!!!RBINTERFACE
!!Purpose
The RBINTERFACE program creates a HIPPA ANSI 834(ANSI X12N 005010X220A1 (834) standard) File layout for reporting benefit information to carriers.
Interchange file segment ordering example\\
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!!Segment Ordering Sample
Interchange file segment ordering example:
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*ISA\\
*GS\\
*ST\\
*BGN\\
*REF\\(employee and dependent details following)
**DTP ...
**1000A N1
**1000B N1
**1000C N1 (situational/optional)
***2000 INS ...
***2000 REF (0F)
***2000 REF (1L)
***2000 REF (F6) (situational/optional)
***2000 DTP ...
****2100 NM1
****2100A PER
****2100A N3 (required for subscriber)
****2100A N4 (required if 2100A N3 is included)
****2100A DMG
****2100C NM1 (situational/optional)
****2100C N3 (situational/optional)
****2100C N4 (situaional/optional)
****2200 DSB
****2200 DTP ...
*****2300 HD ...
*****2300 DTP ...
*****2300 REF (situational/optional)
*SE
*GE
*IEA
!!Required Set Up
!1) Interface File Definition ([IDIF]) Set Up
High Line supplies a standard IDIF file definition, __‘HL$ANSI-X12N834’__, for use with this process.\\
For each vendor required, use the IDIF function and make a copy of this pre-loaded interface layout. Rename the copy to a logical naming convention for the vendor.
Use IDIF to modify the IDIF file definition to contain the required value for the vendor.\\
A mapping has been created between the IDIF and the RBINTERFACE program. \\
Only file columns that require a constant value will be needed to be defined inside this IDIF definition.\\
*The Beginning Position may always be defined as `1`\\
*The Ending Position must be defined in order for the program to know how many characters are required for each column.\\
*The Field Type must be defined as ‘Char’\\
*Constant Value, client must define the element value in this column as it is applicable to their own installation.\\
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||Rec # ||Field # ||Name/Desc ||Beg Posn* ||End Posn ||Field Type ||Constant Value
|10 |1 |ISA segment Element 01 |1 |2 |Char | |
|10 |2 |ISA segment Element 02 |1 |10 |Char | |
|10 |3 |ISA segment Element 03 |1 |2 |Char | |
|10 |4 |ISA segment Element 04 |1 |10 |Char | |
|10 |5 |ISA segment Element 05 |1 |2 |Char |ISA05 = sender (usually ‘30’) |
|10 |6 |ISA segment Element 06 |1 | | |ISA06 = sender (usually a FEIN) (Navigate to IDGV and obtain clients FEIN)|
|10 |7 |ISA segment Element 07 |1 |2 |Char |ISA07 = receiver (usually ‘30’) |
|10 |8 |ISA segment Element 08 |1 |3 |Char |ISA08 = receiver (usually a FEIN) |
|10 |11 |ISA segment Element 11 |1 |1 |Char | |
|10 |12 |ISA segment Element 12 |1 |5 |Char |00501 |
|10 |14 |ISA segment Element 14 |1 |1 |Char | |
|10 |15 |ISA segment Element 15 |1 |1 |Char |ISA15 = P(Production) or T(Test) |
| | | | | | | |
|20 |1 |GS segment Element 01 |1 |2 |Char | |
|20 |2 |GS segment Element 02 |1 |7 |Char |GS02 = sender (Usually agency TIN/FEIN) |
|20 |3 |GS segment Element 03 |1 |6 |Char |GS03 = receiver (Usually carriers TIN/FEIN) |
|20 |7 |GS segment Element 07 |1 |1 |Char | |
|20 |8 |GS segment Element 08 |1 |12 |Char | |
| | | | | | | |
|50 |2 |N1(Identifier P5) segment 02|1 |60 |Char |N1P5-Payer Name |
|50 |3 |N1(Identifier P5) segment 03|1 |2 |Char |‘FI’ |
|50 |4 |N1(Identifier P5) segment04 |1 |80 |Char |N1P5-Payer Identification Code |
| | | | | | | |
|52 |2 |N1(Identifier IN) segment 02|1 |6 |Char |N102 = The name of the client group |
|52 |3 |N1(Identifier IN) segment 03|1 |2 |Char |‘FI’ |
|52 |4 |N1(Identifier IN) segment 04|1 |10 |Char |N104 = Client group TIN (or some other designation) |
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!2) The following User Defined Feld (UDF) is required on [IMUF].
||Data Base Table ||UDF Name|| Used in Segment|| ^
| | | |
|P2K_BE_COVERAGES |REF_DX_LOCATION|member supplemental number('2000 REF02')|
|P2K_BE_BENEFIT_RECIPIENTS|PRIME PHYSICIAN|PHYSICIAN information |
|P2K_HR_CONTACTS |MARITAL_STATUS |Marital status
!!!SYSTEM PROCESSING
!!Processing Sequence\\
*Select all the employee records where employee has an enrolment in either filtered plan types.
