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
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.
Rec # | Field # | Name/Desc | Beg Posn* | End Posn | Field Type | Constant Value | |
---|---|---|---|---|---|---|---|
1 | 1 | Ref 17 Table Location | 1 | 50 | Char | Values can be: P2K_HR_ASSIGNMENT_DETAILS, P2K_CM_POSITION_DETAILS, P2K_CM_DEPARTMENT_DETAILS If null defaults to P2K_BE_COVERAGES | |
5 | 1 | N1 Group Name | 1 | 500 | Char | Default "UNKOWN" if not established | |
5 | 2 | N1 Group Tax ID | 1 | 50 | Char | ||
5 | 3 | TPA Broker Name | 1 | 500 | Char | ||
5 | 4 | TPA Broker Tax ID | 1 | 50 | Char | ||
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) |
Data Base Table | UDF Name | Used in Segment | ^ |
---|---|---|---|
P2K_BE_COVERAGES | REF_DX_LOCATION | member supplemental number('2000 REF02 DX') | |
P2K_BE_BENEFIT_RECIPIENTS | PRIME PHYSICIAN | PHYSICIAN information | |
P2K_HR_CONTACTS | MARITAL_STATUS | Marital status | |
P2K_HR_ASSIGNMENT_DETAILS | REF_17 | member supplemental number('2000 REF02 17') | |
P2K_CM_DEPARTMENT_DETAILS | REF_17 | member supplemental number('2000 REF02 17') | |
P2K_CM_POSITION_DETAILS | REF_17 | member supplemental number('2000 REF02 17') | |
P2K_BE_COVERAGES | REF_17 | member supplemental number('2000 REF02 17') |
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 |
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 | |
Unenrolled in last days | Records marked as "Unenrolled" as of the system date - this field, will be included in this file | |
_Plan Type | Mandatory, LOV Available You must select a Benefit plan type to process (Sample Dental, Medical, Vision, Health) | |
_Plan Code | Optional, LOV Available Select a Benefit plan code to process | |
_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. |
Segment ID | Element | Field Name | Req? | Description (HLC source) | |
---|---|---|---|---|---|
ISA | 01 | Authorization Info Qualifier | Y | IDIF definition Rec#10 Field#1 (constant value) | |
ISA | 02 | Authorization Information | Y | IDIF definition Rec#10 Field#2 (constant value) | |
ISA | 03 | Security Information Qualifier | Y | IDIF definition Rec#10 Field#3 (constant value) | |
ISA | 04 | Security Information | Y | IDIF definition Rec#10 Field#4 (constant value) | |
ISA | 05 | Interchange ID Qualifier | Y | IDIF definition Rec#10 Field#5 (constant value) | |
ISA | 06 | Interchange Sender ID | Y | 7-digit Trading Partner Number assigned by ASK.(from Report run time parameter setting, ‘ASK Partner Number’) | |
ISA | 07 | Interchange Receiver Qualifier | Y | IDIF definition Rec#10 Field#7 (constant value) | |
ISA | 08 | Interchange Receiver ID | Y | IDIF definition Rec#10 Field#8 (constant value) | |
ISA | 09 | Interchange Date | Y | YYMMDD (system date) | |
ISA | 10 | Interchange Time | Y | HHMM (system time) | |
ISA | 11 | Interchange Control Standards ID | Y | IDIF definition Rec#10 Field#11 (constant value) | |
ISA | 12 | Interchange Control Version Number | Y | IDIF definition Rec#10 Field#12 (constant value) | |
ISA | 13 | Interchange Control Number | Y | Created by Sender Must be unique for each transaction (from Report run time parameter setting, ‘ISA Control Number’ ) | |
ISA | 14 | Acknowledgement Requested | Y | IDIF definition Rec#10 Field#14 (constant value) | |
ISA | 15 | Usage Indicator | Y | "This is a Test File" set to "Yes" then value = T otherwise value = P | |
ISA | 16 | Component Element Separator | Y | : |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
