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Data Specifications for all Plans
In what format can you receive and transmit eligibility data including additions and deletions?
We have several EDI layouts, which are provided in the attached implementation guide.
We are currently supporting a 511 fixed width file, or you may elect to report your
enrollment to us through the HIPAA-standard 834 layout.
Please submit a copy of your file format specifications for electronic transmissions.
Please see the attached guide for information regarding our format specifications.
Do you have any limitations with electronic payroll systems? Please describe your technology
capabilities.
Our EDI team is currently supporting a variety of employer types, layout types, and
various group sizes. We are currently working with groups directly and have many
relationships with third-party administrators. We can support and provide services based
on your existing electronic payroll system.
Describe the security parameters for your systems both for the employer and the employees
(ex: passwords).
Delta Dental of Colorado provides employer groups using electronic eligibility with a
secure delivery method known as SFTP. An SFTP account will ensure secure data
transfer for your enrollment data and requires a unique ID and password combination.
Employees are not able to log in to the secure subscriber portion of our website until
they have been loaded into our system with their assigned subscriber ID. Subscribers
must also be effective when they are logging into the subscriber website (e.g., after their
effective date). They must register to use the site using various demographics that match
what has been loaded into our system, and they must create a unique user name and
password.
Do you require an email address for online access?
Yes. In order to have online access to the employer portion of the website, an email
address must be obtained from the person(s) requiring the access.
Guide to Electronic Eligibility
and Enrollment File Transfer
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Guide to Electronic Eligibility
and Enrollment File Transfer
Proprietary and Confidential
1
Introduction ...................................................................4
2
E-File Set-up Questionnaire ..........................................4
3
Understanding Eligibility Files .................................... 6
File Types ....................................................................... 6
File Type Overview ........................................................ 6
Full File .......................................................................... 6
Change File ................................................................... 6
File Names ......................................................................7
Submission Frequency ..................................................8
Day of the Week .............................................................8
4
Selecting a File Format ................................................. 9
Delta Dental of Colorado 511 ........................................ 9
HIPAA 834 .................................................................... 9
5
Constructing an Electronic Eligibility File ..................10
Required Fields ............................................................10
Avoiding Common Errors .............................................11
Dates of Coverage and Termination ............................11
Terminating Coverage ..................................................11
Positive Terminations ...................................................11
Terms-by-Omission ......................................................11
6
Transferring Files to Delta Dental of Colorado ......... 12
Overview of Secure File Transfer Protocol (SFTP) .... 12
Delta Dental of Colorado Enhanced File Transfer ..... 12
Transfer Method Overview .......................................... 12
Questionnaire ...............................................................13
Using an SFTP Application ..........................................13
Installing an SFTP Tool ................................................13
Connecting Via SFTP ...................................................13
Transmitting Files ....................................................... 14
Logging On ................................................................... 14
7
Testing the Electronic Eligibility File ...........................15
8
Emergency Add, Change, and Termination ..............16
9
Understanding Reports & Error Codes ...................... 17
Glossary of Terms ........................................................ 18
Delta Dental of Colorado Contact Information .........19
Appendix A: FAQ—Frequently Asked Questions .... 20
Appendix B: Delta Dental of Colorado—511
Character Format ......................................................... 23
Appendix C: HIPAA 834 ............................................. 33
DELTA DENTAL OF COLORADO 1
Table of Contents
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1. Introduction
Thank you for choosing to submit your organization’s enrollment information
to Delta Dental of Colorado by electronic file. This handbook will help you
successfully implement and maintain electronic enrollment.
User information in this handbook includes:
• E-File setup questionnaire
• Understanding eligibility files
• Selecting a file format
• Constructing an electronic eligibility file
• Selecting and using a HIPAA-compliant, secure file transfer method
• Testing the electronic eligibility file
• Emergency add, change, or terminate requests
• Understanding reports and error codes
• Glossary
• Appendices
For Assistance
If you have additional questions after working through this handbook, please
contact us at 303-741-9300, ext. 3700, or eligibility@ddpco.com.
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2. E-File Set-up Questionnaire
This questionnaire will help you gather the information you need to set up
your file transfers, and to provide essential information for Delta Dental of
Colorado.
Please answer this questionnaire about your eligibility file as you work
through this handbook.
