MVP Health Plan, Inc. MVP Health Services Corporation MVP Health Insurance Company MVP Select Care, Inc. Electronic Data Interchange Member Enrollment for the Benefit Enrollment and Maintenance (834) 005010X220A1 User Manual 2012 Table of Contents
WHAT IS EDI?...... 3
MVP’S TECHNICAL SUBMISSION REQUIREMENTS...... 3
TRANSMISSION MEDIA ACCEPTED...... 3
ENCRYPTION FOR FILES USING THE FTP TRANSMISSION METHOD...... 3
LAYOUT/FORMAT...... 3
TESTING REQUIREMENTS...... 3
APPENDIX “A”...... 3
APPENDIX “B”...... 3
Welcome to Electronic Data Interchange Submission of member enrollment with MVP
What is EDI?
EDI is the acronym for Electronic Data Interchange, which is the electronic transfer of information in a standard format. EDI allows for an exchange of member enrollment and other eligibility change information in a fast and cost effective manner.
Information sent through EDI is generally grouped together and processed nightly in a batch mode.
Some advantages of sending member enrollment through EDI are: Reduced turnaround time Need for handling paper is eliminated Reduces transcription errors Increases quality of data Reduces duplication of data One-time data entry On-line data storage
MVP’s Technical Submission Requirements
MVP requires 45-day notification prior to the EDI transmission Effective Date. This time frame is for conference calls between vendors and EDI team, testing, validation and implementation for the EDI transmission file and the SFTP setup. Files can be transmitted daily Monday through Friday If you would like to change your file layout, frequency or the day your file will be sent MVP requires a 45-day notice for testing and implementation. Please contact the EAS EDI Coordinator at [email protected]. MVP requires weekly change or full replacement files when updating membership. MVP requires full files to be used for auditing purposes on a quarterly basis. MVP requires that all EDI files be sent on the same day and time of the week by the end of a business day. The 2-business day processing time will begin the following day after the file was received as well. Please note that if you do not place your EDI file on the SFTP server within the normal scheduled day and time you must contact the EAS EDI team at [email protected] as soon as possible letting them know when the file will be placed on the server. MVP will process all change or full replacement files including error resolution within 2 business days. All audit files with error resolution will be processed within 5 business days. MVP will communicate any file errors to the groups within the timeframes listed for both the incremental and full files. MVP requires that the employee record be sent for all dependent records MVP requires a termination record for all members that will no longer be utilizing MVP health coverage. The termination date should reflect the date in which the members MVP Health coverage will end, not the date the member’s employment ended. MVP will not term by absence on a file. The termination record is required to be sent on 2 consecutive files and then the termination record needs to be dropped from the file. If member discrepancies are identified through the audit file compare, MVP will forward all discrepancies to the customer for review. The customer must communicate the eligibility update to MVP via manual process or send the update on the next eligibility file. During your group’s “Open Enrollment period” MVP requires full files with terms to be submitted. The group must notify the EAS EDI Coordinator, one month prior to, the submission of the group’s Open Enrollment file to ensure appropriate benefit and/or ID card changes are in place. If a full file, with terms, is not submitted there is a risk that some members may receive incorrect benefits for the following calendar year or receive benefits they should not have because they chose to no longer elect MVP health care.
Transmission Media Accepted SFTP with Password Authentication (MVP will connect to the vendor/employer group site only) o Server DNS Name (preferred over IP address – the Server DNS can be modified to accommodate different IP addresses) o User Name o Password (please call the EAS Coordinator for name of EDI Analyst to provide password to for setup) o Port Number
FTP – Transmission Medium – MVP will provide the form and password after the initial conference call. See Appendix A. o FTP or File Transfer Protocol is used to transfer files from one computer to another over the Internet. FTP is also used to download from or upload to remote servers. The objectives of FTP are: . To promote sharing of files (computer programs and/or data) . To shield a user from variations in file storage systems . To transfer data reliably and efficiently
Encryption for Files using the FTP Transmission Method
Definition - Encryption is the converting of plain text into code to prevent anyone but the intended recipient from reading the text. It provides a level of security to data being transmitted.