GS | 01 | Functional Identifier Code | Y | IDIF definition Rec#20 Field#1 (constant value) |
GS | 02 | Sender’s Code | Y | IDIF definition Rec#20 Field#2 (constant value) |
GS | 03 | Receiver’s Code | Y | IDIF definition Rec#20 Field#3 (constant value) |
GS | 04 | Date | Y | YYMMDD (system date) |
GS | 05 | Time | Y | HHMM (system time) |
GS | 06 | Group Control Number | Y | Created by Sender Must be identical in GE02 (from Report run time parameter setting, ‘GS Control Number’) |
GS | 07 | Responsible Agency’s Code | Y | IDIF definition Rec#20 Field#7 (constant value) |
GS | 08 | Version/Release Code | Y | IDIF definition Rec#20 Field#8 (constant value) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
ST | 01 | Transaction Set Header | Y | 834 |
ST | 02 | Transaction Set Control Number | Y | Populated with a 4-digit number and it should start with 0001. If multiple ST/SE segments are sent in one file, this number will be sequential and ascending. |
ST | 03 | Transaction Set Control Number | Y | IDIF definition Rec#20 Field#8 (constant value) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
BGN | 01 | Transaction Set Purpose Code | Y | 00 for Original |
BGN | 02 | Reference Identification | Y | Sender unique transaction set identifier code. (same as Transaction Set Control Number) |
BGN | 03 | Date | Y | System Date |
BGN | 04 | Time | Y | System Time |
BGN | 08 | Action Code | Y | RX - Replace |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
REF | 01 | Reference Number Qualifier | Y | 38 for Master Policy Number |
REF | 02 | Reference Number | Y | Master Policy Number (MPN) provided by Carrier. (from Report run time parameter setting, ‘Master Policy Number’) |
REF | 03 | Reference Name | Y | Client name provided by the client in IDIF |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
DTP | 01 | Date/Time Qualifier | Y | 007 File Effective Date |
DTP | 01 | Date/Time Period Format Qualifier | Y | D8 (CCYYMMDD) |
DTP | 01 | Date/Time Qualifier | Y | File Effective Date (bend.effective) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
N1 | 01 | Entity Identifier Code | Y | P5 for Plan Sponsor |
N1 | 02 | Name | Y | IDIF definition Rec#50 Field#2(constant value) |
N1 | 03 | Identification Code Qualifier | Y | IDIF definition Rec#50 Field#3 (constant value) |
N1 | 04 | Identification Code | Y | IDIF definition Rec#50 Field#4(constant value) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
N1 | 01 | Entity Identifier Code | Y | IN for Insurer |
N1 | 02 | Name | Y | IDIF definition Rec#52 Field#2 (constant value) |
N1 | 03 | Identification Code Qualifier | Y | IDIF definition Rec#52 Field#3 (constant value) |
N1 | 04 | Identification Code | Y | IDIF definition Rec#52 Field#4 (constant value) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
N1 | 01 | Entity Identifier Code | S | TV for TPA |
N1 | 02 | Name | S | UDF ‘GI BROKER NAME’ attached to the DED table. |
N1 | 03 | Identification Code Qualifier | S | FI for Federal Tax ID |
N1 | 04 | Identification Code | S | UDF ‘GI BROKER TAXID’ attached to the DEN table. |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
INS | 01 | Yes/No Condition | Y | Y if the member is a Subscriber. N if the member is a Dependent. |
INS | 02 | Individual Relationship Code | Y | 01 for Spouse 05 for Grandchild 09 for Adopted Child 15 for Legal Custody Dependent 17 for Step Child 18 for Self (Subscriber) 19 for Child or Student 53 for Domestic Partner |
