Configuring the HIPAA 834 report

The Health Insurance Portability and Accountability Act (HIPAA) 834 report provides benefits enrollment and maintenance data in the required format. Before you can create the HIPAA 834 file or report, you must configure the output.
  • To use the process flow version of creating the HIPAA 834 report, follow the instructions below.
  • To use the File Creation Utility (FCU) to print and access historical report printout, see the Infor HR Talent Integration Architect in the Infor HR Talent Integrations Documentation Library.

To configure the HIPAA 834 file and report:

  1. Sign in as Administrator and select Utilities > Interfaces > Benefits Interface > HIPAA 834.
  2. Alternatively, navigate to Benefits > Utilities > Interface > HIPAA 834.
  3. Click Create and specify this information on the Main tab:
    Description
    Create HIPAA 834 File Specify the name that shows when selecting the file to run from the action.
    Provider
    Specify the provider of the benefit to be transmitted.
    Benefit Type
    Specify the benefit type for the benefit to transmit.
    Benefit Plan
    Select the plans within the benefit type that are included in the file.
    Note: Do not select Waive Plans because most providers do not want to receive data about employees who are not enrolled in the benefit plan.
    File Option
    An HIPAA 834 Electronic Data Interchange (EDI) file is created and saved to the specified file path. If the Update or Validate option is selected for the Transaction Purpose, then the EDI file is always created.
    File Path
    Specify the file path of the folder where the files are saved.
    Note: Best practices for file path setup is to create a folder for test files and a separate folder for production files.
    File Name
    Specify the file name that is using the naming convention according to the provider requirements.

    For example, VSP requires the file name to be:

    Client Name_VSP_HIPAA_YYYYMMDD_Test

    Note: To follow best practices, include a date in the file names. This prevents an override by another file if you run the file again before removing the current file in your delivery folder.
    Delete Prior Transmitted Records
    Select this check box if you are creating a "changes-only" file, such as employee transactions since the last file creation. If you are creating a full file, including everyone in the plan, for the provider, then clear this check box.
  4. Specify the Run Options:
    Transaction Purpose
    Specify the value sent within the 834 file header in the BGN 08 segment.
    • Validate

      Select this to produce a “4” in the BGN 08 segment. Typically, you select Validate to perform a reconciliation or validation of the provider’s membership system vs. Infor HR Talent.

      Note: The Validate option is typically selected when running a full file for reconciling systems.
    • Update
      Select this to produce a “2” in the BGN 08 segment. Typically, you select Update to include only changes of employees' benefits since the last time the file ran.
      Note: Update is typically selected to run a changes-only file. Select the Delete Prior Transmitted Records option in the File Parameters section.
    • Blank (no selection)
      If you do not select an option, then a “0” populates in the BGN 08 segment.
      Note: “0” (zero) is not a valid value in this field. Always select one of the three options unless indicated by the provider.
    Begin Date

    This field is only required when you select Update for Transaction Purpose. If you select Update, specify the date for which you want to include transactions. Example: You ran the previous file on July 15, and run this file weekly. On July 22, you want to run the file again. To capture changes from July 15 to the current date, specify July 15 in the Begin Date field, because that is the last time the changes were captured.

    Note: Best practices for Begin Date is to leave it blank if you select any of the options other than Update in Transaction Purpose.
    End Date

    This field is only required when you select Update for Transaction Purpose. If you selected Update, specify the end date you want to stop looking for transactions. Example: You ran the previous file on July 15, and run this file weekly. On July 22, you want to run the file again. To capture changes from July 15 to the current date, specify July 21 in the End Date field because you are capturing the changes on the next file run on July 22.

