSN of the individual. The linkage to the subscriber SSN is via the REF-01 in the 2000 Loop 0F (Subscriber s SSN). (2) It is possible the dependent SSN will not be on file. If value has been previously supplied it will be sent. (3) Dates will be sent in the CCMMDD format for all fields. (4) The Element Separator used is the "*" asterisk character ASCII Hex value "2A" The Sub Element Separator used is the ">" greater than character ASCII Hex value "3E" The Segment Terminator used is the " ~" caret character ASCII Hex value "7E Ceridian Companion Guide 13 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Acknowledgments and Reports The best way to promote timely account reconciliation is to work your reports consistently. Work reports each day to reconcile. Correct and electronically resubmit file with errors. Our reports are your receipt that we either accepted your enrollment file for processing or rejected it due to errors. This section provides information about acknowledgments and reports that you may receive from Anthem Blue Cross and Blue Shield (Anthem). These reports include the following: Reject Report Indicates the ISA/IEA or GS/GE segments failed basic syntax. ou receive the Reject Report only if we detect related errors. TA1 Interchange Acknowledgment (TA1) Indicates invalid data within the ISA/IEA or GS/GE segments. ou will receive a TA1 only if we detect related errors. 997 Functional Acknowledgment Confirms receipt of your file and reports Level 1 errors (checking for correct syntax according to X12 Control and Transaction standards). Level 2 Status Report Provides results from Level 2 editing, which checks for code set and X12N structure compliance. Activity Log shows your transmission history. Alert Messages we send Alert Messages as needed. They contain information such as EDI system modifications, helpful submission tips, electronic issue alerts, and Anthem communications. It is imperative that you review Alert Messages; they often require important action from you. We send reports to the trading partner who sent the corresponding transaction. The X12N Implementation Guides (IGs) provide information on the 997 Functional Acknowledgment. Please adhere to the instructions explained in both the IGs and this document. The Reject Report, Level 2 Status Report, and Activity Report are Anthem proprietary reports with complete instructions within this section. Ceridian Companion Guide 14 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Reject Report When you send an X12N interchange to Anthem, we check the Interchange Control (ISA/IEA) and Functional Group (GS/GE) header and trailer segments to ensure they are addressed and formatted according to the IGs and our enveloping instructions. If we detect basic syntax errors in the ISA/IEA or GS/GE, we send a Reject Report to indicate the rejection of an ISA/IEA and GS/GE and all of the files within your interchange. If you receive a Reject Report, your interchange stopped before going to our processing system. Use the Reject Report to identify and correct the interchange in error. When Does Anthem Send the Reject Report? We send the Reject Report if the ISA/IEA or GS/GE segments contain basic syntax errors such as mixed delimiters or a wrong data element or segment length. Reject Report Delivery Schedule We send the Reject Report daily, often within two to three hours of interchange receipt. If a holiday schedule necessitates a delivery time change, we send an Alert Message to communicate the change. We send the Reject Report only if we detect basic syntax errors in the envelope (ISA/IEA) If there are no ISA/IEA syntax errors, you will not receive this report. What to Do if ou Receive a Reject Report If you receive a Reject Report, your interchange had basic syntax errors in the ISA/IEA or GS/GE segments and it stopped before going to Anthem processing. Upon receiving a Reject Report, you should take the following steps: 1. Read the Reject Report to determine the error. Identify the interchange in error. Locate the ISA/IEA or GS/GE data element in error and identify the specific error. 2. Correct the data element(s) in error. 3. Send the corrected interchange. Ceridian Companion Guide 15 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

