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834 Submission Section - PM

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Set the 834 Benefit Enrollment Submission file default values.

Prerequisites:

  • The Enable 834 Submissions registry setting must be set to 'Y'.

  1. In the Authorization Information Qualifier (ISA-01) field, choose the additional information category/type.
  2. In the Authorization Information (ISA-02) field, type the authorization information value.
  3. In the Security Information Qualifier (ISA-03) field, select the type of security information requested. The value populates the ISA-03 segment.
  4. In the Security Information (ISA-04) field, enter the security information value.
  5. In the Interchange ID Qualifier (ISA-05) field, select the interchange ID category. The value chosen here populates the ISA-05 segment.
  6. In the Interchange Sender ID (ISA-06) field, add the sender ID.
  7. In the Interchange ID Qualifier (ISA-07) field, select the value, which populates the ISA-07 segment.
  8. In the Interchange Receiver ID (ISA-08) field, type the receiver ID for the interchange.
  9. In the Repetition Separator (ISA-11) field, enter the value to be used as the repetition separator.
  10. In the Acknowledgement Requested (ISA-14) field, denote whether acknowledgement will be requested from the interchange receiver. The value populates the ISA-14 segment.
  11. In the Usage Indicator (ISA-15) field, select the data usage.
  12. In the Application Senders Code (GS-02) field, type the sender's code.
  13. In the Applications Receiver Code (GS-03) field, type the receiver's code.
  14. In the Specify Time Format in GS-05 field, select the time format to use. (HH = two-digit hours, MM = two-digit minutes, SS = two-digit seconds)
  15. In the Version Identifier Code (GS-08) field, select the applicable version for the 834 Submission filing.
  16. In the Master Policy Number (REF-02) field, enter the master policy number.
  17. In the Plan Sponsor Name (N1-02) field, fill in the name of the plan sponsor.
  18. In the Identification Code Qualifier (N1-03) field, select the identification code type.
  19. In the Sponsor Identifier (N1-04) field, enter the sponsor identification code.
  20. In the Insurer Name (N1-02) field, fill in the name of the insurer.
  21. In the Identification Code Qualifier (N1-03) field, select the identification code type.
  22. In the Insurer Identification Code (N1-04) field, enter the insurer identification code.
  23. In the TPA/Broker Name field, fill in the TPA/broker name.
  24. In the Identification Code Qualifier (N1-03) field, select the identification code type.
  25. In the TPA/Broker Identification Code (N1-04) field, enter the TPA/broker ID code.
  26. In the TPA/Broker Account Number (ACT-01) field, enter the number for the TPA/broker account.
  27. In the Specify Information to Include in Status Information Effective Date (2000-DTP-03) field, choose how the Member Level Dates (2000-DTP) segment within the 834 Submission will be populated, based upon the selected value(s) as follows:

  • Maintenance Date (Date Entry Date) - DTP-01 will be populated with '303', DTP-02 will be populated with 'D8', and DTP-03 will be populated with the data entry date of the financial eligibility information.

  • Eligibility Begin Date/End Date - Two DTP segments will be populated. The first DTP segment will be populated as follows: DTP-01 will be populated with '356', DTP-02 will be populated with 'D8', and DTP-03 will be populated with the Coverage Effective Date from Financial Eligibility. The second DTP segment will be populated as follows: DTP-01 will be populated with '357', DTP-02 will be populated with 'D8', and DTP-03 will be populated with Coverage Expiration Date from financial eligibility. The second DTP segment will only be populated if the coverage expiration date is defined.

  1. In the Insurance Line Code (HD-03) field, select the insurance line code to be used in the filing.

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