INS | 03 | Maintenance Type Code | Y | 001 for Change. 021 for Add 024 for Termination 030 if Maintenance Type Code unknown |
INS | 04 | Maintenance Reason Code | Y | 01 for Divorce 02 for Birth 03 for Death 04 for Retirement 05 for Adoption 07 for Termination of Benefits 08 for Termination of Employment 15 for PCP Change 21 (preferred) for Disability (send if member becomes disabled. Maintenance Effective Date reflects date the member became disabled.) 25 (preferred) for if member becomes a student. Maintenance Effective date reflects date the member became a student) 28 for Initial Enrollment 31 for Legal Separation 32 for Marriage 3 for Change of Location (Address) AI for No Reason Given (reason unknown) |
INS | 05 | Benefit Status Code | Y | A if the member is not Cobra. C for Cobra |
INS | 06 | Medicare Plan Code | S | If the data is available: A for Medicare Part A . B for Medicare Part B. C for Medicare Part A and Part B. |
INS | 07 | COBRA Qualifying Event Code | S | Optional |
INS | 08 | Employee Status Code | Y | Subscribers Only. AC for Active RT for Retired Employee. TE for Terminated Employee. |
INS | 09 | Student Status Code | S | F if the member is identified as a student based on the age criteria between Carrier and the Group. |
INS | 10 | Handicap Indicator | S | N for No if the member is not handicapped/disabled. Y for Yes if the member is handicapped/disabled. NOTE: Only sent for disabled children. This is not sent on the Insured or Spouse. |
INS | 11 | Date Time Period Qualifier | S | In the event of a death of the subscriber or dependent, populate with D8. Otherwise, leave blank. |
INS | 12 | Date Time Period | S | Populate this date for the death of the subscriber/dependent NOTE: If INS11 is populated with D8, the date must also be populated. |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
REF | 01 | Reference Number Qualifier | Y | 0F for Subscriber Number |
REF | 02 | Reference Number | Y | Subscriber’s SSN (eid.government_code) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
REF | 01 | Reference Number Qualifier | Y | 1L for Group Number |
REF | 02 | Reference Number | Y | Carrier will provide the number (bpn.policy_number) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
REF | 01 | Reference Number Qualifier | S | F6 for Medicare HIC Number |
REF | 02 | Reference Number | S | UDF ‘MEDICARE HIC REF’ attached to the BPN table. |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
DTP | 01 | Date/Time Qualifier | Y | 303 for Maintenance Effective Date (bend.effective) |
DTP | 01 | Date/Time Qualifier | S | Enrollment Signature Date |
DTP | 01 | Date/Time Qualifier | Y | 336 for Employment Begin for subscribers only. (bend.effective) |
DTP | 01 | Date/Time Qualifier | Y | 338 for Medicare Begin. (bend.effecitve) NOTE: INS06 must be populated with A, B or C. If the member has both Medicare Part A and B, we will send earliest Effective Date and latest Termination Date between the two. |
DTP | 01 | Date/Time Qualifier | Y | 339 for Medicare End. (bend.expiry) NOTE: INS06 must be populated with A, B or C. If the member has both Medicare Part A and B, we will send earliest Effective Date and latest Termination Date between the two. |
DTP | 01 | Date/Time Qualifier | Y | 356 for Eligibility Begin (bend.effective) |
DTP | 01 | Date/Time Qualifier | Y | 357 for Eligibility End for terminations (bend.expiry) |
DTP | 01 | Date/Time Qualifier | S | 394 for Rehire Date (eem.hire_date) |
DTP | 02 | Date/Time Format Qualifier | Y | D8 |