    Note: Best practices for End Date is to leave it blank if you select any of the options other than Update in Transaction Purpose.
    Validate As Of Date
    Specify a date in this field if you are required to produce the REF segment in the 834 file header. Specify the date the file is effective. Typically this is the same day you run the file. If you do not specify a value in this field, the entire DTP line will not populate.
    Rerun Option
    This creates the value that is sent in the BGN 01 segment on the 834 file header.
    • Not a Rerun Option This populates a “00” in the BGN 01 segment. Select this option if this is the first time you run the file for this particular parameter for this period. The “00” indicates the first time the transaction is sent.
    • Rerun; Changes Included This populates a “15” in the BGN 01 segment. Select this option if the original run was incorrect, but has not been processed by the receiver, and you want to rerun the file.
    • Rerun; Duplicate File This populates a “22” in the BGN 01 segment. Select this option if you want to create a copy of the original file.
    • Blank (no selection) This does not produce a value in BGN 01 segment. Only leave this field blank if the provider does not want a value in the BGN 01 segment.
    Identifying Code
    Specify the value that was supplied by your provider. This value populates in the BGN 02 segment.
    Prior
    The prior identifying code must be specified here if the Rerun Option is either Rerun; Changes Included or Rerun; Duplicate File.
    File Effective Date
    This field does not produce a value on the 834 file.
    Include Master Policy Number
    Select this if you are required to send the REF segment in the 834 file header. If you do not select it, the entire REF line will not populate.
    Note: The Master Policy Number is typically hard coded and is not specified on the front end of parameter setup.
    Broker or Third Party Administrator
    Choose this option to send this file to a broker or third party. The available options to select are configured with the Benefits module.
    Time Zone
    Specify the Time Zone to populate the BGN 05 segment in the 834 file header. It is best practice to populate this field if the file sender and the file receiver are not in the same time zone. Ask your provider if they require this value on the 834 file.
  5. On the Options tab, specify the Data Options:
    Resident Address
    Specify the value for resident address. The resident address is sent in the 834 file in the 2100A Loop in the N3 and N4 segments.
    Mailing Address

    Specify the value for the mailing address. The mailing address is sent in the 834 file in the 2100C Loop in the N3 and N4 segments.

    Note: You typically only send the mailing address when the subscriber’s mailing address is different from their residence address. Only the mailing address can be sent for dependent addresses that are different from the subscriber.
    Contact Details
    Specify phone numbers for the 834 file in the 2100A loop in the PER segments. You can send either the work phone, mobile phone, or both based on the selection in this field.
    Number Of Identification Cards Requested

    This field is used to send a value in the 2300 loop in the IDC segment.