*The following record segments will be written at the beginning of the file: “ISA’, ‘GS’, ‘ST’, ‘BGN’, and ‘REF’, ‘DTP’.
*For each employee, and dependants, who are new to the medical/dental plan coverage, or terminates coverage, or has changes in coverages within the reporting period will be processed, the following record segments will be created:
||Record Segment||Code||Description||Processing Conditions||
|1000A N1|P5|Plan Sponsor|One per File|
|1000B N1|IN|Insurer|One per File|
|1000C N1|TV|TPA/Broker Name|Situational|
|2000 INS|Y|Member is a Subscriber|One record only, either ‘Y’ or ‘N’|
|2000 INS|N|Member is a Dependant|
|2000 REF|0F|Subscriber Number|
|2000 REF|1L|Group Number|
|2000 REF|F6|Medicare HIC Number|Situational|
|2000 DTP|303|Maintenance Effective Date|
|2000 DTP|336|Employ Begin Date (Subscriber only)|
|2000 DTP|338|Medicare Begin Date|
|2000 DTP|339|Medicare End Date|
|2000 DTP|356|Eligibility Begin Date|
|2000 DTP|357|Eligibility End/ Termination Date|
|2000 DTP|394|Rehire Date|Situational|
|2100A NM1|IL|Member Name|
|2100A PER|IP|Member Communication Numbers|Situational|
|2100A N3| |Member Resident Street Address|Required for Subscriber segment|
|2100A N4| |Resident City, State, ZIP|Required if Segment ‘2100A N3’ is sent|
|2100A DMG| |Member Demographics|
|2100A NM1|31|Member Mailing Address|Situational|
|2100C N3| |Member Mailing Street Address|Situational|
|2100C N4| |Mailing City, State, ZIP|Situational|
|2200 DSB|2|Long Term Disability|Situational|
|2200 DTP|360|Disability Begin Date|Situational|
|2200 DTP|361|Disability End Date|Situational|
|2300 HD|001|Health Coverage Change|One record code only|
|2300 HD|021|Health Coverage Add|One record code only|
|2300 HD|024|Health Coverage Termination|One record code only|
|2300 HD|030|Maintenance Type Code Unknown|One record code only|
|2300 DTP|348|Benefit Begin Date|
|2300 DTP|349|Benefit End Date|
|2300 REF|1L|Member Policy Number|
*The following record segments will be written at the end of the file: “SE’, ‘GE’, ‘IEA’.
!!Report Parameters
||Report Parameters||Description
|__Entity__ |Mandatory, LOV Available\\You must enter one entity|
|__Interface Format Code__ |Mandatory, LOV Available\\You must select an interface code defined on IDIF (Sample ‘HL$ANSI-X12N834’)|
|__ASK Partner Number__ |Used to populate Segment ‘ISA’ element ‘06’; and Segment ‘GS’ element ’02’.
|__ISA Control Number__ |Used to populate Segment ‘ISA’ element ‘13’; and Segment ‘IEA’ element ‘02’.
|__GS Control Number__ |Used to populate Segment ‘GS’ element ’06’; and Segment ‘GE’ element ‘02’..
|__Master Policy Number__ |Used to populate Segment ‘REF’ element ’02’.
|__From Date__ |The starting date used for records to be included in the file|
|__To Date__ |The ending date used for records to be included in the file|
|__Plan Type__ |Mandatory, LOV Available\\You must select a Benefit plan type to process (Sample Dental,Medical, Vision,Health)|
|__This is a Test File__ |Value of ‘Y’ or ‘N’. Used to populate Segment ‘ISA’ element ’15’ (populate with ‘T’ for test file; and ‘P’ for production file).|
|__This is an Update File__|Value of ‘Y’ or ‘N’. Used to populate Segment ‘BGN’ element ’08’ (populate with ‘RX’ for replace action).|
|__Create File__ |Value of ‘Y’ or ‘N’. If set to 'N' no file will be created.|
|__Directory Name__ |Enter a valid directory name (Directory must be found on the database server)|
|__File Name__ |Enter a file name|
|__Include Exception__ |Value of ‘Y’ or ‘N’ (to include exception messages on the report)|
|__Exception Level__ |Values of ‘0’ to ‘9’ (more exception messages are displayed when a higher level number is used). Use Level-2 if you want to see all the records created (or will be created) on the file listed on the report.
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