Ford 834 Implementation Guidelines - GSEC GEC Hub 834 Implementation Guidelines X12 Implementation...

Ford 834 Implementation Guidelines

X12 Implementation Guidelines

For Outbound

Benefit Enrollment and Maintenance

v004010

(834O)

Ford Motor Company

fd834O (004010) July 21, 2006 1

834 Benefit Enrollment and Maintenance

DRAFT

Functional Group ID=BE

Introduction:

This Draft Standard for Trial Use contains the format and establishes the data contents of the Benefit Enrollment and

Maintenance Transaction Set (834) for use within the context of an Electronic Data Interchange (EDI) environment.

This transaction set can be used to establish communication between the sponsor of the insurance product and the

payer. Such transaction(s) may or may not take place through a third party administrator (TPA). For the purpose of

this standard, the sponsor is the party or entity that ultimately pays for the coverage, benefit or product. A sponsor

can be an employer, union, government agency, association, or insurance agency. The payer refers to an entity that

pays claims, administers the insurance product or benefit, or both. A payer can be an insurance company, health

maintenance organization (HMO), preferred provider organization (PPO), government agency (Medicare, Medicaid,

Champus, etc.), or an entity that may be contracted by one of these former groups. For the purpose of the 834

transaction set, a third party administrator (TPA) can be contracted by a sponsor to handle data gathering from those

covered by the sponsor if the sponsor does not elect to perform this function itself.

Table 1 - Header:

Pos. Seg. Req. Loop Notes and

No. ID Name Des. Max.Use Repeat Comments

Must Use 010 ST Transaction Set Header M 1 Must Use 020 BGN Beginning Segment M 1

030 REF Transaction Set Policy Number O 1

040 DTP File Effective Date O >1

LOOP ID - 1000A 1 Must Use 070 N1 Sponsor Name M 1 n1

LOOP ID - 1000B 1 Must Use 070 N1 Payer M 1 n2

LOOP ID - 1000C 2 Not Used 070 N1 TPA/Broker Name X 1 n3

LOOP ID - 1100C 1 Not Used 120 ACT TPA/Broker Account Information X 1

Table 2 - Detail:

Pos. Seg. Req. Loop Notes and

No. ID Name Des. Max.Use Repeat Comments

LOOP ID - 2000 >1 Must Use 010 INS Member Level Detail M 1 n4 Must Use 020 REF Subscriber Number M 1 n5 Not Used 020 REF Member Policy Number X 1 n6

020 REF Member Identification Number O 6 n7 Not Used 020 REF Prior Coverage Months X 1 n8

025 DTP Member Level Dates O 20

LOOP ID - 2100A 1 Must Use 030 NM1 Member Name M 1

040 PER Member Communications Numbers O 1

050 N3 Member Residence Street Address O 1

060 N4 Member Residence City, State, Zip Code O 1 Must Use 080 DMG Member Demographics M 1

110 ICM Member Income O 1

120 AMT Member Policy Amounts O 1

Ford Motor Company

fd834O (004010) July 21, 2006 2

Not Used 130 HLH Member Health Information X 1 Not Used 150 LUI Member Language X 5

LOOP ID - 2100B 1

030 NM1 Incorrect Member Name O 1 Not Used 080 DMG Incorrect Member Demographics X 1

LOOP ID - 2100C 1 Not Used 030 NM1 Member Mailing Address X 1 Not Used 050 N3 Member Mail Street Address X 1 Not Used 060 N4 Member Mail City, State, Zip X 1

LOOP ID - 2100D 3 Not Used 030 NM1 Member Employer X 1 Not Used 040 PER Member Employer Communications Numbers X 1 Not Used 050 N3 Member Employer Street Address X 1 Not Used 060 N4 Member Employer City, State, Zip X 1

LOOP ID - 2100E 3 Not Used 030 NM1 Member School X 1 Not Used 040 PER Member School Communications Numbers X 1 Not Used 050 N3 Member School Street Address X 1 Not Used 060 N4 Member School City, State, Zip X 1

LOOP ID - 2100F 1

030 NM1 Custodial Parent O 1 Not Used 040 PER Custodial Parent Communications Numbers X 1

050 N3 Custodial Parent Street Address O 1

060 N4 Custodial Parent City, State, Zip O 1

LOOP ID - 2100G 1 Not Used 030 NM1 Responsible Person X 1 Not Used 040 PER Responsible Person Communications Numbers X 1 Not Used 050 N3 Responsible Person Street Address X 1 Not Used 060 N4 Responsible Person City, State, Zip X 1

LOOP ID - 2200 1 Not Used 200 DSB Disability Information X 1 n9 Not Used 210 DTP Disability Eligibility Dates X 2

LOOP ID - 2300 99 Must Use 260 HD Health Coverage M 1 Must Use 270 DTP Health Coverage Dates M 4 Not Used 280 AMT Health Coverage Policy X 4

290 REF Health Coverage Policy Number O 3 Not Used 300 IDC Identification Card X 10

LOOP ID - 2310 30 Not Used 310 LX Provider Information O 1 n10 Not Used 320 NM1 Provider Name M 1 n11 Not Used 360 N4 Provider City, State, Zip Code X 1 Not Used 370 PER Provider Communications Numbers X 2 Not Used 395 PLA PCP Change Reason X 1

LOOP ID - 2320 5

400 COB Coordination of Benefits O 1

405 REF Additional Coordination of Benefits Identifiers O 5 Not Used 410 N1 Other Insurance Company Name X 1

450 DTP Coordination of Benefits Eligibility Dates O 2

Must Use 690 SE Transaction Set Trailer M 1

Ford Motor Company

fd834O (004010) July 21, 2006 3

Transaction Set Notes

1. At least one iteration of loop 1000 is required to identify the sender or receiver.



4. A Subscriber is a person who elects the benefits and is affiliated with the employer or the insurer. A

Dependent is a person who is affiliated with the subscriber, such as a spouse, child, etc., and is therefore

entitled to benefits. Subscriber information must come before dependent information. The INS segment

is used to note if information being submitted is subscriber information or dependent information.

5. The REF segment is required to link the dependent(s) to the subscriber.




9. The DSB loop may only appear for the Subscriber.

10. Loop 2310 contains information about the primary care providers for the subscriber or the dependent,

and about the beneficiaries of any employer-sponsored life insurance for the subscriber.

11. Either NM1 or N1 will be included depending on whether an individual or organization is being

specified.