DTP | 03 | Date Time Period | Y | Date associated with the DTP01 |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
NM1 | 01 | Entity Identifier Code | Y | IL |
NM1 | 02 | Entity Type Qualifier | Y | 1 for Person |
NM1 | 03 | Name Last | Y | Last Name (eid.Last_name) |
NM1 | 04 | Name First | Y | First Name (eid.First_namee) |
NM1 | 05 | Name Middle | N | Middle Name (eid.middle_name) |
NM1 | 07 | Name Suffix | N | Suffix (eid.rank) |
NM1 | 08 | Identification Code Qualifier | Y | 34 |
NM1 | 09 | Identification Code | Y | SSN – Required for all members on the contract. (eid.government_code) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
PER | 01 | Contact Function Code | N | IP for Insured Party |
PER | 03 | Comm Number Qual | N | HP |
PER | 04 | Comm Number | N | Member’s Home Phone Number (eps.phone_number) Note: No punctuation within Phone Number |
PER | 05 | Comm Number Qual | N | WP |
PER | 06 | Comm Number | N | Member’s Work Phone Number (eps.alt_phone_number) Note: No punctuation within Phone Number |
PER | 07 | Comm Number Qual | N | EM |
PER | 08 | Comm Number | N | Member’s E-mail Address (eps.email_address) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
N3 | 01 | Address Line 1 | Y | Member’s Address (eps.address_line_1) NOTE: Only send this segment for the dependent if the address is different than the subscriber’s. |
N3 | 02 | Address Line 2 | N | If the country (N404 <> USA), populate the province in this field |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
N4 | 01 | City | Y | City (eps.locality) |
N4 | 02 | State/Province | Y | State (dsp.state_province) NOTE: If the member does not reside in the US, pass the province in the N302 field) |
N4 | 03 | ZIP Code/Postal Code | Y | Postal Code (eps.zip_postal) |
N4 | 04 | Country Code | Y | If member lives in the United States, pass USA. If not, pass FOR. (dco.country_code) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
DMG | 01 | Date/Time Format Qualifier | Y | D8 |
DMG | 02 | Date/Time Period | Y | Member’s Birth Date (eid.birth_date) |
DMG | 03 | Gender Code | Y | M for Male F for Female (eid.gender) |
DMG | 04 | Marital Status Code | N | B for Registered Domestic Partner D for Divorced I for Single M for Married S for Separated U for Unmarried W for Widowed X for Legally Separated R for Unreported (eps.martital_status) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
NM1 | 01 | Entity Identifier Code | S | 31 for Postal Mailing Address |
NM1 | 02 | Entity Type Qualifier | S | 1 for Person |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
N3 | 01 | Address Line 1 | S | Address Line 1 (eps.mail_address_line_1) |
N3 | 02 | Address Line 2 | N | (eps.mail_address_line_2) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
N4 | 01 | City | S | City (eps.mail_locality) |
N4 | 02 | State/Province | S | State/Province (dsp.state_province_code) |
N4 | 03 | ZIP Code/Postal Code | S | Postal Code (eps.mail_zip_postal) |
N4 | 04 | Country Code | N | USA |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
DSB | 01 | Disability Type Code | S | 2 for Long Term Disability |
DSB | 07 | Product/Service ID Qualifier | S | DX |
DSB | 08 | Medical Code Value | S | 585 for End Stage Renal Disease (only valid value) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
DTP | 01 | Date/Time Qualifier | S | 360 for Disability Begin 361 for Disability End |
DTP | 02 | Date/Time Format Qualifier | S | D8 |
DTP | 03 | Date Time Period | S | Disability date (bend.effective/bend.expiry) |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
