Wiki: RBINTERFACE

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

Segment Ordering Sample#

Interchange file segment ordering example:

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.

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)

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.