Defining HIPAA plan details

This procedure outlines the requirement for defining HIPAA plan details.

  1. Access Plan Details (BN15.2).
  2. Use these guidelines to specify the field values:
    Create Transactions

    Select whether records should be created to identify when enrollment change occurs in this plan. The records created will be used to create the EDI transaction file.

    Plan Sponsor ID

    Specify a plan sponsor ID. By HIPAA mandate, the ID should be the Federal Tax ID number assigned by the IRS to the company.

    This field can be used to override the Plan Sponsor ID entered on Benefits Company (BN00.1). If different process levels offer different benefit plans, then they can have unique sponsor identification numbers.

    If different plans require different plan sponsor ID numbers, then this number can be overridden at the plan level on BN15.1.

    If you will not be sending EDI transactions, or will be using the Company ID on BN00.1, then you can leave this field blank.

    Member ID

    Select whether to use the employee's social number or the employee or dependent number as an identifier for the subscriber when passing enrollment data to the carrier.

    Insurance Line

    Select the line of insurance product that corresponds to this plan.