12. The interchange control headers set the actual values of the data element separator, sub element

separator, and the data segment terminator for this interchange. It is expected that these values be read

dynamically by an EDI translator and are defined here for informational purposes only. In the segment

diagram below the data element separator is represented by the "~" character (ASCII Hex '7E' Decimal

'126'). The Sub Element Separator is represented by the "<" character (ASCII Hex '3C' Decimal '60').

The Segment Terminator appears graphically as a "." or a small box (ASCII Hex '1C' Decimal '28'). For

the purposes of creating this document a period was used as the segment terminator and should not be

interpreted as the literal value for a segment terminator. The values are used consistently from the header

through the interchange trailer. Refer to the Ford Motor Company "X12 Interchange" document for a

full representation of the interchange enveloping structures.

Ford Motor Company

fd834O (004010) July 21, 2006 4

Segment: ST Transaction Set Header

Position: 010

Loop:

Level: Heading:

Usage: Mandatory

Max Use: 1

Purpose: To indicate the start of a transaction set and to assign a control number

Syntax Notes:

Semantic Notes: 1 The transaction set identifier (ST01) used by the translation routines of the

interchange partners to select the appropriate transaction set definition (e.g., 810

selects the Invoice Transaction Set).

Comments:

Notes: Example: ST~834~0001.

Data Element Summary

Ref. Data

Des. Element Name Attributes

>> ST01 143 Transaction Set Identifier Code M ID 3/3 Code uniquely identifying a Transaction Set

834 Benefit Enrollment and Maintenance

>> ST02 329 Transaction Set Control Number M AN 4/9 Identifying control number that must be unique within the transaction set

functional group assigned by the originator for a transaction set

The transaction set control numbers in ST02 and SE02 must be identical. This

unique number also aids in error resolution research. For example, start with

the number 0001 and increment from there. This number must be unique

within a specific group and interchange, but the number can repeat in other

groups and interchanges.

Ford Motor Company

fd834O (004010) July 21, 2006 5

Segment: BGN Beginning Segment

Position: 020

Loop:

Level: Heading:

Usage: Mandatory

Max Use: 1

Purpose: To indicate the start of a transaction set

Syntax Notes: 1 If BGN05 is present, then BGN04 is required.

Semantic Notes: 1 BGN02 is the transaction set reference number.

2 BGN03 is the transaction set date.

3 BGN04 is the transaction set time.

4 BGN05 is the transaction set time qualifier.

5 BGN06 is the transaction set reference number of a previously sent transaction

affected by the current transaction.

Comments:

Notes: Example: BGN~00~2001072320101700~20010723~201017~ES~~~2.


Ref. Data


>> BGN01 353 Transaction Set Purpose Code M ID 2/2 Code identifying purpose of transaction set

00 Original

Used to indicate that this is the first time Daily or

Monthly change transactions are being sent.

Daily Change N102 will contain "PEOPLESOFT

DAILY CHANGE", N101=P5

22 Information Copy

Used to indicate that the data is to be used to conduct an

audit. Represents a Full Positive file.

N102 will contain "PEOPLESOFT FULL POS",

N101=P5

>> BGN02 127 Reference Identification M AN 1/30 Reference information as defined for a particular Transaction Set or as

specified by the Reference Identification Qualifier

Transaction set reference number assigned by the transaction builder to

uniquely identify this occurrence of the transaction for future reference. The

reference number is derived from run date (format CCYYMMDD) and run

time (HHMMSSDD).

>> BGN03 373 Date M DT 8/8 Date expressed as CCYYMMDD

Identifies the date the submitter created the file. Represents run date or date

mailboxed

>> BGN04 337 Time M TM 4/8 Time expressed in 24-hour clock time as follows: HHMM, or HHMMSS, or

HHMMSSD, or HHMMSSDD, where H = hours (00-23), M = minutes (00-

59), S = integer seconds (00-59) and DD = decimal seconds; decimal seconds

are expressed as follows: D = tenths (0-9) and DD = hundredths (00-99)

Used to identify the time of day the submitter created the file. Represents run

time or time mail boxed. Format is HHMM.

BGN05 623 Time Code O ID 2/2

Code identifying the time. In accordance with International Standards

Organization standard 8601, time can be specified by a + or - and an indication

in hours in relation to Universal Time Coordinate (UTC) time; since + is a

restricted character, + and - are substituted by P and M in the codes that follow

ES Eastern Standard Time

Ford Motor Company

fd834O (004010) July 21, 2006 6

X BGN06 127 Reference Identification O AN 1/30 Reference information as defined for a particular Transaction Set or as


X BGN07 640 Transaction Type Code O ID 2/2

Code specifying the type of transaction

Refer to 004010 Data Element Dictionary for acceptable code values.

>> BGN08 306 Action Code M ID 1/2 Code indicating type of action

2 Change (Update)

Value of '2' used to denote a daily activity file. Used to

identify a transaction of additions, terminations and

changes to the current enrollment.

4 Verify

Used for Full Positive File, which is a full enrollment

transaction to verify that the sponsor's and payer's

systems are synchronized.

X BGN09 786 Security Level Code O ID 2/2

Code indicating the level of confidentiality assigned by the sender to the

information following


Ford Motor Company

fd834O (004010) July 21, 2006 7

Segment: REF Transaction Set Policy Number

Position: 030

Loop:

Level: Heading:

Usage: Optional

Max Use: 1

Purpose: To specify identifying information

Syntax Notes: 1 At least one of REF02 or REF03 is required.

2 If either C04003 or C04004 is present, then the other is required.


Semantic Notes: 1 REF04 contains data relating to the value cited in REF02.

Comments:

Notes: Example: REF~38~001.


Ref. Data


>> REF01 128 Reference Identification Qualifier M ID 2/3 Code qualifying the Reference Identification

38 Master Policy Number

Value of '38' is used for Reporting Carrier ID - the

carrier that administers coverage or distributes data to

other carriers

>> REF02 127 Reference Identification M AN 1/30 Reference information as defined for a particular Transaction Set or as


Contains Reporting Carrier ID

X REF03 352 Description X AN 1/80 A free-form description to clarify the related data elements and their content

X REF04 C040 Reference Identifier O

To identify one or more reference numbers or identification numbers as

specified by the Reference Qualifier

X C04001 128 Reference Identification Qualifier M ID 2/3 Code qualifying the Reference Identification


X C04002 127 Reference Identification M AN 1/30 Reference information as defined for a particular Transaction Set or as


X C04003 128 Reference Identification Qualifier X ID 2/3 Code qualifying the Reference Identification


X C04004 127 Reference Identification X AN 1/30 Reference information as defined for a particular Transaction Set or as


X C04005 128 Reference Identification Qualifier X ID 2/3

Code qualifying the Reference Identification




Ford Motor Company

fd834O (004010) July 21, 2006 8

Segment: DTP File Effective Date

Position: 040

Loop:

Level: Heading:

Usage: Optional

Max Use: >1

Purpose: To specify any or all of a date, a time, or a time period

Syntax Notes:

Semantic Notes: 1 DTP02 is the date or time or period format that will appear in DTP03.