1. Enter your group name on the questionnaire.
2. List your organization’s contacts for:
• Human Resources
• IT
• File errors
3. Enter group and sub-group numbers to be reported in the eligibility file.
Contact your account representative to confirm group and sub-group
numbers, if necessary.
Note: You must contact your sales representative before adding new groups
or subgroups to a file once in production. Eligibility information for new
groups and subgroups will not be processed unless they have been added to
the eligibility system.
4. Continue to work through the rest of this handbook to answer the
remaining questions.
5. When all questions have been answered, please scan and email the form to
eligibility@ddpco.com or fax it to 303-773-3880 ATTN: EDI.
Questionnaire
Enter your group’s contact information, group name, and group numbers for
file transfer on the E-File Set-up Questionnaire.
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E-File Set-up Questionnaire
Delta Dental of Colorado Date: ___________________
Group Name: ______________________________________________________________________
HR Contact
Name: ___________________________________________________________________________
Phone Number: ___________________________________________________________________
Email Address: ____________________________________________________________________
IT Contact
Name: ___________________________________________________________________________
Phone Number: ___________________________________________________________________
Email Address: ____________________________________________________________________
File Issues Contact
If there are issues with your file, whom should Delta Dental of Colorado contact?
Name: ___________________________________________________________________________
Phone Number: ___________________________________________________________________
Email Address: ____________________________________________________________________
Group Numbers
What groups and sub-groups will be reported on your eligibility file?
Group Numbers __________________________________________________________________
Sub-Group Numbers _______________________________________________________________
Guide to Electronic Enrollment 4 Proprietary and Confidential
File Type
What kind of file are you submitting? Full File Change File*
*Note: If you chose to submit a change file, you are required to send a full audit file, quarterly. A change file
is a file that contains additions, terms, and changes only. A full file contains all of your enrollees.
File Frequency
How often will you submit your eligibility file to Delta Dental of Colorado?
Weekly Bi-weekly Semi-monthly Monthly Quarterly
What day of the week or date of the month will you are submitting your file?
Monday Tuesday Wednesday Thursday Friday
Date: ______________________________
Format Type
What format will you submit?
511 character HIPAA 834-4010 HIPAA 834-5010
(specs available upon request)
Method of Transmission
How will your files be transmitted? Secure website SFTP
Comments
Rep Name: __________________________________________________________________________
Signature: ___________________________________________________________________________
Scan and email your completed form to eligibility@ddpco.com or fax it to 303-773-3880,
ATTN: EDI.
Delta Dental 0f Colorado 5
E-File Set-up Questionnaire
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3. Understanding Eligibility Files
Your organization’s electronic enrollment eligibility files are either full files or change
files, and will be submitted periodically to Delta Dental of Colorado, using provided
file names.
This section of the guidebook explains file type, file names, and file submission
methods. See section 4 for information on how to select a format type, and section 5
for how to construct an electronic eligibility file.
You may wish to consult with your IT department on the best way to implement your
electronic eligibility file submission.
File Types
There are two types of files your organization can send to update eligibility
information:
• Full file
• Change (or negative) file
File Type Overview
Full files and change files transmit different information to Delta Dental of Colorado.
File Type Overview
Eligibility Information Full File Change File
All Current Eligible Members x
All Adds x x
All New and Retro Terms x x
All New Changes x x
Terms by Omission x
Full File
A full file contains a complete snapshot of your group’s eligibility. If you are new to
Delta Dental of Colorado, your initial file transfer must be a full file that provides
complete information for all of your subscribers and dependents.
Change File
A change file contains only changes, additions, and terminations. The change file is
compared to the Delta Dental of Colorado eligibility system, and updates are made
accordingly.
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Questionnaire
Enter the file type on the E-File Set-up Questionnaire.
Tips
• If you are a new group joining Delta Dental of Colorado, your initial file must be a full file that
provides complete information for all of your subscribers and dependents.
• If you are a current group transitioning to electronic enrollment, your most recent enrollment
data will already be stored in the Delta Dental of Colorado eligibility system. Continue to send
your updates as you normally would until notified that your file has been tested and approved for
production.
• If you are sending change files, we recommend that you provide full files at least once per quarter to
reconcile your group’s data with the Delta Dental of Colorado database. Please notify the Electronic
Eligibility (EDI) department before submitting this file.
• Files must contain only one record per individual and only one transaction per record. Example: an
addition and a termination for the same member cannot occur in one record and/or file. See section
6 for more information on constructing files.
