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 021 60 Char N1P5-Payer Name
50 3 N1(Identifier P5) segment 031 2 Char ‘FI’
50 4 N1(Identifier P5) segment04 1 80 Char N1P5-Payer Identification Code
52 2 N1(Identifier IN) segment 021 6 Char N102 = The name of the client group
52 3 N1(Identifier IN) segment 031 2 Char ‘FI’
52 4 N1(Identifier IN) segment 041 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_LOCATIONmember supplemental number('2000 REF02')
P2K_BE_BENEFIT_RECIPIENTSPRIME PHYSICIANPHYSICIAN 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 SegmentCodeDescriptionProcessing Conditions
1000A N1P5Plan SponsorOne per File
1000B N1INInsurerOne per File
1000C N1TVTPA/Broker NameSituational
2000 INSYMember is a SubscriberOne record only, either ‘Y’ or ‘N’
2000 INSNMember is a Dependant
2000 REF0FSubscriber Number
2000 REF1LGroup Number
2000 REFF6Medicare HIC NumberSituational
2000 DTP303Maintenance Effective Date
2000 DTP336Employ Begin Date (Subscriber only)
2000 DTP338Medicare Begin Date
2000 DTP339Medicare End Date
2000 DTP356Eligibility Begin Date
2000 DTP357Eligibility End/ Termination Date
2000 DTP394Rehire DateSituational
2100A NM1ILMember Name
2100A PERIPMember Communication NumbersSituational
2100A N3 Member Resident Street AddressRequired for Subscriber segment
2100A N4 Resident City, State, ZIPRequired if Segment ‘2100A N3’ is sent
2100A DMG Member Demographics
2100A NM131Member Mailing AddressSituational
2100C N3 Member Mailing Street AddressSituational
2100C N4 Mailing City, State, ZIPSituational
2200 DSB2Long Term DisabilitySituational
2200 DTP360Disability Begin DateSituational
2200 DTP361Disability End DateSituational
2300 HD001Health Coverage ChangeOne record code only
2300 HD021Health Coverage AddOne record code only
2300 HD024Health Coverage TerminationOne record code only
2300 HD030Maintenance Type Code UnknownOne record code only
2300 DTP348Benefit Begin Date
2300 DTP349Benefit End Date
2300 REF1LMember Policy Number
  • The following record segments will be written at the end of the file:  “SE’, ‘GE’, ‘IEA’.

Report Parameters#

Report ParametersDescription
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 FileValue 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.

This particular version was published on 26-Nov-2021 10:22 by Kevin Higgs.Top