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EDI 834- Benefit Enrollment and Maintenance

Get required support for ANSI X12 834 transactions with our comprehensive EDI solutions

Working with EDI 834

Avail the benefits of secure and smooth EDI transactions with the help of our EDI professionals.

The EDI 834 is a standard file format in which employers communicate employees’ health insurance and benefits enrollment and maintenance data to insurance carriers. The 834 is a type of Benefits Enrollment transaction that is found in the X12 transaction set directory. It is also used by unions, insurance agencies, and government agencies to enroll their employees in healthcare benefit plans. Standard EDI formats include EDIFACT, ANSI, X12 along with its subsets.

The document establishes communication between the sponsor of the insurance product and the payer. Specified by HIPAA 5010 standards for the electronic exchange, it includes information, such as plan subscription, benefits, employee demographic information, etc. A3logics offers a wide range of EDI services to help you process these documents and files without any hassle. No matter whether the documents into an accounting or ERP system or a readable format for manual entry, our comprehensive solutions will handle it all. Connect with our EDI experts, specify your issues, and they will come up with the best plan to address all your needs related to EDI transactions.

Use of EDI 834

The enrollment statuses of health plan membership is enumerated in EDI 834.

Adds

For new enrollments or to add new members to the health benefits plan.

Reinstatements

Reinstatement of a previous member’s benefits plan enrollment

Changes

Modify or make changes in a member’s enrollment plan or data and information.

Terminations

To remove or disenroll a member’s from a benefit plan.

EDI 834 Template Workflow

With our efficient EDI solutions, we convert all complicated EDI files into pre-built solutions to avoid all major challenges

Sort

This T-Connect EDI component sorts all the ANSI EDI 834 files based on members, subscribers, and dependents, and puts them in a configured order. This EDI feature ensures that you can process benefit enrollments by family.

Split

System has inbuilt functionality to split the files based on eligibility criteria OR Enrolment type. Whether you want to have the files based on your classes OR by your plan types, system can dynamically generate combined OR split files. This even works for proprietary formats as well.

Enrichment Rules

With seamless EDI services, we provide you with an EDI API built in different framework. It allows you to build custom enrichment rules and policies that check 834 data is processed as per your established rules.

File Generator

Most EDI 834 files are snapshots with no changes in data for weeks or even months. EDI 834 Delta file generator component runs the file, processes all transactions to find changes since the last time the file was processed or sent.

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A3logics Compliance Status

Empowering more than million lives through carrier connect solutions ensuring timely updates.

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ISO:27001

A3logics India Pvt Ltd. is ISO 27001:2013 certified organization with ISO valid till April 2019. Internal Information Security audits are performed quarterly to validate the compliance along with annual external audit.

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GDPR

A3logics is putGng ePorts to analyze the requirements of General Data Protection Rule (GDPR). Awareness training with respect to GDPR is conducted for projects hand ling client’s data. A Gap analysis is performed and current processes are under modification to comply with GDPR requirements.

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SOC 2 —Type II

All the processes and policies are aligned with the requirements of SOC2 Trust Service Principles. SOC2 Type II assessment is scheduled in September 2018.

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HIPAA

A3logics Process database is aligned to the requirements of HIPAA with Ad ministrative, Technical & Physical safeguards in place.

Carrier Connect Solution

we offer all exclusive carrier connect solutions covering data flow from benefits system to carrier and benefits.

Error reports handling

  • Data error
  • Structural error

Quarterly governance meetings

  • Stakeholders review and feedback
  • Teams review on the measurable parameters
  • Identify takeways of of next quarters targets

Maintenance of the implemented carrier feed

  • Updating the existing plan
  • Information structural changes requested
  • Ongoing file including updates in the EDI code sets

Carrier feed implementations

  • File specification | Review setup
  • Transmission | File type
  • Frequency| Scenario testing

Scheduled data audits

  • Collects data quarterly/half yearly basis
  • Collect the correct data to avoid any incorrect enrollment

System support

  • Server release
  • 24*5 system support
  • Production release for application
  • &EDI desktop user support

EDI Phases

Our EDI service offering includes the following 4 phases

Phase I

Initiation phase

  • Client installation
  • Requirement gathering
  • Data authentication process
Phase II

Analysis phase

  • Data validation between carrier and client files
  • Determination of file transfer mode (FTP/SFTP)
  • Behavior check of carrier for transmission information
Phase II

Testing & production

  • Test file creation
  • Three phase testing (EDI analyst + QA + carrier)
Phase IV

Error handling

  • Structural error: occurs due to failure in file building or internal testing
  • Mapping error: when there is an error in EDI mapping process or file settings
  • Data error: error generated due to data discrepancy

Project Management Methodology

A3logics follows agile Project Management and Scrum Development Methodology. We have a team of Certified Scrum Masters, certified testers and ITIL experts.

The Team

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EDI integration services to meet business demands