File Names
File names are assigned by Delta Dental of Colorado and are unique to your group.
Delta Dental of Colorado’s Electronic Eligibility department will provide you with the file
names you should use when submitting electronic eligibility information. This file name
should be consistently used to ensure timely and accurate processing of your eligibility
information.
Additionally, if you are submitting a change file, you will need to include the word “negative”
in the file name. This allows Delta Dental of Colorado’s eligibility system to properly handle
the file.
Tips
• Delta Dental of Colorado will verify that your files are named properly during the preparation and
testing phase of electronic enrollment.
• Using a file name that does not adhere to the naming convention may delay the loading of your
eligibility records, or result in incorrect changes to your eligibility information in Delta Dental of
Colorado systems.
3. Understanding Eligibility Files
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Submission Frequency
Select the frequency for your file transmission. The frequency options are:
• Weekly
• Bi-weekly
• Semi-monthly
• Monthly
• Quarterly
Most groups choose to submit weekly or semi-monthly.
Day of the Week
You may submit files any day of the week, but they will only be loaded into the
Delta Dental of Colorado system Monday through Friday.
Questionnaire
Enter the frequency and day of the week or month for file transfer on the
E-File Set-up Questionnaire.
Tips
• Contact our Electronic Eligibility department for additional guidance in selecting
an appropriate submission frequency for your group
• For information on emergency transmissions, see section 8.
• If you submit a file in error and wish to stop it from processing, contact the
Electronic Eligibility department immediately at 1-800-233-0860, ext. 3700.
• For more information in selecting the appropriate file format,
email eligibility@ddpco.com, or call 800-233-0860, ext. 3700.
Guide to Electronic Enrollment 8
3. Understanding Eligibility Files
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Delta Dental 0f Colorado 9
4. Selecting a File Format
Delta Dental of Colorado supports two file formats for electronic submission
of eligibility information:
• Delta Dental 511
• HIPAA 834
Delta Dental 511
The Delta Dental 511 format is a proprietary flat (.txt) file format used
exclusively for sending dental eligibility information to Delta Dental of
Colorado.
The file should be constructed and maintained as a plain-text flat file.
You may wish to consult with your organization’s Information Technology
department when creating your 511-format file.
See Appendix B for the Delta Dental of Colorado 511 character layout table.
HIPAA 834
The HIPAA 834 format is a standard, HIPAA-compliant format recognized
by both medical and dental carriers. Implementation will most likely require
significant involvement of your Information Technology department to
properly construct a file in the 834 format.
The 834 format file should be constructed and maintained as a plain-text flat
file. See Appendix C for the HIPAA 834 character layout table.
Questionnaire
Mark the file format selection with your preferred file format type on the
E-File Set-up Questionnaire.
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5. Constructing an Electronic Eligibility File
Electronic eligibility files are required to contain specific eligibility
information and to be constructed in either the Delta Dental 511 or
HIPAA 834 format, as discussed in section 4 and in Appendix B and C.
Required Fields
Information required in electronic eligibility files includes:
Group number First Name
Sub-group number Last Name
Effective Date Gender
Subscriber SSN Address
Rate/Coverage Code City
Relationship Code State
Hire Date Zip Code
Date of Birth
Tips
• Address information is necessary in order to deliver explanation of
benefits, send payment checks when necessary, and to prevent potential
HIPAA violations.
• See section 4 for more information on file formats.
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Delta Dental 0f Colorado 11
Avoiding Common Errors
Some of the most common record errors involve establishing coverage and sending
terminations.
Dates of Coverage and Termination
To avoid record errors, an active contract must be in force for your organization in advance
of coverage effective date or coverage termination date. Please ensure that all effective and
termination dates fall within a period during which coverage with Delta Dental of Colorado
has been or is established.
Terminating Coverage
There are two ways to terminate coverage:
• Positive terminations
• Terms-by-omission
Positive Terminations
Positive terminations work with both full files and change files. A positive termination
requires that you add a termination date in the appropriate field (based on file format) of the
subscriber and/or dependent record.
Terms-by-Omission
This method of termination only works with full files. Terms-by-omission occurs when
subscribers and/or dependents are not included in the most recent file uploaded to Delta
Dental of Colorado. If a member is active in the Delta Dental of Colorado eligibility system,
but not on the submitted eligibility file, they will be considered a termination for the current
period.