Comments:

Notes: Example: DTP~007~D8~20010723.


Ref. Data


>> DTP01 374 Date/Time Qualifier M ID 3/3

Code specifying type of date or time, or both date and time

007 Effective

Value of '007' represents a report data or the date the

data was generated in the system.

>> DTP02 1250 Date Time Period Format Qualifier M ID 2/3 Code indicating the date format, time format, or date and time format

D8 Date Expressed in Format CCYYMMDD

>> DTP03 1251 Date Time Period M AN 1/35 Expression of a date, a time, or range of dates, times or dates and times

Used to communicate report date.

Ford Motor Company

fd834O (004010) July 21, 2006 9

Segment: N1 Sponsor Name

Position: 070

Loop: 1000A Mandatory

Level: Heading:

Usage: Mandatory

Max Use: 1

Purpose: To identify a party by type of organization, name, and code

Syntax Notes: 1 At least one of N102 or N103 is required.

2 If either N103 or N104 is present, then the other is required.

Semantic Notes:

Comments: 1 This segment, used alone, provides the most efficient method of providing

organizational identification. To obtain this efficiency the "ID Code" (N104) must

provide a key to the table maintained by the transaction processing party.

2 N105 and N106 further define the type of entity in N101.

Notes: Example: N1~P5~NESC - HRIMS Daily Change~FI~380549190.


Ref. Data


>> N101 98 Entity Identifier Code M ID 2/3 Code identifying an organizational entity, a physical location, property or an

individual

P5 Plan Sponsor

Value of 'P5' used to indicate Systems Source Type.

N102 will contain employer and file type of daily, or

full positive.

N102 93 Name X AN 1/60 Free-form name

If daily change, N102 will contain "PEOPLESOFT DAILY CHANGE"

If Information Copy (BGN01=22), N102 will contain "PEOPLESOFT FULL

POS"

>> N103 66 Identification Code Qualifier M ID 1/2 Code designating the system/method of code structure used for Identification

Code (67)

FI Federal Taxpayer's Identification Number

The developers recommend that this code be used until

the HIPAA standard identifier is implemented.

ZZ Mutually Defined

The value 'ZZ', when used in this data element shall be

defined as "HIPAA Employer Identifier" once this

identifier has been adopted. Under the Health Insurance

Portability and Accountability Act of 1996, the

Secretary of the Department of Health and Human

Services must adopt a standard employer identifier for

use in this transaction.

>> N104 67 Identification Code M AN 2/80 Code identifying a party or other code

This will contain Ford's Federal Taxpayer ID Number until the HIPAA

Employer Identifier is adopted.

X N105 706 Entity Relationship Code O ID 2/2 Code describing entity relationship


X N106 98 Entity Identifier Code O ID 2/3

Code identifying an organizational entity, a physical location, property or an

individual


Ford Motor Company

fd834O (004010) July 21, 2006 10

Segment: N1 Payer

Position: 070

Loop: 1000B Mandatory

Level: Heading:

Usage: Mandatory

Max Use: 1

Purpose: To identify a party by type of organization, name, and code

Syntax Notes: 1 At least one of N102 or N103 is required.

2 If either N103 or N104 is present, then the other is required.

Semantic Notes:

Comments: 1 This segment, used alone, provides the most efficient method of providing

organizational identification. To obtain this efficiency the "ID Code" (N104) must

provide a key to the table maintained by the transaction processing party.

2 N105 and N106 further define the type of entity in N101.

Notes: Example: N1~IN~ABC Health Insurance~XV~555.


Ref. Data


>> N101 98 Entity Identifier Code M ID 2/3 Code identifying an organizational entity, a physical location, property or an

individual

IN Insurer

Value of 'IN' indicates that N102 will contain the

Reporting Carrier Name.

N102 93 Name X AN 1/60 Free-form name

Will contain Reporting Carrier Name.

>> N103 66 Identification Code Qualifier M ID 1/2 Code designating the system/method of code structure used for Identification

Code (67)

FI Federal Taxpayer's Identification Number

XV Health Care Financing Administration National Payer

Identification Number (PAYERID)

Required if the National PlanID is mandated for use.

Otherwise, one of the other listed codes may be used.

This code will be used to indicate a Carrier ID in N104

until the National PlanID is mandated for use.

>> N104 67 Identification Code M AN 2/80 Code identifying a party or other code

This field will contain the Reporting Carrier ID

X N105 706 Entity Relationship Code O ID 2/2

Code describing entity relationship


X N106 98 Entity Identifier Code O ID 2/3 Code identifying an organizational entity, a physical location, property or an

individual


Ford Motor Company

fd834O (004010) July 21, 2006 11

Segment: INS Member Level Detail

Position: 010

Loop: 2000 Mandatory

Level: Summary:

Usage: Mandatory

Max Use: 1

Purpose: To provide benefit information on insured entities

Syntax Notes: 1 If either INS11 or INS12 is present, then the other is required.

Semantic Notes: 1 INS01 indicates status of the insured. A "Y" value indicates the insured is a

subscriber: an "N" value indicates the insured is a dependent.

2 INS10 is the handicapped status indicator. A "Y" value indicates an individual is

handicapped; an "N" value indicates an individual is not handicapped.

3 INS12 is the date of death.

4 INS14, INS15, and INS16 identify where the employee works.

5 INS17 is the number assigned to each family member born with the same birth date.

This number identifies birth sequence for multiple births allowing proper tracking

and response of benefits for each dependent (i.e., twins, triplets, etc.).

Comments:

Notes: Example: INS~Y~18~021~28~A~~~FT.

INS~N~01~021~028~A~~~FT~~~~~~~~~1.

INS~Y~01~021~11~A~~~RT.

INS~N~19~021~11~A~~~RT~~~~~~~~~2.


Ref. Data


>> INS01 1073 Yes/No Condition or Response Code M ID 1/1 Code indicating a Yes or No condition or response

N No

Value of 'N' represents a dependent.

Y Yes

Value of 'Y' represents the Primary Insured (Employee).

>> INS02 1069 Individual Relationship Code M ID 2/2 Code indicating the relationship between two individuals or entities

01 Spouse

15 Ward

By Trading Partner Agreement, Ford will use this value

to denote "court-ordered dependents". Carrier should

bill Ford as primary for court-ordered dependants.

