Point C Health

HIPAA 834 format, 5010 Platform

Carrier Platform Settings

• Report ended enrollments for    30 days
• Send only the earliest eligibility begin (356) for all enrollments - Yes
• Send only the latest eligibility end (357) for all enrollments - Yes
• Send only the latest maintenance (303) for all enrollments - Yes

Plans

Select each plan you wish to include on the file, and select the appropriate HD03 value for each plan. This carrier accepts the following:

Client Level Configurations 

Required Fields:

Header 

• Header ISA_06: Client Tax ID
• Header GS_02 (Application Sender's Code): Client Tax ID

Loop 1000A 

• 1000A N1_02 (Plan Sponsor Name): Client Name
• 1000A N1_04 (Sponsor Identifier): Client Tax ID
   

Loop 2300

• 2300 REF_PID_02 (Insured Group or Policy Number): Program Identification Number - IAA expects to see the member’s Benefit Class (or plan Id) from the Account Structure. 

Open Enrollment

• Carrier has not provided Open Enrollment expectations. Please work with them to configure the Open Enrollment file correctly.