HNE has developed the following Companion Guide as a support tool for the Benefit Enrollment and Maintenance Guide ASC X12 834 version 004010 HIPAA Implementation Guide, First Addenda. The implementation guide is 004010X095A1; published in October 2002 and available from http://www.wpc-edi.com (PDF download for registered users.)

Communications

Our partners may select from two options for filing enrollments electronically:

• You can send files to our FTP server.
• You can place files on your FTP server where we can retrieve them.

Either method may use PGP or SSL encryption. SSL is preferred.

EDI Controls

X12 EDI transactions use the ISA, GS, and ST segments as control segments. HNE’s requirements for these segments are as follows: 

HNE has no standard or preference for delimiters. Your standard or preference works for us. If you have no standard or preference, then use the HIPAA Implementation Guide guidelines.

ISA Segment

The ISA segment is the first line that HNE receives in a EDI file. Some elements within each ISA segment have a number of possible values. Please use the following values for each ISA element: 

ISA01 00

ISA02 10 spaces

ISA03 00

ISA04 10 spaces

ISA05 We accept all of the codes listed in appendix B.1. Our preference is not to use ZZ.

ISA06 Assign the value based on the qualifier.

ISA07 We accept 01, 30, 33 and ZZ. Our preference is not to use ZZ. We prefer 01.

ISA08 You can use these values:

Qualifier Value

01 152427324

30 042864973

33 95673

For other ISA elements, please follow the implementation guide.

GS Segment

Please use the following values for each GS element:

GS01 BE

GS02 We accept anything, but prefer to mimic what is in ISA06.

GS03 We accept anything, but prefer to mimic what is in ISA08. 

For other GS elements, please follow the implementation guide.

Control Numbers

We expect at least one of the ISA, GS and ST control numbers to increment from day to day. Our software has a separate counter for each trading partner to seed the ISA control number, and a separate counter for each trade agreement to seed the GS control number; the software always starts the ST control number at 1. All three control numbers are incremented by one.

The 997 Functional Acknowledgement transaction does not echo back the ISA control number. If you want to use the 997 to reconcile the 834 (or any other transaction we do in the future) then the GS and/or ST control numbers should increment from day to day.

• EnvelopesWe can accept multiple ISA-IEA envelopes within a single file, but this is not required.
• We can accept multiple GS-GE envelopes within a single ISA-IEA, but this is not required.
• We can accept multiple ST-SE envelopes within a single GS-GE, but this is not required.

834 Requirements

 

1. IRS# Employer Identification numbers and Social Security Numbers should not contain hyphens or any other formatting.
2. ZIP+4 codes should not contain hyphens or any other formatting.
3. Telephone numbers should not contain hyphens, parentheses, or any other formatting.
4. For members with Medicare please forward a copy of their Medicare coverage (fax, USPS). Members with Medicare will pend until this documentation is received.
5. For student dependents (as defined by the age policy for your group) please forward a copy of their enrollment confirmation (fax, USPS). Student dependents will pend until this documentation is received.
6. Only send a dependant address when it is different from the subscriber’s address.