17 Stepson or Stepdaughter

18 Self

19 Child

Dependent between the ages of 0 and 19; age

qualifications may vary depending on policy

23 Sponsored Dependent

Refer to the Ford Trading Partner Guide for a definition

of this type of dependent.

38 Collateral Dependent

A child who is related to the primary enrollee by blood

or marriage and is claimed as an exemption by the

primary enrollee for federal income tax purposes. The

child is eligible for company-provided coverage until

the end of the year they reach age 25 if they meet the

above criteria. Examples are grandchildren, nieces,

nephews, sisters, brothers.

53 Life Partner

>> INS03 875 Maintenance Type Code M ID 3/3 Code identifying the specific type of item maintenance

Ford Motor Company

fd834O (004010) July 21, 2006 12

001 Change

This code is used to indicate a change to an existing

subscriber/dependent record.

021 Addition

This code is used to indicate an addition of a subscriber

or dependent.

030 Audit or Compare

This code is used in conjunction with N102 in 1000A

loop and BGN01 to represent an audit or compare for

verification that the sponsor and the payer databases are

synchronized. In this case, N102 in the 1000A loop

will contain "PEOPLESOFT FULL POS" and

BGN01=22

INS04 1203 Maintenance Reason Code O ID 2/3

Code identifying the reason for the maintenance change

25 Change in Identifying Data Elements

A change has been made to the primary elements that

identify a specific employee. Such elements are first

name, last name, social security number, date of birth,

and employee identification number

This code value is used to represent that there is a

change to the contract.

28 Initial Enrollment

11 Surviving Spouse

By Trading Partner Agreement, this code value is used

to denote Spouse Only or Spouse and Dependent Only

XN Notification Only

>> INS05 1216 Benefit Status Code M ID 1/1 The type of coverage under which benefits are paid

A Active

S Surviving Insured

INS06 1218 Medicare Plan Code O ID 1/1 Code identifying the Medicare Plan

A Medicare Part A

Portion of Medicare bill involving patient's hospital

stay; hospital insurance

B Medicare Part B

Portion of Medicare bill involving charges by doctor, or

other non hospital related services

C Medicare Part A and B

X INS07 1219 Consolidated Omnibus Budget Reconciliation Act

(COBRA) Qualifying Event Code

O ID 1/2

A Qualifying Event is any of the following which results in loss of coverage

for a Qualified Beneficiary


INS08 584 Employment Status Code O ID 2/2

Code showing the general employment status of an employee/claimant

FT Full-time

Value of FT used as default for all non-retired

subscribers.

RT Retired

X INS09 1220 Student Status Code O ID 1/1 Code indicating the student status of the patient if 19 years of age or older, not

handicapped and not the insured


INS10 1073 Yes/No Condition or Response Code O ID 1/1

Code indicating a Yes or No condition or response

Ford Motor Company

fd834O (004010) July 21, 2006 13

Y Yes

Used to identify all totally and permanently disabled

dependents.

INS11 1250 Date Time Period Format Qualifier X ID 2/3

Code indicating the date format, time format, or date and time format


Must be provided if date of death is reported in INS12.

Only used by NESC to report date of death.

INS12 1251 Date Time Period X AN 1/35

Expression of a date, a time, or range of dates, times or dates and times

Used to report date of death of the subscriber/dependent.

X INS13 1165 Confidentiality Code O ID 1/1

Code indicating the access to insured information


X INS14 19 City Name O AN 2/30

Free-form text for city name

X INS15 156 State or Province Code O ID 2/2

Code (Standard State/Province) as defined by appropriate government agency

X INS16 26 Country Code O ID 2/3 Code identifying the country

INS17 1470 Number O N0 1/9 A generic number

A number used to uniquely identify each dependent for a contract.

Ford Motor Company

fd834O (004010) July 21, 2006 14

Segment: REF Subscriber Number

Position: 020


Level: Summary:

Usage: Mandatory

Max Use: 1






Comments:

Notes: Examples: REF~0F~123456789.


Ref. Data



0F Subscriber Number

At least 1 '0F' is required to report employee's Social

Security Number (without hyphens).



Will contain employee's Social Security Number.


















Ford Motor Company

fd834O (004010) July 21, 2006 15

Segment: REF Member Identification Number

Position: 020


Level: Summary:

Usage: Optional

Max Use: 6






Comments:

Notes: Examples: REF~F6~234567890D.

REF~ZZ~123.

REF~17~A.

REF~DX.001.

REF~Q4~555666777.


Ref. Data



17 Client Reporting Category

Code assigned by the client to categorize participants

for reporting requirements

Used to identify Union Code.

DX Department/Agency Number

Used to identify Ford company code.

F6 Health Insurance Claim (HIC) Number

A unique number assigned by the government to each

person entitled to Medicare benefits

Used to identify the Medicare Number.

Q4 Prior Identifier Number

Used to identify the contract/social security number of a

policy in which this individual was previously covered.

ZZ Mutually Defined

Used to identify the carrier that is providing the basic

HSM coverage.















Ford Motor Company

fd834O (004010) July 21, 2006 16





X C04006 127 Reference Identification X AN 1/30

Reference information as defined for a particular Transaction Set or as


Ford Motor Company

fd834O (004010) July 21, 2006 17

Segment: DTP Member Level Dates

Position: 025


Level: Summary:

Usage: Optional

Max Use: 20


Syntax Notes:


Comments:

Notes:

Example: DTP~336~D8~20010801.


Ref. Data




286 Retirement date

Date on which the subscriber or dependent retired

336 Employment Begin

This qualifier will be used to communicate the Ford

Service Date




Will contain Retirement Date or Ford Service Date

Ford Motor Company

fd834O (004010) July 21, 2006 18

Segment: NM1 Member Name

Position: 030


Level: Summary:

Usage: Mandatory

Max Use: 1

Purpose: To supply the full name of an individual or organizational entity

Syntax Notes: 1 If either NM108 or NM109 is present, then the other is required.

2 If NM111 is present, then NM110 is required.

Semantic Notes: 1 NM102 qualifies NM103.

Comments: 1 NM110 and NM111 further define the type of entity in NM101.

Notes: Example: NM1~IL~1~DOE~JOHN~J~~~34~345678901.

NM1~74~1~DOE~JOHN~J~~~74~345678901.


Ref. Data


>> NM101 98 Entity Identifier Code M ID 2/3 Code identifying an organizational entity, a physical location, property or an

individual

74 Corrected Insured

This code is used to correct identifier information on a

member already enrolled. When this code is used,

another NM1 segment is sent with a code of '70' in loop

2100B.