    Note:  This is rarely used because most receivers cannot read this value on the file. Most transactions of additions or plan changes trigger plan card generation.
  6. Enable these Include options:
    • Coverage Options: Select this to populate the coverage level on the subscriber record. Example: Employee Only, Employee Spouse, Family, etc. This produces a value in the 2300 loop in the HD*05 segment.
    • Premium Amounts: Select this to populate premium amounts per benefit on the 834 file. This is not a common practice and you probably will not be required to select this option. This produces values in the 2100A loop in the AMT*02 line segment.
    • Marital Status: Select this to populate the subscriber’s marital status on the 834 file in the 2100B loop in the DMG*04 segment.
    • Disabled Status: Select this to populate if the subscriber or dependent is disabled on the 834 file in the 2000 loop in the INS*10 segment.
    • Student Status: Select this to include the dependent’s student code (FT, PT, Not a student) on the 834 file in the INS*09 segment in the 2000 loop.
    • Prior Months Coverage: This field is how many months of prior coverage the subscriber has had. This is typically not sent. This will produce a REF*QQ value in the 2300 loop.
    Primary Care Provider
    Select this if you want to transmit PCP information. This is passed in the 2310 loop on the 834 file. Typically, select this for any medical or dental plan files.
    Employment Begin Date
    This data field drives if the employee’s hire date should be sent on the file. Select either Start Date or Adjusted Start Date. If you select either of these options, the start date/adjusted start date will be sent on the 834 file in the 2000 loop as DTP*336.
    Coverage End Date
    This data field drives if the eligibility end date and benefit end date should be sent on the 834 file. The eligibility end date is DTP*357, which is sent in the 2000 loop and the benefit end date is DTP*349, which is sent in the 2300 loop. Select either or both end dates.
  7. On the Headers tab, specify the Interchange Control Header information:
    Include Interchange Control Header
    Select this unless the provider has asked you not to send a control header on the file.
    Authorization Information/Qualifier
    The value selected here populates on the 834 file header in the ISA 01 segment.
    • No Authorization Information Present: This populates “00” in the ISA 01 segment in the 834 file header.
      Note: This is the most common option for the 834 file.
    • Additional Data: This option produces a “03” in the ISA 01 segment. Specify the code from your provider in the field next to the drop-down list.
    Security Information/Qualifier
    The value specified here populates on the 834 file header in the ISA 03 segment.
    • No Security Information Present: This populates “00” in the ISA 03 segment.
      Note: This is the most common option for the 834 file.
    • Password: This populates a “01” in the ISA 03 segment.
      Note: If you select Password, a value for the password is required. That password populates in the ISA 04 segment.
    Sender ID Qualifier/Interchange
    This field populates the value in the ISA 05 and ISA 06 segment in the 834 file header.
    • Duns (Dun and Bradstreet) populates a “01” in the ISA 05 segment.
    • Duns Plus Suffix populates a “14” in the ISA 05 segment.
    • Health Industry Number (HIN) populates a “20” in the ISA 05 segment.
    • Carrier Identification Number as assigned by HCFA populates a “27” in the ISA 05 segment
    • Fiscal Intermediary Identification number as assigned by HCFA populates a “28” in the ISA 05 segment.
    • Medicare Provider and Supplier Identification Number populates a “29” in the ISA 05 segment.
    • U.S. Federal Tax Identification Number populates a “30” in the ISA 05 segment.
    • National Association of Insurance Commissioners Company Code (NAIC) populates a “33” in the ISA 05 segment.
    • Mutually Defined populates a “ZZ” in the ISA 05 segment.
    Receiver ID Qualifier/Interchange
    Populates the value in the ISA 07 and ISA 08 segment in the 834 file header.
    • Duns (Dun and Bradstreet) populates a “01” in the ISA 07 segment.
    • Duns Plus Suffix populates a “14” in the ISA 07 segment.
    • Health Industry Number (HIN) populates a “20” in the ISA 07 segment.
    • Carrier Identification Number as assigned by HCFA populates a “27” in the ISA 07 segment
    • Fiscal Intermediary Identification number as assigned by HCFA populates a “28” in the ISA 07 segment.
    • Medicare Provider and Supplier Identification Number populates a “29” in the ISA 07 segment.
    • U.S. Federal Tax Identification Number populates a “30” in the ISA 07 segment.
    • National Association of Insurance Commissioners Company Code (NAIC) populates a “33” in the ISA 07 segment.
    • Mutually Defined populates a “ZZ” in the ISA 07 segment.
    Interchange Control Number
    Populates the value in the ISA 13 segment in the 834 file header. This number is usually provided by the customer.
    Note: This value in the ISA 13 segment MUST be identical to the associated interchange number in the footer of the file in the IEA 02 segment. The file will generate an error for the provider if the numbers do not match.
    Acknowledgement Requested
    Populates the value in the ISA 14 segment on the 834 file header. This field is used to notify the receiver to send you an acknowledgement that the file was received.
    • Yes: A value of 1 is sent.
    • No A value of 0 is sent.
    Interchange Usage Indicator
    Populates the value in the ISA 15 segment on the 834 file header. It notifies the receiver if the file is a test file or a production file.
    • Test Data: This selection will populate a “T”.
    • Production Data: This selection will populate a “P”.
  8. Specify the Functional Group Header information:
    Include Functional Group Header
    Enable this check box to populate the functional group header with the specified Application Sender and Receiver Codes.
    Application Sender/Receiver Codes
    Populates the GS 02 and GS 03 834 header field. The sender is in GS 02 and the receiver is in the GS 03. Your provider supplies these values.
  9. On the Transaction Set Control Totals tab, specify this information:
    Include Transaction Set Control Totals
    Enable this check box to populate the functional group header. Do not select any value in this field unless your provider has asked you to send the count of subscribers, dependent, and/or totals on the 834 file. If you populate this field, the highlighted value will populate right below the 834 file header and right before the member contract.
    Group Control Number
    Populates a value in the 834 file’s footer in the GE 02 segment. The GE 02 segment is a unique value assigned to the file.
    Note: This is typically left blank because by default the value is populated by the system.
    Transaction Set Control Number
    Populates a value in the 834 file’s footer in the SE 02 segment. The SE 02 segment is a unique value assigned to the file.
    Note: This is typically left blank because by default the value is populated by the system.
  10. Click Save to save the provider and benefit HIPAA 834 report output configuration.