The 834 File: Why you should consider it

Health carriers are still mainly tied to the HIPPA ANSI 834 file format, also known as the 834 file, as it is the industry standard used by most health, dental, and vision providers.

The file allows carriers to receive your group’s demographic and enrollment information on a weekly file, including adds, terms, and changes. You save time since there’s no need to generate reports to send to the carrier, and no need to do manual entry in the carrier or TPA portal.

We’ve designed our EDI services to be easily configured so you can get up and running faster. As the 834 product is self-service, sending data to a carrier will require users to set-up, manage, and monitor the file transmissions.

However, for your agency’s first file, EN provides a 1-on-1 session free of charge to configure your file. To read more on getting setup for a 1-on-1 session, click here.

As Employee Navigator continues to modernize its integrations, you should always utilize the carriers connected on our EN-Exchange rather than 834 EDI. As of today, there are only a select few health carriers participating but this list will grow as we move into 2020.

Low cost, high efficiency

There are recurring fees billed to the licensee for all 834 EDI files transmitted through Employee Navigator’s engine, except for the Platinum license level. After moving a file to production, the recurring fee is billed one time per enrolled employee per month (PEPM) fee of $0.45. Employee Navigator looks at the number of enrolled employees in any of the plan models that a file is sent for. If there are 100 EEs eligible at ABC Company, but only 60 are enrolled for medical, we bill 60 x $0.45 = $27.00 monthly.

Connected carriers

Employee Navigator has over 260 connected carriers and TPAs. Click here to see a list of our participating partners. Don’t see your carrier? The cost to establish a completely new 834 carrier is a one-time fee of $750 (the fee does not apply to set up a file with our
already pre-configured carriers, just the PEPM).

Some limitations

Generally, the 834 file only includes medical, dental, and vision lines of coverage.

You may also encounter insurance carriers requiring companies to have at least 100 employees to use their EDI services; this requirement is not legal. HIPAA legally requires carriers to accept the standard data format for companies with 2 or more employees and cannot charge a fee to do so.

To read more about the 834 file feed, click here to read our FAQ.


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