IL Insured or Subscriber

>> NM102 1065 Entity Type Qualifier M ID 1/1 Code qualifying the type of entity

1 Person

>> NM103 1035 Name Last or Organization Name M AN 1/35 Individual last name or organizational name

This field will contain the last name of the subscriber.

>> NM104 1036 Name First M AN 1/25 Individual first name

This field will contain the first name of the subscriber.

NM105 1037 Name Middle O AN 1/25 Individual middle name or initial

This field will contain the middle name of the subscriber.

NM106 1038 Name Prefix O AN 1/10 Prefix to individual name

NM107 1039 Name Suffix O AN 1/10 Suffix to individual name

NM108 66 Identification Code Qualifier X ID 1/2

Code designating the system/method of code structure used for Identification

Code (67)

34 Social Security Number

ZZ Mutually Defined

Value is required if National Individual Identifier is

mandated for use. Otherwise, one of the other listed

codes may be used. Since National Individual ID is not

yet mandated for use, Ford Motor Company will use a

qualifier of 34 with a Social Security Number in

NM109.

NM109 67 Identification Code X AN 2/80

Code identifying a party or other code

Will contain Social Security Number of subscriber (9 digits with no hyphens).

Ford Motor Company

fd834O (004010) July 21, 2006 19

X NM110 706 Entity Relationship Code X ID 2/2 Code describing entity relationship


X NM111 98 Entity Identifier Code O ID 2/3


individual


Ford Motor Company

fd834O (004010) July 21, 2006 20

Segment: PER Member Communications Numbers

Position: 040


Level: Summary:

Usage: Optional

Max Use: 1

Purpose: To identify a person or office to whom administrative communications should be directed

Syntax Notes: 1 If either PER03 or PER04 is present, then the other is required.

2 If either PER05 or PER06 is present, then the other is required.

3 If either PER07 or PER08 is present, then the other is required.

Semantic Notes:

Comments:

Notes: Example: PER~IP~~TE~5552125555.


Ref. Data


>> PER01 366 Contact Function Code M ID 2/2 Code identifying the major duty or responsibility of the person or group named

IP Insured Party

X PER02 93 Name O AN 1/60 Free-form name

>> PER03 365 Communication Number Qualifier M ID 2/2 Code identifying the type of communication number

TE Telephone

>> PER04 364 Communication Number M AN 1/80 Complete communications number including country or area code when

applicable

Will contain the telephone number of the subscriber.

X PER05 365 Communication Number Qualifier X ID 2/2 Code identifying the type of communication number


X PER06 364 Communication Number X AN 1/80 Complete communications number including country or area code when

applicable

X PER07 365 Communication Number Qualifier X ID 2/2 Code identifying the type of communication number


X PER08 364 Communication Number X AN 1/80

Complete communications number including country or area code when

applicable

X PER09 443 Contact Inquiry Reference O AN 1/20 Additional reference number or description to clarify a contact number

Ford Motor Company

fd834O (004010) July 21, 2006 21

Segment: N3 Member Residence Street Address

Position: 050


Level: Summary:

Usage: Optional

Max Use: 1

Purpose: To specify the location of the named party

Syntax Notes:

Semantic Notes:

Comments:

Notes: Mandatory for employee add or when submitting a change of address for the employee.

Example: N3~255 Main Street.


Ref. Data


>> N301 166 Address Information M AN 1/55

Address information

N302 166 Address Information O AN 1/55 Address information

Required if a second address line exists.

Ford Motor Company

fd834O (004010) July 21, 2006 22

Segment: N4 Member Residence City, State, Zip Code

Position: 060


Level: Summary:

Usage: Optional

Max Use: 1

Purpose: To specify the geographic place of the named party

Syntax Notes: 1 If N406 is present, then N405 is required.

Semantic Notes:

Comments: 1 A combination of either N401 through N404, or N405 and N406 may be adequate to

specify a location.

2 N402 is required only if city name (N401) is in the U.S. or Canada.

Notes: Mandatory for employee add or when submitting a change of address for the employee.

Example: N4~Dearborn~MI~48126.

N4~Dearborn~MI~48126~60~US (for International Service Employees only)


Ref. Data


>> N401 19 City Name M AN 2/30 Free-form text for city name

N402 156 State or Province Code O ID 2/2 Code (Standard State/Province) as defined by appropriate government agency

This field is mandatory for addresses in the US and Canada (CA).

N403 116 Postal Code O ID 3/15 Code defining international postal zone code excluding punctuation and blanks

(zip code for United States)


N404 26 Country Code X ID 2/3 Code identifying the country

N405 309 Location Qualifier X ID 1/2 Code identifying type of location

60 Area

Defined by trading partner agreement to indicate host country/work

location (used only for International Service Employees)

N406 310 Location Identifier O AN 1/30 Code which identifies a specific location

Defined by trading partner agreement to contain the host country for

International Service Employees

Ford Motor Company

fd834O (004010) July 21, 2006 23

Segment: DMG Member Demographics

Position: 080


Level: Summary:

Usage: Mandatory

Max Use: 1

Purpose: To supply demographic information

Syntax Notes: 1 If either DMG01 or DMG02 is present, then the other is required.

Semantic Notes: 1 DMG02 is the date of birth.

2 DMG07 is the country of citizenship.

3 DMG09 is the age in years.

Comments:

Notes: Example: DMG~D8~19670630~M.

DMG~D8~19530101~F~~~~CN


Ref. Data


>> DMG01 1250 Date Time Period Format Qualifier M ID 2/3 Code indicating the date format, time format, or date and time format


>> DMG02 1251 Date Time Period M AN 1/35 Expression of a date, a time, or range of dates, times or dates and times

Used to communicate date of birth.

>> DMG03 1068 Gender Code M ID 1/1 Code indicating the sex of the individual

F Female

M Male

U Unknown

X DMG04 1067 Marital Status Code O ID 1/1 Code defining the marital status of a person


X DMG05 1109 Race or Ethnicity Code O ID 1/1 Code indicating the racial or ethnic background of a person; it is normally self-

reported; Under certain circumstances this information is collected for United

States Government statistical purposes


DMG06 1066 Citizenship Status Code O ID 1/2

Code indicating citizenship status


DMG07 26 Country Code O ID 2/3

Code identifying the country

This element is used to denote home country/citizenship by trading partner

agreement. Used only for International Service Employees.