HD | 01 | Maintenance Type Code | Y | 001 for Change. 021 for Add 024 for Termination 030 if Maintenance Type Code unknown (?) |
HD | 03 | Insurance Line Code | Y | IF r_be_ben.bpt_plan_type='MEDICAL' then v_segment_hd_03:='HLT'; ELSIF r_be_ben.bpt_plan_type='STANDALONE' then --SK20200710 v_segment_hd_03:='AK'; ELSIF r_be_ben.bpt_plan_type='EXCLUSIVE PROVIDER ORGANIZATION' then --SK20200710 v_segment_hd_03:='EPO'; ELSIF r_be_ben.bpt_plan_type='HEARING' then --SK20200710 v_segment_hd_03:='HE'; ELSIF r_be_ben.bpt_plan_type='HEALTH MAINTENANCE ORGANIZATION' then --SK20200710 v_segment_hd_03:='HMO'; ELSIF r_be_ben.bpt_plan_type='MAJOR MEDICAL' then --SK20200710 v_segment_hd_03:='AK'; ELSIF r_be_ben.bpt_plan_type='POINT OF SERVICE' then --SK20200710 v_segment_hd_03:='POS'; ELSIF r_be_ben.bpt_plan_type='PREFERRED PROVIDER ORGANIZATION' then --SK20200710 v_segment_hd_03:='PPO'; ELSIF r_be_ben.bpt_plan_type='PRESCRIPTION' then --SK20200710 v_segment_hd_03:='PDG'; ELSIF r_be_ben.bpt_plan_type='FACILITY' then --SK20200710 v_segment_hd_03:='FAC'; ELSIF r_be_ben.bpt_plan_type='HEALTH' then --SK20200710 v_segment_hd_03:='HLT'; ELSIF r_be_ben.bpt_plan_type='DENTAL' then v_segment_hd_03:='DEN'; ELSIF r_be_ben.bpt_plan_type='VISION' then --SK20200707 v_segment_hd_03:='VIS'; ELSE v_segment_hd_03:=; END IF; |
HD | 04 | Plan Coverage Description | Y | Carrier will provide the values based on Group coverage. (r_be_ben.bcg_policy_number) Note: Optional for Dependents |
HD | 05 | Coverage Level Code | Y | Note: (SELECT DECODE (r_be_ben.bcg_coverage_code,'SINGLE','EMP','COUPLE','ESP','FAMILY','FAM','EMPLOYEE ONLY','EMP', 'DEPENDENT ONLY','DEP','EMPLOYEE AND ONE DEPENDENT','E1D','EMPLOYEE AND SPOUSE','ESP','EMPLOYEE AND TWO OR MORE DEPENDENTS','E6D', 'EMPLOYEE AND CHILDREN','ECH','COMPOSITE','FAM','PHARMACY','RX','CHILDREN ONLY','CHD','INDIVIDUAL','IND','SPOUSE & CHILDREN','SPC', 'SPOUSE ONLY','SPO’,r_be_ben.bcg_HIPPA_code) ) A. This is optional for Dependents B. Provided by Carrier. |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
DTP | 01 | Date/Time Qualifier | Y | 348 for Benefit Begin.(bend.effective) |
DTP | 01 | Date/Time Qualifier | Y | 349 for Benefit End (bend.expiry) Note: Required if member is canceling coverage with Carrier. |
DTP | 02 | Date/Time Format Qualifier | Y | D8 |
DTP | 03 | Date/Time Period | Y | Benefit Date |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
REF | 01 | Reference Number Qualifier | Y | 1L |
REF | 02 | Reference Identification | Y | UDF ‘DIS POLICY REF’ attached to the BPN table. |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
SE | 01 | Number of Segments | Y | System counter. |
SE | 02 | Transaction Set Control Number | Y | Same as the ‘Transaction Set Control Number’ in the ST segment. |
Segment ID | Element | Field Name | Req? | Description (HLC source) |
---|---|---|---|---|
GE | 01 | Number of Transaction sets | Y | System counter |
GE | 02 | Group Control Number | Y | Same as the ‘Group Control Number’ in the GS segment. |
Note: Required Segment ID | ||||
---|---|---|---|---|
Segment ID | Element | Field Name | Req? | Description (HLC source) |
IEA | 01 | Number of Functional Groups | Y | System counter. |
IEA | 02 | Interchange Control Number | Y | Same as the ‘Interchange Control Number in the ISA segment |
Screen captures are meant to be indicative of the concept being presented and may not reflect the current screen design.
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