TA1 Interchange Acknowledgment After an interchange passes ISA/IEA and GS/GE syntax, we check data within ISA/IEA and GS/GE segments. If we detect errors within these segments, we send the TA1 Interchange Acknowledgment indicating the rejection of the ISA/IEA or GS/GE and all of the files within the interchange. We send this report within the 864 Text Message wrapper. The title in the 864 segment MIT02 (Description) is TA1 REPORT. In addition to the TA1 wrapped in the 864, we also send the TA1 that follows the format described in the Implementation Guides, Appendix B. See the IG for additional information. Note: The X12 version of the TA1 (not wrapped in 864) identifies syntactical errors in the ISA/IEA only. The wrapped TA1 identifies syntactical and other errors. We send theta1 only if we detect related errors. If you receive a TA1, your interchange stopped before going to our processing system. When Does Anthem Send the TA1? We send the TA1 if data within the ISA/IEA and GS/GE segments includes errors. Example of an error that trigger a TA1 include: Blank ISA06 (Interchange Sender ID), ISA08 (Interchange Receiver ID), GS02 (Application Sender s Code), or GS03 (Application Receiver s Code) segments Note: The X12 version of the TA1 (not wrapped in 864) identifies syntactical errors in the ISA/IEA only. The wrapped TA1 identifies syntactical and other errors. TA1 Delivery Schedule What to Do if ou Receive a TA1 We send the TA1 daily, often within two to three hours of interchange receipt. If a holiday schedule necessitates a delivery time change, we send an Alert Message to communicate the change. We send the TA1 only if we detect errors within the ISA/IEA and GS/GE data. If there are no related errors, you will not receive this report. If you receive a TA1, the original interchange had data errors within the ISA/IEA and/or GS/GE segments. These interchanges stop before going to Anthem processing. Upon receiving a TA1, take the following steps: 1. Read the TA1 to determine the error. In the TA1 interchange, find the value in ISA13, Interchange Control Number to identify the interchange in error. Exception: If the source interchange has errors in the Receiver ID (ISA08) or the Interchange Control Number (ISA13), use the Receipt Date shown on the TA1 to identify the interchange. Use the Reject Reason from the TA1 to identify the error. 2. Locate and correct the data element(s) in error in your interchange. Ceridian Companion Guide 16 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

3. Send the corrected interchange. TA1 Example The following example shows a TA1, wrapped in an 864. The MSG segments include the actual TA1. This is an illustrative example; therefore, some spacing may differ on your actual report. Note: The X12 version of the TA1 (not wrapped in 864) identifies syntactical errors in the ISA/IEA only. The wrapped TA1 identifies syntactical and other errors. TA1 Interchange Acknowledgment Example Ceridian Companion Guide 17 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

997 Functional Acknowledgment Upon receipt of an EDI interchange, the Enterprise EDI Gateway (Gateway) performs Level 1 edits to check the syntax of each functional group (GS/GE) and each transaction set (ST/SE) to determine whether they adhere to the syntactical requirements of the X12N Implementation Guide. After these syntactical edits, we compile the 997 Functional Acknowledgment. Since we send a 997 for every interchange, whether it passes syntax edits or not, the 997 is your indication that Anthem received your interchange. In addition, if we detect syntactical errors, we deem the entire interchange (including all functional groups and transaction sets within the interchange) as noncompliant, and we notify you using the 997. Therefore, the 997 is (1) an acknowledgment that we received your interchange and, (2) if applicable, an error report identifying syntactical errors within the interchange functional groups and transaction sets. If you receive a 997 with errors, the interchange stopped before going to our processing system. When Does Anthem Send the 997? Upon receipt of an EDI interchange, the Enterprise EDI Gateway performs Level 1 edits. In response, the Gateway compiles the 997 to (1) verify that we received the interchange and (2), if applicable, report syntactical errors. 997 Delivery Schedule During a typical business week, you can anticipate receiving the 997 within two to three hours after we receive the transmission. If a holiday schedule necessitates a delivery time change, we send an Alert Message to communicate the change. Ceridian Companion Guide 18 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

