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. |
RECORD LAYOUTS#
ISA – Interchange Control Header record
#
Purpose: To start and identify an interchange of documents Repeat: 1
Notes: The ISA is a fixed record length segment and all positions with each of the data elements must be filled (i.e. space fill). These segments are always required
| 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 | IDIF definition Rec#10 Field#15 (constant value) | |
| ISA | 16 | Component Element Separator | Y | : |
Example:
ISA*00* *00* *ZZ*9999999*ZZ*ASK*090101*1916*U*00401*999999999*1*T*>\\
Processing:
This record is always created, one record per file.
