TPA need to follow the Snip 1 and Snip 2 edits mandated by HIPAA. Exchange TPA must send single 820 for each Group/Employer. Process TPA must follow the companion guide for 820 published by Maryland Health Connection. Files to the Maryland Health Connection server need to be encrypted by the TPA before uploading the files to the SFT server Success There are two sets of acknowledgements received from Carrier to TPA. Carrier sends TA1 to TPA as an initial acknowledgement after no errors found at interchange level. Carrier 999 to TPA as implementation acknowledgement after no EDI errors found for the entire file 820 file format errors at interchange level Scenario1 Carrier rejects the complete 820 file. Carrier generates the TA1 file and sent the file to SFT server. TPA corrects and resends 820 file to Carrier. 820 file has format errors at transaction level Scenario2 Carrier rejects the only the transactions that has the format errors. Carrier loads the transactions that are following the companion guide. Carrier generates the 999 file and sent the file to SFT server. TPA corrects and resends erroneous transactions. GetEffectuationEnrollmentDataFromCarrier transaction addresses effectuation of Description GetEffectuationEnrollmentDataFromCarrier enrollment scenarios for "Add", "Reinstate", "Update" or "Terminate” of the Employee, dependents from Carrier to TPA. It is listed in detail as Add an new Employee Reinstate an new Employee Update an existing Employee Terminate an existing Employee Add a new dependent Reinstate a new dependent. Update an existing dependent Terminate a existing dependent Interaction Batch File Name < Carrier _ID>_<TPA_ID>_YYYYDDMMHHMMSS.X12_834.pgp Archive File < Carrier Name _ID>_<TPA_ID>_YYYYDDMMHHMMSS.X12_834.pgp.processed Frequency
TPA need to follow the Snip 1 and Snip 2 edits mandated by HIPAA. Exchange Process TPA must send single 820 for each Group/Employer. TPA must follow the companion guide for 820 published by Maryland Health Connection. Files to the Maryland Health Connection server need to be encrypted by the TPA before uploading the files to the SFT server Success There are two sets of acknowledgements received from Carrier to TPA. Carrier sends TA1 to TPA as an initial acknowledgement after no errors found at interchange level. Carrier 999 to TPA as implementation acknowledgement after no EDI errors found for the entire file Scenario1 820 file format errors at interchange level Carrier rejects the complete 820 file. Carrier generates the TA1 file and sent the file to SFT server. TPA corrects and resends 820 file to Carrier. Scenario2 820 file has format errors at transaction level Carrier rejects the only the transactions that has the format errors. Carrier loads the transactions that are following the companion guide. Carrier generates the 999 file and sent the file to SFT server. TPA corrects and resends erroneous transactions. GetEffectuationEnrollmentDataFromCarrier Description GetEffectuationEnrollmentDataFromCarrier transaction addresses effectuation of enrollment scenarios for "Add", "Reinstate", "Update" or "Terminate” of the Employee, dependents from Carrier to TPA. It is listed in detail as Add an new Employee Reinstate an new Employee Update an existing Employee Terminate an existing Employee Add a new dependent Reinstate a new dependent. Update an existing dependent Terminate a existing dependent Interaction Batch File Name < Carrier _ID>_<TPA_ID>_YYYYDDMMHHMMSS.X12_834.pgp Archive File Name < Carrier _ID>_<TPA_ID>_YYYYDDMMHHMMSS.X12_834.pgp.processed Frequency