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.

• 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.

Preferred File Format

• 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

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American National Standards Institute (ANSI) 834 5010:

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

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Checklist for EDI Preparation 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).

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180 Days 180 Days Before Before

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150 Days 150 Days Before Before

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120 Days 120 Days Before Before

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Checklist for EDI Preparation 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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90 Days 90 Days Before Before

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60 Days 60 Days Before Before

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30 Days 30 Days Before Before

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