X DMG08 659 Basis of Verification Code O ID 1/2 Code indicating the basis of verification


X DMG09 380 Quantity O R 1/15

Numeric value of quantity

Ford Motor Company

fd834O (004010) July 21, 2006 24

Segment: ICM Member Income

Position: 110


Level: Detail

Usage: Optional

Max Use: 1

Purpose: To supply information to determine benefit eligibility, deductibles, and retirement and

investment contributions

Syntax Notes:

Semantic Notes: 1 ICM01 is the frequency at which an individual's wages are paid.

2 ICM02 is the yearly wages amount.

3 ICM03 is the weekly hours.

4 ICM04 is the employer location qualifier such as a department number.

Comments:

Notes: Example: ICM~U~0~~1028~HRLY.


Ref. Data


>> ICM01 594 Frequency Code M ID 1/1 Code indicating frequency or type of payment

U Unknown

This is used as a default value.

>> ICM02 782 Monetary Amount M R 1/18 Monetary amount

0 is the default amount.

X ICM03 380 Quantity O R 1/15 Numeric value of quantity

>> ICM04 310 Location Identifier M AN 1/30 Code which identifies a specific location

This field is used to identify plant number/employee location.

>> ICM05 1214 Salary Grade M AN 1/5 The salary grade code assigned by the employer

Value of ICM05 will be "HRLY" to denote hourly, "SLRY" to denote salary,

"HD" for Hourly Deceased, or "SD" for Salary Deceased.

X ICM06 100 Currency Code O ID 3/3 Code (Standard ISO) for country in whose currency the charges are specified

Ford Motor Company

fd834O (004010) July 21, 2006 25

Segment: AMT Member Policy Amounts

Position: 120

Loop: 2100A Optional

Level: Detail

Usage: Optional

Max Use: 1

Purpose: To indicate total monetary amount

Syntax Notes:

Semantic Notes:

Comments: This segment will be used to identify those hourly employees who retire prior to1/1/04

for the purposes of placing the retirees in the appropriate drug co-payment groups as

specified in the Ford Purchasing letter on this subject.

The segment will also be used to identify those employees who are enrolled in a High

Deductible Health Plan.

Notes: Example: AMT~C1~0.

AMT~B9~1.


Ref. Data


>> AMT01 522 Frequency Code M ID 1/3 Code indicating frequency or type of payment

B9 Co-Insurance – Actual

This qualifier is used when AMT02 is '1' for those

salaried employees who are enrolled in a High

Deductible Health Plan (HDHP)

C1 Co-Payment Amount

This qualifier is used when AMT02 is '0' for those

hourly retirees with a retirement date prior to 1/1/04 and

who qualify for a reduced drug co-payment plan.

>> AMT02 782 Monetary Amount M R 1/18 Monetary amount

'0' is used as an indicator that the member is an hourly employee who has

retired prior to 1/1/04 and who qualifies for a reduced drug co-payment .

'1' is used to indicate that the member is enrolled in the HDHP.

Neither 0 nor 1 are intended to represent actual amounts. They are to be used

only as indicators of the above.

Ford Motor Company

fd834O (004010) July 21, 2006 26

Segment: NM1 Incorrect Member Name

Position: 030

Loop: 2100B Optional

Level: Summary:

Usage: Optional

Max Use: 1


This segment will be used to correct a Social Security Number that was previously

reported incorrectly.





Notes: Example: NM1~70~1~DOE~JOHN~J~~~34~111222333.


Ref. Data



individual

70 Prior Incorrect Insured

This code value is used when correcting a SSN for a

member already enrolled. In this case, NM109 will

contain the incorrect SSN that was previously sent in

error.


1 Person


This field will contain the last name of the subscriber.


This field will contain the first name of the subscriber.


This field will contain the middle name of the subscriber.



NM108 66 Identification Code Qualifier X ID 1/2

Code designating the system/method of code structure used for Identification

Code (67)


ZZ Mutually Defined

Value is required if National Individual Identifier is

mandated for use. Otherwise, one of the other listed

codes may be used. Since National Individual ID is not

yet mandated for use, Ford Motor Company will use a

qualifier of 34 with a Social Security Number in

NM109.

NM109 67 Identification Code X AN 2/80


Will contain Social Security Number of subscriber (9 digits with no hyphens).

Ford Motor Company

fd834O (004010) July 21, 2006 27

X NM110 706 Entity Relationship Code X ID 2/2 Code describing entity relationship


X NM111 98 Entity Identifier Code O ID 2/3


individual


Ford Motor Company

fd834O (004010) July 21, 2006 28

Segment: NM1 Custodial Parent

Position: 030

Loop: 2100F Optional

Level: Summary:

Usage: Optional

Max Use: 1






Notes: This loop is used to transmit custodial parent information for a QMCSO (Qualified

Medical Court Support Order) dependent. Ford determines QMCSO eligibility status

based on "Procedures for Detraction and Administration of Qualified Medical Court

Support Order under ERISA". QMCSO eligibility entitles the custodial parent to obtain

and receive information pertaining to the QMCSO specified dependent. The carrier is

required to accept and store the custodial parent name and address, in accordance with

Ford business requirements.

Example: NM1~S3~1~DOE~JANE~K.


Ref. Data



individual

S3 Custodial Parent


1 Person


Will contain last name of custodial parent.


Will contain first name of custodial parent.


Will contain middle name of custodial parent.



X NM108 66 Identification Code Qualifier X ID 1/2 Code designating the system/method of code structure used for Identification

Code (67)


X NM109 67 Identification Code X AN 2/80


X NM110 706 Entity Relationship Code X ID 2/2

Code describing entity relationship


X NM111 98 Entity Identifier Code O ID 2/3 Code identifying an organizational entity, a physical location, property or an

individual


Ford Motor Company

fd834O (004010) July 21, 2006 29

Segment: N3 Custodial Parent Street Address

Position: 050


Level: Summary:

Usage: Optional

Max Use: 1

Purpose: To specify the location of the named party

Syntax Notes:

Semantic Notes:

Comments:

Notes: Required for a QMCSO dependent with a custodial parent residing at a different address.

Example: N3~255 Main Street.


Ref. Data


>> N301 166 Address Information M AN 1/55 Address information

N302 166 Address Information O AN 1/55 Address information

Required if a second address line exists.

Ford Motor Company

fd834O (004010) July 21, 2006 30

Segment: N4 Custodial Parent City, State, Zip

Position: 060


Level: Summary:

Usage: Optional

Max Use: 1

Purpose: To specify the geographic place of the named party

Syntax Notes: 1 If N406 is present, then N405 is required.

Semantic Notes:

Comments: 1 A combination of either N401 through N404, or N405 and N406 may be adequate to

specify a location.