Tips
• Terms-by-omission may automatically occur when subscribers and/or their dependents are not
included in a file upload while currently active in the Delta Dental of Colorado eligibility system.
5. Constructing an Electronic Eligibility File
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6. Transferring Files to Delta Dental of Colorado
Delta Dental of Colorado uses an Enhanced File Transfer solution for receiving
electronic eligibility information from customers. Enhanced File Transfer supports
both Secure File Transfer Protocol (SFTP) and web-based transactions.
This method is HIPAA compliant for security purposes, and will allow you to send
either Delta Dental 511 or HIPAA 834 file formats. No additional security measures,
such as ZIP files with passwords or PGP encryption, are necessary.
Overview of Secure File Transfer Protocol (SFTP)
Secure File Transfer Protocol (SFTP) securely transmits data to Delta Dental of
Colorado for processing.
Once logged in to the Delta Dental of Colorado SFTP server, the session is encrypted
between your system and Delta Dental of Colorado, ensuring the safety of your data
as it is transmitted.
Files may be sent manually via the SFTP application according to your selected
submission schedule, or, if your selected application allows, file submission can be
scheduled and automated. Please consult your SFTP application manual for more
information on capabilities.
More details on how to connect to Delta Dental of Colorado’s SFTP server are in the
following sections.
Delta Dental of Colorado Enhanced File Transfer
Delta Dental of Colorado allows you to upload files manually via the Delta Dental of
Colorado Enhanced File Transfer website. SecureTransport can be accessed via your
web browser at the following URL: https://mft.deltadentalco.com
Using Enhanced File Transfer, the transmission of files from your organization to
Delta Dental of Colorado’s system is secure and encrypted. There is no need to ZIP
your eligibility file with a password or to use additional encryption (e.g. PGP).
Enhanced File Transfer is a manual application that requires you to use your web
browser to login and submit files for processing.
Transfer Method Overview
SFTP Secure Website
Software other than web browser required X
Can be automated X
Can be a manual process X X
Login required X X
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Delta Dental 0f Colorado 13
Questionnaire
Enter your chosen method of file transfer on the E-File Set-up Questionnaire.
When finished with the questionnaire, fax the form to 303-773-3880, ATTN: EDI, or email to
eligibility@ddpco.com.
Using an SFTP Application
Prior to using SFTP to submit your electronic eligibility files to Delta Dental of Colorado,
you will need to select an SFTP application. Some popular SFTP packages include:
• FileZilla – http://filezilla.sourceforge.net
• Core FTP – http://www.coreftp.com
• WS-FTP (6.0 or greater) – http://www.wsftp.com
Your organization’s IT department may prefer or require the use of other SFTP applications.
Please consult with the appropriate staff in your organization to determine which application
should be used or if this function may be owned by your IT department.
Installing an SFTP Tool
Follow the manufacturer’s instructions for installing the SFTP application onto the
machine(s) that will transmit electronic eligibility files to Delta Dental of Colorado.
Connecting Via SFTP
After installing your SFTP application, it must be configured to send files to Delta Dental of
Colorado over Secure File Transfer Protocol (SFTP).
Note: Some tools may offer multiple ways to send files. Be sure to select the SFTP option for
secure encryption and to ensure that you are able to connect.
To begin using an SFTP application to connect to Delta Dental of Colorado, you must have a
user account on the SFTP server. Contact our Electronic Eligibility department at 1-800-233
-0860, ext. 3700, to request an account and password if one has not already been supplied.
Once your account has been established, to set up a file transfer using SFTP you will need
to:
1. Select file transfer method: SFTP
2. Enter host name: https://mft.deltadentalco.com
3. Enter username
4. Enter password
5. Select level of trust, if required
6. Transferring Files to Delta Dental of Colorado
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Transmitting Files
To upload a file to the Delta Dental of Colorado server:
1. Select the file from your computer to upload.
3. Drag to move the file from your computer to the Delta Dental of Colorado Enhanced File
Transfer.
The file will then be picked up by Delta Dental of Colorado for processing.
To transfer the file, go to the My Files and Folders pane and click the arrow to move file to
Remote Server Files and Folders.
When the transfer is complete, the file will appear in the Remote Site view pane.
Tips
• Usernames and passwords are case sensitive.
