834 Version
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Version for 10/1
– 5010220A1 standard
– Batch file processing only, no real time enrollment
transactions
– Outbound standard for Individual, SHOP,
reconciliation, CMS reporting
– Inbound standard from Carriers and TPAs utilize
same version
Inbound Scheduling
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834 files from the Maryland Health Connection
will be transmitted during the nightly batch
process
– Midnight to 5:00 am (pending production volume)
Maryland Health Connection expects
acknowledgements to be delivered within a 24
hour window
Outbound Scheduling
834 files from the Carrier and TPAs will be processed
starting at 9:00 am
Maryland Health Connection generates
acknowledgements within a 24 hour window
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Inbound and Outbound
Validation
Carrier and TPA must follow SNIP 1 and SNIP 2
edits mandated by HIPAA
Maryland Health Connection will follow the SNIP 1
and SNIP 2 edits mandated by HIPAA
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Connectivity
SFTP server where a Carrier/TPA picks up the file
Inbox
– Inbound files from Maryland Health Connection to Carrier/TPA
Outbox
– Outbound files from Carrier/TPA to Maryland Health Connection
Files are archived in corresponding archive folders for future reference and/or error resolution
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Security
Files that contain PHI must be encrypted:
– Inbound – files from the Maryland Health
Connection sent to the Carrier and TPA will be
encrypted using PGP with the respective Carrier
and TPA public key
– Outbound – files from Carrier and TPA sent to the
Maryland Health Connection will be encrypted
using PGP with the Maryland Health Connection’s
public key
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ISA – Interchange Control Header
ISA06 – Interchange Sender ID
– HIX01MD
ISA08 – Interchange Receiver ID
– Assigned to Carrier and TPA as per the Business Agreement
ISA13 – Interchange Control Number
– Unique control number for each file sent must increment from one day to the next
ISA15 – Usage Indicator
– T = Test Data
– P = Production Data
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GS – Functional Group Header
GS02 – Application Sender's Code
– Must be the same value as ISA06
GS03 – Application Receiver’s Code
– Must be the same value as ISA08
GS06 – Group Control Number
– Unique control number for each group sent must
increment from one day to the next
GS08 – Version Identifier Code
– Must be 005010X220A1
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ST – Transaction Set Header
SE – Transaction Set Trailer
Individual Market
– One individual information will be looped in one ST-
SE transaction
SHOP Market
– One group information will be looped in one ST-SE
transaction
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Loop 1000A – Sponsor Name
Individual Market
– N102 – Subscriber name or Responsible Person name
– N103 – FI
– N104 – SSN is required as the identification code
SHOP Market
– N102 – Employer group name
– N103 – 24
– N104 – Employer TIN is required as the identification code
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Loop 1000B – Payer
N102 – Carrier Name
N103 – FI
N104 – Assigned to Carrier as per the Business
Agreement (same as ISA08 & GS03)
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Loop 1000C / 1100C –
TPA/Broker/Navigator
Individual Market
– Navigator Information
– Broker Information
SHOP Market
– Navigator Information
– Broker Information
– TPA and Broker Information
N102 – Navigator or Broker Name
N103 – FI
N104 – Navigator or Broker Tax ID
ACT01 – Navigator, Broker, or TPA Account Number
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INS – Member Level Detail
INS01 – Response Code
– Y = Insured
– N = Dependent
INS03 – Maintenance Type Code
– Maryland Health Connection uses this code to
identify the specific type of maintenance001-Change
021-Addition
024-Cancellation
025-Reinstatement
030-Audit or Compare
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REF – Subscriber Identifier
REF01 – 0F (0F=Subscriber Number)
REF02 – Subscriber Number assigned by
Maryland Health Connection for identification
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Loop 2100A – Demographic
Information
NM103 – Last Name
NM104 – First Name
NM108 – 34
NM109 – SSN
N3/N4 – Address
DMG02 – Date of Birth
DMG03 – Gender Code
DMG05-1 – Race Code
HLH01 – Tobacco Usage Indicator
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HD – Health Coverage
HD01 – same as INS03
HD03 – Insurance Line Code (DEN, HLT)
– Used to identify the insurance type under coverage
HD05 – Coverage Level Code (EMP, FAM, etc.)
– Level of coverage being provided
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DTP – Health Coverage Dates
DTP01 – 303/348
– Effective date of coverage
DTP01 – 349
– Coverage termination date
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REF – Health Coverage
Policy Number
REF01 – 1L (1L = Qualifier for Policy Number or
Plan ID)
– Will transmit when the Exchange Assigned Policy
Identifier will be conveyed in the associated REF02
element.
REF02 – Policy Number or Plan ID
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Loop 2310 – Provider
Information
LX – Provider Information is sent when required
by Carrier
NM108 – Provider Identification Code Qualifier
– SV = Service Provider Number
– XX = Centers for Medicare and Medicaid Services
National Provider Number
NM109 – Provider Identification Code
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Loop 2750 – MD-Specific
Reporting Categories
N101 – Participant
N102 – Carrier to Bill/CSR AMT/APTC AMT
REF02 – CSR AMT/APTC AMT
DTP03 – Effective Date
APTC
– Amount the QHP issuer can expect to receive toward the total premium payment (APTC)
CSR
– Advance CSR payment amount
If an individual elects to pay the Carrier, this information is sent in this reporting category loop
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Reconciliation
Reconciliation files will be processed on the 15th
of each month
Refer to the Carrier Integration Package, Section
10.5 for a list of required reconciliation data
elements
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