RBINTERFACE#
Purpse#
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 |
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. |
