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August 18, 2017

ACTION NEEDED -  BCBSKS 834 Health Care Benefit Enrollments and Maintenance Editing September 5, 2017

September 5, 2017 BCBSKS will implement editing on the 834 Health Care Benefit Enrollment and Maintenance transaction.

This change will ensure requirements are met for complete and valid information and will reduce delays caused by these types of errors.

New editing

  • 2000 INS01 - Missing Subscriber Indicator
  • 2000 INS02 - Missing Relationship Code
  • 2000 INS02 - Invalid Relationship Code 
  • 2000 INS03 - Missing Maintenance Type Code
  • 2000 INS03 - Invalid Maintenance Type Code
  • All DTP segments - Invalid Date Format – Ex: 02/31/2017 or Ex: 99/99/9999
  • 2100A DMG02 - Missing DOB IF DMG segment is present
  • 2100A DMG03 - Missing Gender IF DMG segment is present 
  • 2100A NM109 - Missing SSN IF NM108=34  
  • 2100A NM109 - Invalid SSN IF NM108=34 Default values of 0's,1's,2's,3's,4's,5's,6's,7's,8's,9's or invalid value such as 123456789
  • 2000 REF*0F - Missing Subscriber Identifier Missing entire segment and/or missing REF02 only
  • 2300 HD03 - Missing Insurance Line Code IF HD segment is present 
  • 2300 HD03 - Invalid Insurance Line Code IF HD segment is present 
  • 2300 HD05 - Invalid Coverage Line Code IF HD segment is present and HD05 is invalid
  • Header REF*38 - Missing/Invalid MPN  
  • 2300 HD04 - Missing/Invalid Plan Coverage Description
  • 2300 HD05 - Missing Coverage Level Code

BCBSKS returns the 999 Industry Standard Acknowledgment for the ANSI X12 834 transaction for each successful submission.  The 999 reflects if the ANSI X12 834 transaction was accepted, rejected or accepted with syntax warnings. 

A new proprietary BCBSKS 834 Acknowledgement was developed. The BCBSKS 834 Acknowledgement will be available in your "Outbound" folder when your file receives warnings or rejections.  The file name is: ACK*filename*dateandtime.txt

All acknowledgements should be downloaded and reviewed after each submission confirming the file was accepted for processing.

  • Warnings should be corrected with the next file submission.  
  • Rejections will need to be corrected and the file resubmitted.  

For your reference you can find more information regarding Acknowledgements at:  https://ask-edi.com/edi_employer_groups/

 

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