• If you’re having difficulty accessing the site, double-check the web address. It is https://mft.
deltadentalco.com
• “Help! I’ve forgotten my Username.” Please call our Electronic Eligibility department for assistance
at: 303-741-9300, ext. 3700.
Guide to Electronic Enrollment 14
6. Transferring Files to Delta Dental of Colorado
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Delta Dental 0f Colorado 15
7. Testing the Electronic Eligibility File
Electronic eligibility files must be thoroughly tested prior to going live
in the transaction processing system. The average implementation
and testing time for both new groups and for current groups making
changes to their file formats is approximately six weeks.
Please be aware six weeks is an average time frame. Your organization’s
implementation could require more or less time to move into
production due to several factors:
• The file format selected
• Your organization’s technical capabilities
• Error correction and acceptance process
Delta Dental of Colorado is committed to expediting the process and
assuring the transition is as smooth as possible.
Because Delta Dental is committed to serving you and your employees,
a file will not be loaded into production until all parties agree that the
file format is correct and that it should be used to establish eligibility.
Tips
When you are ready to upload a test file, double check that your file has the
term “test” included in its naming convention.
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8. Emergency Add, Change, and Termination
If a member needs to be added, have their eligibility details changed, or
terminated from the plan between regularly scheduled transmissions, you
can fax or upload the emergency member information to update eligibility.
To update information between regularly scheduled file transmissions,
please send an email to eligibility@ddpco.com. Be sure to include detailed
information about the changes you are making. You may also fax the
information to 303-741-3880; however, this method will take longer for
Delta Dental to process.
Tips
• Never send an SSN in an email due to HIPAA regulations.
• Notify eligibility@ddpco.com, if you are uploading a file via SFTP or the Delta
Dental of Colorado Secure Transfer Tool outside of your regular transmission cycle.
• Before your next file transmission, be sure to update your file with the emergency
add, change, or termination information. Failure to do so will result in the
emergency transmission being overwritten by your file data on the Delta Dental of
Colorado system.
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Guide to Electronic Enrollment 16 Proprietary and Confidential
9. Understanding Reports & Error Codes
After Delta Dental of Colorado receives your eligibility file, a series of
validations are performed against the data prior to loading the file into our
database. This helps ensure the integrity of the data within the system and can
provide valuable feedback both to you and Delta Dental of Colorado.
Once the validations are complete, you will receive an e-mail indicating
that your report is ready for review. This report will be available either via a
Zipfile to your email, or by logging into the Employer section of our website,
depending on the setup you have requested.
An error report guide will be provided with your first test file error report.
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Glossary of Terms
Adds Additions of members eligible for coverage.
Change File A flat file with changes in eligibility only.
Current Eligible All group members currently eligible for benefits.
Delta Dental of Colorado
Secure Transfer Tool A HIPAA-compliant, secure website to upload eligibility files.
https://www.upload.deltadentalco.com
File Naming Convention Naming convention established by Delta Dental of Colorado
to identify file types.
Flat File A plain-text file, usually ending in the extension .txt or .edi, used for
transmitting your eligibility data to Delta Dental of Colorado.
Full File A file containing all eligibility data for your organization.
New Changes New changes in eligibility status.
New Terms New terminations.
Retro Terms Retroactive terminations; terminations prior to the current period.
SFTP Secure File Transfer Protocol
STT Secure Transfer Tool, Delta Dental of Colorado’s secure website
located at http://upload.deltadentalco.com
Terms-by-Omission Any member not in the file, but in our eligibility system, will
be terminated unless your account has this feature disabled.
Whereas you will be responsible for all terms.
Glossary
of Terms
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Delta Dental of Colorado Contact Information
Delta Dental of Colorado URL
http://www.deltadentalco.com
Secure File Transfer Protocol (SFTP) Domain Name
transfer.deltadentalco.com
Delta Dental of Colorado Secure Transfer Tool (STT)
https://transfer.deltadentalco.com
Electronic Eligibility Department (EDI)
Email: eligibility@ddpco.com
Tel: 800-233-0860, ext. 3700
Fax: 303-773-3880
Emergency Add, Change, Term - Eligibility Department (EDI)
Email: eligibility@ddpco.com
Tel: 303-741-9300, ext. 3700
Fax: 303-773-3880
Customer Relations — For Members
Email: customer_service@ddpco.com
Tel: 800-233-0860
Fax: 303-741-2116
Sales & Marketing
Email: marketing@ddpco.com
Tel: 303-741-9300, ext. 116
Fax: 303-741-4233
Contact
info
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Appendix A: FAQ—Frequently Asked Questions
The questions listed in this section are common questions asked at Delta Dental of
Colorado. You should be able to find answers to many of your questions in this section.