Encryption will be used for all transmissions except CD and Diskette. Encryption will be done using the following: PGP (Pretty Good Privacy) Encryption Software - Preferred encryption software FTP SSL Encryption
Layout/Format
ANSI 834 - Version 5010A1
The 834_5010_companion_guide_wgrpinfo.xls is located in Appendix B. This document lists the file elements and their description and it also includes a tab with examples. A PDF version has also been included in Appendix B for you. If you have any questions about the 834 5010A1 file layout the following website maintains the ANSI transaction standards required by HIPAA. The ANSI 834 transaction is the main guide, and MVP’s companion guide is only intended to assist in providing information necessary to our particular processing needs.
Washington Publishing company website:
MVP compliance checks all inbound files to ensure adherence to the HIPAA standards. A 999 acknowledgement file will be produced in response to all inbound files sent to MVP. The 999 guide is also available at the WPC site. This file will let you know the file has been received and whether or not the file passed HIPAA compliance. If it does not pass compliance, it will provide information as to why it did not pass and what corrections will need to be made so that the file can be resubmitted and processed.
Testing Requirements
MVP requires at least one full replacement file and one (change) incremental file for testing purposes. MVP requires that the ISA15 has T for test files. MVP requires that the (change) incremental test file contain between 25-50 members. MVP requires the following enrollment scenarios to be included within your test file. Scenarios should include past, current and future effective dates: 1. New subscriber enrollment record (add). . Please include at least one record with and without dependants. . PCP records are required for new enrollment and will only need to be sent if the employer group is requesting PCP data be sent 2. Adding a dependant member to an existing contract. 3. Subscriber record termination, retroactive and future. 4. Dependant record termination, retroactive and future. 5. Subscriber reactivation 6. Dependant reactivation 7. Subscriber product change, send termination of existing product then subsequent reactivation record of new product. 8. Subscriber address change to existing subscriber contract 9. Dependant address change to existing dependant record 10. First and Last name change to existing subscriber contract. 11. Send a subscriber termination record and subsequent Cobra reactivation record. 12. Send a dependant termination record and subsequent enrollment subscriber add record for that same dependant. 13. Send a subscriber enroll record with a domestic partner. 14. If your group tracks employment data, send additions and changes to this data. 15. If your group has split enrollment contracts, send additions and changes to these contracts. 16. If your group has surviving spouse contracts, send additions and changes to these contracts.
Appendix “A”
MVP Health Care’s FTP Procedures and Policies
Overview This document informs the user about MVP’s FTP Site and policies associated with it. General Information
Host or URL Address: ecomftp.mvphealthcare.com
Username:
Password: Call for password
Directory Structure: 834/ - For inbound enrollment files 999/ - For outbound acknowledgement files
Security MVP would like to stress the importance of keeping the data transfers between your company and ours as secured as possible when transferring files over the Internet using FTP. We have come up with two solutions to accomplish this: 1) Using WS_FTP Pro with using the SSL option. This FTP client software supports transferring data to MVP with using SSL (Secured Socket Layer). This will encrypt the data at 128-bit. Here is the link to review this product: http://www.ipswitch.com/Products/WS_FTP/index.html 2) Using any FTP Client with PGP Encryption. Before you transfer the files to us, encrypt the data with MVP’s Public key. MVP will supply this to you either through e-mail. Once the file is encrypted then transfer the file to our FTP Site. If you are transferring files from MVP’s FTP Site we will have the encrypted files ready for you to pick up. This will be encrypted using your Public key. Once the files are completely transferred then you will have to decrypt these files with your Private key. You can go to http://www.pgp.com for more information.
Please choose one of the following options and contact the EAS EDI Coordinator at [email protected] Appendix “B”
834_5010_companio n_guide_wgrpinfo.xls
PDF versions of excel document
834_5010_companio 834_5010_companio n_guide_wgrpinfo.pdfn_guide_wgrpinfo_example.pdf