![]() ![]() ![]() 1.1 HIPAA Purpose In 1991, the Secretary of the Department of Health and Human Services organized a forum to discuss the challenges of reducing administrative costs within the health care industry. Use this Companion Guide in conjunction with the ASC X12N 834 Implementation Guide. The purpose of this Companion Guide is to simplify the implementation of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 provisions for administrative simplification that support the electronic exchange of benefit enrollment and maintenance information. ii Chapter 1 Introduction HIPAA Purpose Overview of ANSI ASC X12N Transactions Scope of this Companion Guide Overview of this Companion Guide References Advantages of Electronic Data Interchange (EDI) Version and Release Numbers Conventions for Charts Normal text (No Italics or Parentheses) Italics Parentheses ( ) Shaded Cells.9 Chapter 2 Getting Started Working with Anthem EDI Methodology Direct 834 Submission Enrollment Vendor Choose Your EDI Method Trading Partner Group Set up Working with Anthem EDI Specialists.11 Chapter 3 Testing Preliminary Testing Processes Preliminary Testing Steps Initiating the Testing Process Testing Phases Phase 1 Connectivity testing Phase 2 Anthem 834 Compliance testing Phase 3 Anthem 834 Translation testing Production Anthem 834 Final Testing Information for Chapter 4 Connectivity and Communications.14 Chapter 5 Acknowledgments and Reports Interchange Acknowledgment (TA1) TA1 Transactions TA1 Error Code Data Description Functional Acknowledgment Delivery Schedule Work with Your EDI Enrollment Vendor Important Implications for You Tools to Read the What to Do Upon Receiving the Resubmitting Transactions that Fail Compliance (AK901 = R or AK901 = P) Delimiters.37 Part II.39 Chapter 6 Envelope Control Segments Interchange Control Header (ISA) Interchange Control Trailer (IEA) Functional Group Header (GS) Functional Group Trailer (GE).41 Chapter Companion Document Basic Instructions Receipt Time for Same-Day EDI Processing Send Frequency Full 834 Transactions Policy/834 Agreement for Spouse/Dependent Coverage Changing the Primary Care Physician (PCP) Changing the Insurance Line (PPO, HMO, or POS).43 IG Version A1 3Ĥ 834 Companion Guide Anthem File Enrollment System Delimiters Header Detail Trailer.53 Chapter 8 Business Rules and FAQs Business Rules Compliance Transaction Reconciliation Full 834 Transactions Accurate Group Number Always Enter a Health Coverage Date New Policy Effective Date to Change Keep Existing Policy Effective Date Policy/834 Agreement for Spouse/ Dependent Coverage Identify PCP When Adding Members to a POS or HMO Policy Updating PCP for member Processing Times and Holiday schedules Support Hours Future Cancellations Cancellation by Omission Reinstatements Separate Transactions required for each insurance line PCP Information Frequently Asked Questions (FAQs) Type of File Requirement No Charge for File Enrollment ID Cards ID Card Replacement File Submission methods Full 834 Files Only Anthem Contact Send Frequency s TA1s.58 Appendix A.59 Anthem 834 Group Set Up Form.59 Appendix C.61 FES Business rules and testing scenarios IG Version X095A1ĥ 834 Companion Guide Anthem File Enrollment System Chapter 1 Introduction Anthem Blue Cross Blue Shield of Virginia, hereafter referred to as Anthem, is pleased to provide this Companion Guide (CG) to help employer groups or their representatives to produce a HIPAA-compliant 834 Benefit Enrollment and Maintenance transaction. ii IG Version X095A1ģ 834 Companion Guide Anthem File Enrollment System This page is intentionally blank. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.Ģ This page is intentionally blank. ![]() ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. ![]() Independent licensee of the Blue Cross and Blue Shield Association. 1 Anthem 834 Companion Guide ANSI ASC X12N 834 Benefit Enrollment and Maintenance Transactions Incoming to the File Enrollment System (FES) Anthem Blue Cross Blue Shield, Virginia EDI IG Version: X095A1 CG Release: 1.9 (December 2010) Anthem Health Plans of Virginia, Inc. ![]()
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