Q: How do I change a previously submitted SSN?
A: To prevent data conflicts, changes to SSNs that have already been loaded into our
system must be submitted manually to Delta Dental of Colorado. Please email your
change request to Electronic Eligibility at eligibility@ddpco.com. Also, please ensure
that the new SSN is reflected on future file submissions. Until the manual change has been
completed, the e-file change cannot be made.
Q: If I submit a manual change to Delta Dental and do not update my eligibility file accordingly,
what will happen?
A: Any manual changes made in our system will be overwritten by the contents of your eligibility
file. Thus, another manual change would be required to correct the information. Please ensure that
your eligibility file is updated any time you make a manual change.
Q: If there are errors on my submitted file, what do I do?
A: When you submit a file for processing, a report is generated and emailed to the recipients
selected by the group. Your error report will be confirmation the file has been accepted and loaded
into our system. All errors will be listed in this report. Please review this report and use the
information in this manual to attempt to correct the errors.
If your file has a large number of errors, Delta Dental of Colorado will not load the file and will
contact you to help you with the situation.
Q: I am unsure about what I should put in a required field. Is it OK just to leave it blank or make
something up, and provide the information later?
A: For each member, it is essential that the SSN, first and last name, date of birth, and address be
accurate and complete. Leaving these fields’ blank or providing invalid data will adversely affect
Delta Dental of Colorado’s ability to properly process your employees’ claims.
Q: How do I correct an incorrect effective date to a more current one on my file?
A: To prevent any potential eligibility issues, Delta Dental of Colorado requests that you send in a
manual request to change the effective date on a member. If this is for a large number of members,
please contact the Electronic Eligibility department and they will work with you to resolve the
effective date issue.
Important: Please ensure that your next file submission contains the corrected information.
FAQ
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Delta Dental 0f Colorado 21
Q: I sent an incorrect termination date for a member on my last file. How do I change
this to the correct termination date?
A: To prevent any potential eligibility issues, Delta Dental of Colorado requests that you send in
a manual request to change the termination date on a member. If this is for a large number of
members, please contact the Electronic Eligibility department and they will work with you to resolve
the termination date issue.
Important: Please ensure that your next file submission contains the corrected information.
Q: How can I move members between groups and sub-groups?
A: If there is no break in coverage and you are submitting all of the groups in one file, simply
update the group and/or subgroup information for the member in your eligibility file with the
new effective date. When the file is processed, the member will be terminated from the old group/
subgroup and placed in the new group/subgroup based on the submitted effective date.
If the new group is on a separate file, you will need to terminate the member from the original
group/subgroup first, and then submit an addition on your next file that has the new group/
subgroup.
If there is a break in coverage, please terminate the member from the original group/subgroup
first, and then submit an addition on your next file that has the new group/subgroup. If the timing
of this presents a problem for your member, please contact Delta Dental of Colorado’s Eligibility
department to perform a manual update.
Important: Please ensure that your next file submission contains the corrected information.
Q: How do I report student eligibility status on my eligibility file?
A: If you choose to administer student status eligibility for your group, you should consult your
contract for more specific information on student eligibility or contact your Delta Dental of
Colorado account representative.
The effective date in the file should reflect the date that student status becomes effective as a
student, rather than the member’s original effective date of coverage. To prevent eligibility issues,
the student status indicator should only be used on child dependent records over the age of 18.
If reporting a termination, please report the termination only once.
Q: Do I have to list all subscribers and dependents on every file?
A: If you are set up to send full eligibility files to Delta Dental of Colorado, then all subscribers and
dependents must be included on each file. Any member not in the file will be terminated by the
system as of the last day of the month prior to when the file was submitted or the end the month for
which the file is being loaded depending on your groups set up (see Terms-by-Omission).
If you submit change files, you are not required to submit all subscribers and dependents on your
routine eligibility updates. However, Delta Dental of Colorado encourages you to submit a full file
at least quarterly for reconciliation purposes. Please be certain to contact the Electronic Eligibility
department before changing the type of file you submit.
