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The EDI 834 file

Put as simply as possible, an Electronic Data Interchange (EDI) 834 file is the standard format in which employers can communicate their employees’ health insurance enrollment and maintenance data to insurance carriers.

A brief history: The Health Insurance Portability and Accountability Act of 1996 (HIPAA), specifically title II, required these standard formats be set for a variety of transactions and code sets.  And the 834 file format was specifically created for EDI benefit enrollment and maintenance, while there are others such as the 276 for claim status requests, the 270 for health care eligibility/benefit inquiries, the list goes on…

Overview: Most companies create these files and deliver them automatically as part of a carrier connection solution.  You’ll typically find these capabilities with benefits management and enrollment solutions, HR platforms, some payroll platforms, etc.

EDI 834 the “standard” format: With all health insurance carriers having to accept the 834 format, you would think delivering health insurance enrollment and maintenance data would be easy, right?  Not so much.  And although the format itself is standard meaning all record types and properties are classified in the same way, the information contained within the properties can differ from carrier to carrier.  Meaning, if you have one file configured for UnitedHealth, that same file can’t be sent to Aetna, Humana, or really any other carrier (even if in some strange world they all provided the exact same plan).

Furthermore, once you expand beyond conveying more than just health insurance data to a carrier, to include something like dental plan data, carriers will typically require a different format.

Benefit plans utilizing the EDI 834 format: There are a number of different benefit plans and insurance types communicated through EDI this includes dental, vision, medical, short-term disability, and long-term disability.  However, as mentioned above, it’s typical that carriers will require different information or a modified version of the 834 file format for these types of insurance.  The 834 is required to be accepted by law for health plan information, but carriers are not required to accept this for other types of plans.

The pros: The alternative to an EDI transfer of the 834 file format is typically faxing paper enrollment forms to the carrier or manually inputting enrollment data into the carrier’s website.  Once a connection is established, there is a significant level of automation that occurs.  This method of getting enrollment data to the carriers is more accurate than paper because it eliminates the misinterpretation of handwriting and manual data entry that carriers will have to do on their end.

The cons: If you’ve ever seen one of these completed 834 files, chances are, you can’t actually interpret this data or read the file very well.  Carriers typically only accept EDI feeds with this file for companies with 100 employees or more, which traditionally leaves small businesses stuck with the paper forms.  Although configuration of this file can be quick, but going back and forth with the carrier can typically take 8-12 weeks before a connection is established.

Source: https://www.everythingbenefits.com/blog/what-is-an-edi-834-file

Medicare, explained

If you are like most individuals or professionals in human resources or employee benefits, you likely find Medicare confusing. Its enrollment, eligibility, coordination rules, policies, and conditions are confusing. It’s not just you.

Medicare Interactive is a website and non-profit group created with you in mind.

Check it out by clicking here:

Is someone else getting rich of your medical data?

You may never have heard of it, but many private corporations know an awful lot about your medical history.
One such company based in Danbury, Connecticut, IMS (ims) buys bulk data from pharmacy chains such as CVS (cvs, -0.56%), doctor’s electronic record systems such as Allscripts, claims from insurers such as Blue Cross Blue Shield and from others who handle your health information. The data is supposed to be anonymized—stripped from the identifiers that identify individuals. In turn, IMS sells insights from its more than half a billion patient dossiers mainly to drug companies.
So-called health care data mining is a growing market. Last week, the company reported 2015 net income of $417 million on revenue of $2.9 billion, compared with a loss of $189 million in 2014 (an acquisition also boosted revenue over the year). “The outlook for this business remains strong,” CEO Ari Bousbib said in announcing the earnings.

Read more CLICK HERE.

Trump Administration to Dismantle SHOP Exchange

Frankly the ACA Small Business Health Options Program, SHOP Exchange, never really took off.  The Obama Administration had big plans for small and larger employers to eventually purchase their employer-sponsored plans through these ACA exchanges. However, it was a bit more “complicated” than the original designers ever thought.  Getting subsidies for these smaller business was too often out of reach and unattainable pursuant to the IRS qualifying rules.

The Trump administration said Monday that it will dismantle part of the Affordable Care Act that created online insurance marketplaces for small businesses and tried in vain foster a greater choice of health plans for their workers.

In starting with the Small Business Health Options Program, or SHOP, the administration is targeting an aspect of the ACA that has been troubled from the outset and never lived up to its proponents’ expectations. As of early this year, federal figures show, nearly 230,000 people were covered through SHOP health plans — a fraction of the 4 million that congressional budget analysts had predicted as the small-business marketplaces began in 2014.

Read more click here:

Cataract Surgery for $20

The doctors were “gods” to an old, blind Burmese woman whose sight was restored by a quick operation.  Cataracts had stolen her sight for years, while others had been blind for decades – before the simple operation allowed them to see again. Bill Whitaker reports from Burma, also known as Myanmar, where two eye surgeons were bringing their program that has already reversed blindness in over 4 million people and could help to eliminate cataract and other reversible blindness in the developing world.

The story of co-founders Drs. Geoff Tabin and Sanduk Ruit, and their revolutionary, low-cost, 10-minute procedure caught the attention of 60 Minutes, the prestigious CBS television news magazine. The eye surgeons started the Himalayan Cataract Project to eradicate as much unnecessary blindness as possible, and so far, together with partners have screened and treated over 7.3 million people, provided more than 625,000 sight-restoring surgeries and trained hundreds of other doctors.

Read more click here. $20 Cataract Surgery  

Watch video click here. Out of the Darkness