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EDI

EDI. Overview. EDI customers will need to change the file format they use before migration. In cases where file format does not change, files must still be modified to meet new platform specs. The impact of this change to customers depends on the file format currently used.

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EDI

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  1. EDI

  2. Overview • EDI customers will need to change the file format they use before migration. In cases where file format does not change, files must still be modified to meet new platform specs. • The impact of this change to customers depends on the file format currently used. • IBC is preparing customers for EDI changes 6 months prior to migration. In order for employees to receive timely ID cards, the new EDI file must be ready by the first day of the month prior to the migration date.

  3. Preferred File Format American National Standards Institute (ANSI) 834 5010: • Standard used by the health care industry to exchange member data • Accepts more data values than its predecessor, ANSI 834 4010 • Better suited for newer products in the health insurance market such as spending accounts

  4. File Format Target Plan Current Format Post-Migration Format IBC 5010 →→→ Highmark 5010 IBC 4010→→→Highmark 5010 METS →→→ Highmark 5010 or Highmark IFF IBC 4010 →→→ Highmark IFF

  5. Checklist for EDI Preparation 180 Days Before Migration 150 Days Before Migration 120 Days Before Migration • EDI team to provide file format information to customer. IBC Account Executive should provide this file format to the customer. • Schedule EDI Deployment kick off with customer and their vendor, IBC EDI team, and new platform EDI team. • Establish call schedule as needed or per customer request. • Submit formatted customer file to EDI team for Phase 1 testing (compliance and connectivity). • Submit formatted customer file to EDI team for Phase 2 testing (data structure, formatting and test scenarios).

  6. Checklist for EDI Preparation 90 Days Before Migration 60 Days Before Migration 30 Days Before Migration • Provide customer with new group structure, and membership mapping file. • Provide EDI team with new coverage key. This will be modified by the EDI team into the equivalent of the coverage key mapping documents they currently provide to customers, with all applicable EDI groups mapped. • Submit fully synchronized file for Phase 3 testing. All files include a customer’s membership mapped to their new corresponding group numbers, while using anniversary date as the membership effective date. • Provide EDI team with new coverage key for any new 1/1/14 benefits, to be converted into a new coverage key mapping document for the customers use. • Submit OE elections file during the first week of the month to ensure customers have ID Cards by their anniversary date.

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