What to Do Upon Receiving the 997 We send a 997 for every X12N interchange that we receive. The 997 confirms our receipt of your interchange and, if applicable, reports syntactical errors in the functional group(s) (GS/GE) and/or transaction set(s) (ST/SE). Each day, you should monitor the 997s received. Upon receipt of the 997, take the following steps: 1. Read the 997 to determine if the interchange was accepted or rejected. As necessary, refer to the following document: The appropriate IG (834) for information on the transaction and on the 997 2. Reconcile the files you sent with the ones received by Anthem. If the 997 does not indicate errors (if AK501 equals A, Accepted), then the remaining steps in this section are not necessary. 3. If AK501 (Transaction Set Acknowledgment Code) equals R (Rejected), identify and correct the error(s), then resubmit the corrected transaction. If AK501 equals A (Accepted), no further action is required. 4. If AK901 (Functional Group Acknowledge Code) equals R (Rejected), correct and resubmit the functional group. 5. Locate and correct the error. Resubmit the functional group or transaction set as appropriate. 6. Send the corrected interchange. 997 Example The 997 Functional Acknowledgment confirms receipt of an 834 Electronic Enrollment and indicates errors. The example below highlights some pertinent information provided by the 997. ISA*00* *00* *ZZ*VAWKMEMFUL *ZZ*VA00002E *090407*0929*U*00401*000000001*0*T*:~ GS*FA*VAWKMEMFUL*VA00002E*20090407*0928*10001*X*004010X095A1~ ST*997*0001~ AK1*BE*2~ AK2*834*0001~ AK5*A~ AK9*A*1*1*1~ SE*6*0001~ GE*1*10001~ IEA*1*000000001~ Ceridian Companion Guide 19 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Resubmitting Transactions that Fail Compliance (AK501 = R) If you receive a 997 Functional Acknowledgment indicating errors (AK501 = R), the transaction was not processed. If corrections are required, make them and resubmit according to the instructions below. 1. Review the original transaction, identify the error, and correct the transaction. 2. Resubmit the transaction. Be sure that the Group Control Number in the Functional Group Header (GS06) and Trailer (GE02) are identical to each other. Ceridian Companion Guide 20 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Level 2 Status Report If your interchange passes enveloping (ISA/IEA) and Level 1 (GS/GE and ST/SE) edits, it advances to Level 2 edits to check for code set and X12N structure compliance. The Level 2 Status Report provides the results from Level 2 editing, which checks for code set and X12N structure compliance. The Level 2 Status Report identifies how many transactions within the interchange passed and/or failed Level 2 edits and reports any errors. The Level 2 Status Report clearly reports transactions that passed and those that failed. We send this report within the 864 Text Message wrapper. The title in the 864 segment MIT02 (Description) is ENROLLMENT AND MAINTENANCE REPORT when it responds to an 834 Enrollment File. If you receive a Level 2 Status Report with errors, the transaction stopped before going to our processing system. When Does Anthem Send the Level 2 Status Report? ou will receive a Level 2 Status Report for each interchange that passed Level 1 edits (checking GS/GE and ST/SE syntax per the IG) and proceeded to the Level 2 edit process (checking IG compliance). Level 2 Status Report Delivery Schedule During a typical business week, you can anticipate receiving the Level 2 Status Report within two to three hours after we receive the transmission. If a holiday schedule necessitates a delivery time change, we send an Alert Message to communicate the change. What to Do Upon Receiving the Level 2 Status Report ou receive the Level 2 Status Report for each interchange you send (whether or not the interchange has Level 2 errors). If you receive a Level 2 Status Report with errors, the transaction stopped before going to our processing system. Each day, monitor your Level 2 Status Reports. Upon receiving a Level 2 Status Report, you should take the following steps: 1. Read the Level 2 Status Report to identify how many passed or failed Level 2 edits. If any failed, use the Level 2 Status Report to identify the field in error, error message, and the data Anthem received on the enrollment file. For help, call the Anthem EDI Specialists (Richmond Area: 804-354-4470, Toll Free: 800-991-7259, Option 2, Option 2; or Fax: 804-354-2529). 2. Correct and electronically resubmit the file that failed. Do not resubmit without correcting the invalid or missing data. Example: Level 2 Status Report On the next page, you will find an example of the Level 2 Status Report. The MSG segments include the actual Level 2 Status Report. Ceridian Companion Guide 21 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Ceridian Companion Guide 22 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a