2 N402 is required only if city name (N401) is in the U.S. or Canada.

Notes: Required for a QMCSO dependent with a custodial parent residing at a different address.

Example: N4~Dearborn~MI~48126.


Ref. Data


>> N401 19 City Name M AN 2/30 Free-form text for city name

N402 156 State or Province Code O ID 2/2 Code (Standard State/Province) as defined by appropriate government agency


N403 116 Postal Code O ID 3/15 Code defining international postal zone code excluding punctuation and blanks

(zip code for United States)


N404 26 Country Code X ID 2/3 Code identifying the country

X N405 309 Location Qualifier X ID 1/2 Code identifying type of location


X N406 310 Location Identifier O AN 1/30 Code which identifies a specific location

Ford Motor Company

fd834O (004010) July 21, 2006 31

Segment: HD Health Coverage

Position: 260


Level: Summary:

Usage: Mandatory

Max Use: 1

Purpose: To provide information on health coverage

Syntax Notes:

Semantic Notes: 1 HD06 is the number of collateral dependents for the primary insured. A collateral

dependent is a relative related by blood or marriage who resides in the home and is

dependent on the employee for support.

2 HD07 is the number of sponsored dependents for the primary insured. A sponsored

dependent is a dependent between the ages of 19 and 25 who is not in school.

3 HD09 is a late enrollee indicator. A "Y" value indicates the insured is a late enrollee,

which can result in a reduction of benefits; an "N" value indicates the insured is a

regular enrollee.

4 HD11 is a prescription drug service coverage indicator. A "Y" value indicates that

prescription drug service coverage applies; an "N" value indicates that prescription

drug service coverage does not apply.

Comments:

Notes: Examples: HD~021~~HLT~FMP~ESP.

HD~021~~HLT~LAB~ESP.

HD~021~~DEN~~FAM.

HD~021~~LTD~A.

HD~021~~HLT~~SPC.

HD~021~~HLT~~SPO.


Ref. Data


>> HD01 875 Maintenance Type Code M ID 3/3 Code identifying the specific type of item maintenance

001 Change

Used to report a change in coverage information.

021 Addition

Used to add coverage.

024 Cancellation or Termination

Used to cancel coverage.

030 Audit or Compare

X HD02 1203 Maintenance Reason Code O ID 2/3 Code identifying the reason for the maintenance change


>> HD03 1205 Insurance Line Code M ID 2/3

Code identifying a group of insurance products

AG Preventive Care/Wellness

DEN Dental

HE Hearing

HLT Health

LTD Long-Term Disability

A plan that provides a source of monthly income for

covered employees who are unable to work because of

total disability; benefits are payable for a period of 5 to

10 years, or more commonly to the employee's normal

age of retirement

This value will be used to represent life insurance

coverage. Agreement was made with the carrier to use

this value since there is no value available for this

purpose.

Ford Motor Company

fd834O (004010) July 21, 2006 32

PDG Prescription Drug

STD Short-Term Disability

A plan that provides a source of income for covered

employees who are unable to work because of

disability; benefits are payable for a period of 13, 26, or

52 weeks

VIS Vision

HD04 1204 Plan Coverage Description O AN 1/50

A description or number that identifies the plan or coverage

Used to communicate insurance coverage level code (Ford Medical Plan,

Comprehensive Medical Plan or Basic Medical Plan). Value will be "FMP",

"CMP or "BMP". Also used to communicate Lab (HD04=LAB), DME

(HD04=DME), Footcare (HD04=FOOTCARE) coverage, Physical Therapy

(HD04=PHYSICAL THERAPY), Imaging (HD04=IMAGING), with

HD03=HLT. Also used to communicate Life and Disability codes when

HD03=LTD or STD. Codes understood by trading partner agreement.

HD05 1207 Coverage Level Code O ID 3/3

Code indicating the level of coverage being provided for this insured

ECH Employee and Children

ESP Employee and Spouse

FAM Family

IND Individual

SPC Spouse and Children

SPO Spouse Only

TWO Two Party

X HD06 609 Count O N0 1/9 Occurrence counter

X HD07 609 Count O N0 1/9 Occurrence counter

X HD08 1209 Underwriting Decision Code O ID 1/1 Code indicating the decision made by the underwriter


X HD09 1073 Yes/No Condition or Response Code O ID 1/1 Code indicating a Yes or No condition or response


X HD10 1211 Drug House Code O ID 2/3 Code indicating a drug house with which the insurance plan is affiliated


X HD11 1073 Yes/No Condition or Response Code O ID 1/1 Code indicating a Yes or No condition or response


Ford Motor Company

fd834O (004010) July 21, 2006 33

Segment: DTP Health Coverage Dates

Position: 270


Level: Summary:

Usage: Mandatory

Max Use: 4


Syntax Notes:


Comments:



Ref. Data




303 Maintenance Effective

Date on which the maintenance is effective

(note: When a full positive file is sent, you could

potentially receive maintenance effective dates of all

zeros due to this data being unavailable at the time that

Ford populated its database).

348 Benefit Begin

Date on which the subscriber's or dependent's benefit

begin

349 Benefit End

Date on which the subscriber's or dependent's benefit

ends




Ford Motor Company

fd834O (004010) July 21, 2006 34

Segment: REF Health Coverage Policy Number

Position: 290


Level: Summary:

Usage: Optional

Max Use: 3






Comments:

Notes: Examples: REF~1L~555.

REF~ZZ~N.

REF~17~HAM.


Ref. Data



17 Client Reporting Category

Used to report the eVerest Segment Population Code

1L Group or Policy Number

Used to report Carrier ID.

ZZ Mutually Defined

Used to indicate termination action code for life

insurance, disability and vision coverage.



REF02 will contain the eVerest Segment Population Code when REF01=17

REF02 will contain the Carrier ID when REF01=1L

REF02 will contain the termination action code for life insurance, disability or

vision coverage when REF01=ZZ


















Ford Motor Company

fd834O (004010) July 21, 2006 35



Ford Motor Company

fd834O (004010) July 21, 2006 36

Segment: COB Coordination of Benefits

Position: 400

Loop: 2320 Optional

Level: Summary:

Usage: Optional

Max Use: 1

Purpose: To supply information on coordination of benefits

Syntax Notes:

Semantic Notes: 1 COB02 is the policy number.

Comments:

Notes: This loop is used to communicate Medicare A and B begin and end dates. A new COB

loop will be generated for each date transmitted. The loop is also used to communicate

the date that Medicare became primary or the date it became secondary. A new COB

loop is generated to communicate these dates.

Example: COB~P~~1.


