Create HIPAA834 File

We are a self insured, self administered insured benefits plan. We currently do all eligibility and are slowly completing all the claims processing from last year on an existing system. We now need to move the data from the existing system into the Lawson system and as part of that project will need to create eligibilility on the BN106 job that creates the HIPAA834 format file and send to a 3rd party vendor to format the final output to the benefits vendor we now have to process benefits.

We need to send a full positive file of all active employees and or dependents, retirees and or dependents, cobra participants and some contract non-employees and or dependents.

I was wondering if anyone might be performing this task and if anyone would be interested in sharing their setup in order to perform this task with me.

I have done some initial testing and am able to get a file out of the BN106, but I am not sure I have all the setup to handle all the groupings correct.

Any help would be appreicated.

Thanking you in advance.

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Legacy Contributor

We are currently using a custom HIPAA 834 program to generate the data file. We do not have in house program support so I am trying to work with the BN106 data file. I have some SQL programming experience, but have little experience with adding deliminator to a string of data where each new string has different field specifications. If you would be interested in sharing ideas or if you are willing to share some suggestions that you receive I would be very appreciative. Our time line is to get this completed before our next open enrollment period in November.

dEPM-613a-Demo Creating a Custom Sub Plan.mp4

christopher-bush

We have not made a decision yet as to whether we will write something to take the HIPAA 834 file ourselves or see if the 3rd party vendor we have partnered with will be able to take the 834 file and do it for us. We have recently purchased the ION Middleware and were thinking we might be able to utilize the software to complete the 834 process. I really would not be much help at this point in how to write the file. Our existing software vendor for the benefits system wrote the program to send to our 3rd Party vendor that formats and massages the data to send to BCBS. I will keep you in mind as we make the decisions on this one.

How are your groups you send out to the 834 file set up.
1. Employees are coming out OK. The dependents have not been loaded yet, but I did do a test and they came out OK on the BN106 run. These people have benefit deductions taken out of their payroll checks and the benefits are set up for them.
2. Current Retirees and their dependents came out OK. We do not have any deductions set up for this group for benefits. I was able to set them up in the BN72.1.
3. We have retirees that when the system went live 3 years ago, we only converted benefits for active employees. We do have the retirees in the employee master, but any older retirees that are on our existing benefits system did not have any payroll or benefit deductions converted over. These seem to be giving me some challenges. I think the status on the HR03 for this group has No Pay No Benefits and that may be the issue.
4. We have some retirees that get a pension cola check paid out of Lawson payroll. The status for this group states Pay with no benefits and the system will not let me key in any benefits for the people with this status. I was hoping to see how setup for someone that had retiree benefits being processed was done.
5. I am also having an issue with how to setup and maintain COBRA participants. Any help on the setup and flow for this group would be helpful.
6. I have another group that do not get paid out of Lawson, but we do administer benefits for. They are set up in a special process level with a special status that has No Pay but allows benefits. I am able to get the records for this group out in the 834 file.

I am thinking that maybe we need to set up the status for the retirees and their dependents as No Pay with Benefits. I am in the process of testing those.

Any screen shots of the setup screens for your groups for processing benefits would be appreciated if anyone can share.
Thanks

christopher-bush

I forgot, anyone that is utilizing the COBRA Particpant and COBRA Benefit module that could give me a brief summary of how they process them; it would be greatly appreciated.

Current Setup in the HR11 for these people? Do you move them to another process level and department just for CoBRA participants and or dependents, or do you just flag them with a COBRA status in the HR11. Is there something in Lawson that automatically puts the terminated people into the COBRA Participant Table or is every participant manually keyed into the BN70.1, BN70.2, BN71.1.
Thanks

Legacy Contributor

We use the Cobra and Retiree forms BN70, BN71, BN72. I can send screen shots tomorrow on how we have these setup. Here are some of the basic setups we have in place and are working well for the 834 out to BCBS.
Verify company parameters for Cobra are setup. I can't recall the form id. I think these are in HR00 or BN00 subforms. Here you define the excess premium rate as well as other details of your cobra plans.
BN15 - set Cobra participants - Y on the eligibility tab
BN15 - build Cobra coverages and contribution amounts.
HR55.3 - our employee groups identify benefit eligibility using job class - to determine level of benefits, Status and Total FTE to determine FT contributions, PT contributions and non benefited. (note: For retirees we use a specific employee group that uses the status R1 as the determination for retirees)
When employees have status changes that result in loss of coverage, we provide them with a Cobra packet. If they elect Cobra we manually build the participant record in BN70 and enroll them on BN71.

The are reported correctly in our output. Hope this helps.

christopher-bush

Thanks for the summary of how it is used. Yes, if you could send me the screen shots of your setup I would appreciate it.

Thanks

christopher-bush

Also, has anyone run into this situation. When I run the BN106 it outputs the
NM1 record with the subscriber and or dependents name
NM3 Address
NM4 City State ZIP

NM1311 with blank
NM3 Same address as above
NM4 Same Address as above

Not sure why the second NM1, NM3, NM4 is being output and what it means. It appears for everyone subscriber and dependents.

Any help would be appreciated.

Legacy Contributor

We have not seen that... but check your job setup, what do you have under Data options do you have both Addresses selected? We only select 1 of them.

EtiquetteUMS.pdf

christopher-bush

Thanks for the Tip. I will check it out.

christopher-bush

That was it. Thanks for your help.

linda-telles

I would also be interested in obtaining the screen shots for setting up the COBRA module.

Just cursious how does tracking COBRA in Lawson help with the administration? Are you able to track the monthly payments?

christopher-bush

We are just starting this project and in the Benefits Technical Text manual, there is inforamtion on invoicing and tracking payments for COBRA. We have not set anything up yet, but I am doing the research to see if we can also track the payments. In our case, we do think we want to invoice the particpants, just track the payments. I am not sure if we can do that without invoicing, there is a manual invoice BN80.1 and You can enter the payment in the BN81.1 Cash Entry. I need to do more research on this, to see if we can accomplish just the one side.

christopher-bush

I gave you the incorrect techinal guide earlier. It is the Personnel Admin technical Guide. I have been reseraching too many manuals today.

christopher-bush

You can also reference the Technical Text for Benefifts Administration manual for help. It has the information on how all the different areas work together in Lawson. If you have time today, can you please send me screen shots of your setup for COBRA and Retirees. Did you set up a separate plan for COBRA or just have a separate status for COBRA?

Legacy Contributor

Attached are some setup screen examples from production and some BN70 , BN71, BN72 enrollment screens.

Let me know if you have any questions.

christopher-bush

Thanks for the setup. It is password protected. Can you please send me the password at sowens@lafayettela.gov .

As soon as I get it, I will reveiw the screen shots.

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