Activity Log The Activity Log shows your transmission history and can be a helpful troubleshooting tool. On occasion, your Anthem EDI Specialist may request that you review your transmission history by accessing your Activity Log. To ensure your most current activity is included, wait about thirty minutes after transmitting before accessing your Activity Log. Ceridian Companion Guide 23 07/16/2009 trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

Alert Messages Anthem sends Alert Messages on as as-needed basis. These messages may contain information such as the following: system modifications and their effective dates important electronic issues helpful EDI hints holiday processing schedules seminar schedules general information regarding transactions and reports It is imperative that you review Alert Messages. These messages may contain information that requires action on your part, such as changes in programming or billing practices. If you think you missed an Alert Message, go to www.edi.anthem.com, and click Virginia, then Communications, then News Bulletins. We send Alert Messages within the 864 Text Message wrapper. Alert Messages are formatted within the 864 MSG segments. Carefully review all Alert Messages to determine their impact on your operations. Please make sure that all staff members know how important Alert Messages are and where to direct them. Alert Message Example ISA\00\ \00\ \ZZ\VAWKMEMFUL \ZZ\VA00002E \050908\1253\U\00401\900000019\0\P\:~ GS\TX\VAWKMEMFUL\VA00002E\20050908\1253\900000019\X\004010~ ST\864\1000~ BMG\00\ANTHEM VIRGINIA 864/ALERT MESSAGE\ME~ MIT\ALERT\GENERAL REPORT INFORMATION~ MSG\ \SS~ MSG\CONSISTENTL WORKING REPORTS PROMOTES TIMEL ACCOUNT RECONCILIATION.\SS~ MSG\THIS MESSAGE BRIEFL INTRODUCES REPORTS OU MA RECEIVE FROM ANTHEM.\SS~ MSG\ \SS~ MSG\THE REJECT REPORT INDICATES REJECTION OF AN INTERCHANGE. \SS~ MSG\OU RECEIVE A REJECT REPORT ONL IF WE DETECT SNTAX ERRORS IN THE ISA/IEA OR GS/GE. MSG\ \SS~ MSG\THE TA1 INTERCHANGE ACKNOWLEDGMENT INDICATES REJECTION OF AN INTERCHANGE. OU\SS~ MSG\RECEIVE A TA1 ONL IF WE DETECT DATA ERRORS IN THE ISA/IEA OR GS/GE. MSG\ \SS~ MSG\THE 997 FUNCTIONAL ACKNOWLEDGMENT CONFIRMS THE RECEIPT OF OUR FILE AND REPORTS\SS~ MSG\LEVEL 1 ERRORS (CHECKING GS/GE AND ST/SE SEGMENTS TO ENSURE COMPLIANCE TO\SS~ MSG\X12 STANDARDS). THE 997 IS OUR FIRST INDICATION THAT WE RECEIVED OUR\SS~ MSG\INTERCHANGE. IF OU RECEIVE A 997 WITH ERRORS, THE INTERCHANGE WAS STOPPED\SS~ MSG\BEFORE GOING TO PROCESSING AND IS NOT AVAILABLE ON POINT OF CARE.\SS~ MSG\ \SS~ MSG\THE LEVEL 2 STATUS REPORT, DELIVERED IN AN 864 TEXT MESSAGE, GIVES LEVEL 2 EDITING\SS~ MSG\RESULTS (COMPLIANCE WITH IGS). IF SOME TRANSACTIONS IN A FUNCTIONAL GROUP PASS\SS~ MSG\LEVEL 2 EDITS AND OTHERS DO NOT, WE REMOVE NON- COMPLIANT TRANSACTIONS, ADJUST THE\SS~ MSG\ENVELOPE SEGMENT COUNT AND SEND REMAINING TRANSACTIONS TO PROCESSING. THIS IS AN \SS~ MSG\ANTHEM PROPRIETAR REPORT.\SS~ MSG\ \SS~ MSG\THE LEVEL 3 FRONT-END ERRORS NOTIFICATION (FEEN), DELIVERED IN AN 864 TEXT MESSAGE,\SS~ MSG\GIVES FRONT-END EDIT RESULTS FOR DATA VALIDIT, COMPATABILIT AND FORMATTING. \SS~ MSG\OU RECEIVE A FEEN ONL IF A CLAIM DOES NOT PASS FRONT END EDITS. IF OU RECEIVE A \SS~ MSG\FEEN, THE TRANSACTION WAS STOPPED BEFORE GOING TO PROCESSING AND\SS~ MSG\IS NOT AVAILABLE ON POINT OF CARE. THIS IS AN ANTHEM PROPRIETAR REPORT.\SS~ MSG\ \SS~ MSG\THE LEVEL 3 ADJUDICATED CLAIMS RESPONSE, DELIVERED IN AN 864 TEXT MESSAGE, \SS~ MSG\GIVES PROCESSING STATUS FOR EACH VALID CLAIM SUBMITTED TO PRODUCTION AND IS \SS~ MSG\OUR RECORD OF TIMEL FILING. IF OU RECEIVE AN ADJUDICATED CLAIMS RESPONSE WITH \SS~ MSG\ERRORS, THE CLAIM WAS STOPPED BEFORE BEING PROCESSED AND IS NOT AVAILABLE \SS~ MSG\ON POINT OF CARE. THIS IS AN ANTHEM PROPRIETAR REPORT.\SS~ Ceridian MSG\ Companion \SS~ Guide 24 07/16/2009 SE\34\1000~ GE\1\900000019~ In Virginia IEA\1\900000019~ (excluding the City of Fairfax, the Town of Vienna and the area east of State Route 123), Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. Independent licensee of the ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.