Ref. Data


>> COB01 1138 Payer Responsibility Sequence Number Code M ID 1/1 Code identifying the insurance carrier's level of responsibility for a payment of

a claim

P Primary

S Secondary

X COB02 127 Reference Identification O AN 1/30 Reference information as defined for a particular Transaction Set or as


>> COB03 1143 Coordination of Benefits Code M ID 1/1 Code identifying whether there is a coordination of benefits

1 Coordination of Benefits

A method of integrating benefits payable under more

than one group health insurance plan so that the

insured's benefits from all sources do not exceed 100

percent of the allowable medical expenses

Value of "1" is used as a default value.

Ford Motor Company

fd834O (004010) July 21, 2006 37

Segment: REF Additional Coordination of Benefits Identifiers

Position: 405

Loop: 2320 Optional

Level: Summary:

Usage: Optional

Max Use: 5






Comments:

Notes: Used to report Medicare Part A and Medicare Part B and whether Medicare is primary or

secondary.

Examples: REF~ZZ~MEDA.

REF~ZZ~MEDB.

REF~ZZ~MEDPRIMARY.

REF~ZZ~MEDSECONDARY.


Ref. Data



ZZ Mutually Defined



For Medicare Part A, field will contain 'MEDA'

For Medicare Part B, field will contain 'MEDB'

If Medicare is primary, field will contain 'MEDPRIMARY'

If Medicare is secondary, field will contain 'MEDSECONDARY'



















Ford Motor Company

fd834O (004010) July 21, 2006 38

Segment: DTP Coordination of Benefits Eligibility Dates

Position: 450

Loop: 2320 Optional

Level: Summary:

Usage: Optional

Max Use: 2


Syntax Notes:


Comments:



Ref. Data




344 Coordination of Benefits Begin

Date on which Coordination of Benefits begin

Ford uses this qualifier to indicate Medicare A and B

Begin Dates and the date that Medicare became

primary.

345 Coordination of Benefits End

Date on which Coordination of Benefits end

Ford uses this qualifier to indicate Medicare A and B

End Dates and the date that Medicare became

secondary.




Field will contain Medicare Begin or End Dates or the date that Medicare

became Primary or Secondary.

Ford Motor Company

fd834O (004010) July 21, 2006 39

Segment: SE Transaction Set Trailer

Position: 690

Loop:

Level: Summary:

Usage: Mandatory

Max Use: 1

Purpose: To indicate the end of the transaction set and provide the count of the transmitted

segments (including the beginning (ST) and ending (SE) segments)

Syntax Notes:

Semantic Notes:

Comments: 1 SE is the last segment of each transaction set.

Notes: Example: SE~40~0001.


Ref. Data


>> SE01 96 Number of Included Segments M N0 1/10

Total number of segments included in a transaction set including ST and SE

segments

>> SE02 329 Transaction Set Control Number M AN 4/9 Identifying control number that must be unique within the transaction set

functional group assigned by the originator for a transaction set

The transaction set control numbers in ST02 and SE02 must be identical. This

unique number also aids in error resolution research. For example, start with

the number 001 and increment from there. This number must be unique within

a specific group and interchange, but the number can repeat in other groups and

interchanges.

Ford Motor Company

fd834O (004010) July 21, 2006 40

Change Notes:

Change

Date

Loop Segment Element Change Description

1/22/2003 Updated guideline for posting on

GSEC web site. Changed delimiters

in examples and file name to match

Ford Standard.

4/17/2003 2100F Added comments in the 2100F loop

to indicate the purpose of the loop

and the requirement of the carrier to

store this data.

4/17/2003 2300 REF REF01 Removed qualifier of '17' from the

REF01 and the reference to APA in

REF02 as well as in the data example

in the notes section of the this

segment. The APA is no longer sent.

4/24/2003 Heading BGN BGN01 Removed value of '15' for

'resubmission' since Ford does not

use this value.

4/29/2003 2300 REF REF02 The termination action code is now

sent for vision coverage. Previously

sent for life and disability only.

9/3/03 2320 COB,

REF and

DTP

COB01,

REF02,

DTP01,

DTP03 of

the 2320

loop

Fields modified to accommodate

Medicare Primacy indicator/date and

Medicare Secondary indicator/date.

10/27/03 2100A AMT AMT01,

AMT02

New segment added to identify

Hourly Retirees who retired prior to

1/1/04.

11/20/03 2300 HD HD04 New notes added to indicate that Ford

will begin sending "PHYSICAL

THERAPY" and "IMAGING" in this

field.

11/20/03 2300 REF REF01 Added new value of '17' to transmit

the Everest Population Group. Also

added a data example and notes to

REF02 that this field will contain the

eVerest Population Group when

REF01=17

11/20/03 2100A ICM ICM05 Updated comments for ICM05 to

indicate new values of "HD" for

Hourly Deceased and "SD" for Salary

Deceased.

11/20/03 2300 HD HD04 Updated comments to indicate that

HD04 will also be used to transmit

Ford Motor Company

fd834O (004010) July 21, 2006 41

coverage codes for life and disability.

8/23/05 1000A N1 N102 Updated comments to indicate

naming convention of files changed

to "PEOPLESOFT FULL POS" and

"PEOPLESOFT DAILY CHANGE"

and removed all references to the

monthly activity file since it is no

longer sent with the launch of

PeopleSoft.

1/6/06 2310 LX, NM1 Removed these segments. They were

previously used to transmit Primary

Care Physician data but have not

been used in quite some time. Also

marked them as not used in the

segment overview section.

1/6/06 Heading BGN BGN08 Removed reference to HRIMS and

NESC, since data is now fed from

PeopleSoft

1/6/06 Heading DTP DTP01 Removed reference to NESC and

HRIMS as well as the information

regarding the timing of delivery for

the full positive, since it is no longer

relevant.

2/15/06 2300 HD HD03 Added value of 'AG' for preventive

care

2/23/06 2100A AMT AMT01,

AMT02

Added qualifier of 'B9' to AMT01

and value of '1' to AMT02 for those

enrolled in the HDHP. Changed

wording for this segment as it

previously indicated that 'C1' for

AMT01 and '0' for AMT02 would be

used as default values. Now, this

segment may be used to indicate pre

1/1/04 retirees who qualify for a

lower drug co-pay plan as well as for

those members enrolled in a HDHP.

7/21/06 2100A N4 N405

N406

Changed these elements from "not

used" to "used" to accommodate

sending a host country/work location

for International Service Employees

7/21/06 2100A DMG DMG07 Changed this element from "not

used" to "used" to accommodate

sending a home country/citizenship

for International Service Employees

Date post:	15-Apr-2018
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