FAQ Appendix A: FAQ—Frequently Asked Questions
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Appendix B: Delta Dental of Colorado – 511 Character Format
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Appendix B: Delta Dental of Colorado – 511 Character Format
Required? Position Field Descriptor Format Valid
Values
Programming Requirements
and Notes
Y 1–9 Subscriber ID 9 Numeric The nine-digit number for the
subscriber whose eligibility
information is to be added, modified,
or terminated. For most companies
this is the employee’s Social Security
number. It should be provided in
the traditional nine-digit format.
If the record describes dependent
information, the subscriber number
provided must belong to the
subscriber in the group plan.
This is assigned by DDCO for each
group under which subscriber
eligibility information is added,
modified or terminated.
Y 10–18 Group ID 9 Numeric This should be nine digits in length
with leading zeros. Contact Delta
Dental of Colorado’s EDI department
for more information regarding the
exact code to use.
This is assigned by DDCO for
subscriber eligibility information is
added, modified, or terminated.
Y 19–26 Sublocation ID 8 Numeric This should be eight digits in
length with leading zeros. Contact
Delta Dental of Colorado’s EDI
department for more information
regarding the exact code to use..
Y 27–30 Division ID 4 Numeric Unless otherwise indicated, this
field should be four zeros. Contact
Delta Dental of Colorado’s EDI
department for more information
regarding the exact code to use.
N 31–34 Product Code Leave Null
Proprietary and Confidential Delta Dental 0f Colorado 23
Appendix B: Delta Dental of Colorado – 511 Character Format
Required? Position Field
Descriptor
Format Valid Values Programming Requirements
and Notes
N 35–38 Plan Code Leave Null
Y 39–42 Rate Code 2 Numeric 01= Subscriber
Only
02= Subscriber/
Spouse
03= Family
05= Subscriber/
Child
06= Subscriber/
Children
This identifies the
Coverage Tier for a given
covered member. The
below values can be
submitted for the Rate
Code; however all of the
codes may not be applicable
per the group contract.
Contact Delta Dental of
Colorado’s EDI department
for the specific values that
apply to your file.
Required? Position Field
Descriptor
Format Valid Values Programming Requirements
and Notes
Y 43–50 Coverage
Effective
Date
8 Date/
Numeric
YYYYMMDD
YYYYMMDD
(E.g. May 31, 2005
= “20050531”)
This is the date the
subscriber becomes eligible
for coverage.
Y
(if
terminating
a member)
51–58 Coverage
Termination
Date
8 Date/
Numeric
YYYYMMDD
YYYYMMDD
(E.g. May 31, 2005 =
“20050531”)
This is the date that
eligibility should
be terminated, if a
termination is to be made.
Appendix B: Delta Dental of Colorado – 511 Character Format
Required? Position Field
Descriptor
Format Valid Values Programming Requirements
and Notes
N 83–84 Compensation
Code
2 Numeric 01= Hourly
02= Salary
99= Unknown
This code indicates the
payment type of the
employee.
N 85–86 Compensation
Code
2 Numeric 01= Union
02= Non-Union
99= Unknown
This code identifies union
membership.
N 87–88 Work Status 2 Numeric
5= Executives
8= Hourly/
Non-Exempt
9= Salary/Exempt
10= All Others
17= Class 1
18= Class 2
20= Class 3
25= Management
28= Class 4
-1= All
This code identifies
the work status of the
employee.
N 89–90 COBRA Code 2 Numeric
01= Eligible for 18
Months
02= Eligible for
36 Months
99= Unknown
This code identifies the
COBRA eligibility coverage
period (COBRA employees
only).
Y 91–98 COBRA
Effective Date
8 Date/
Numeric
YYYYMMDD
YYYYMMDD
(E.g. May 31, 2005
= “20050531”)
This is the date the
subscriber becomes
eligible for COBRA
coverage (COBRA
employees only).
Proprietary and Confidential Delta Dental 0f Colorado 25
Appendix B: Delta Dental of Colorado – 511 Character Format
Required? Position Field
Descriptor
Format Valid Values Programming Requirements
and Notes
N 99–100 Qualifying
Event
2
Numeric
01= Marriage
02= New Child
03= Adoption
04= Retired
05= Child Age
Limit Reached
06= Child’s
Marriage
07= Divorce
09= Open
Enrollment
10= Other
This code identifies
the reason for a benefit
change.
N 101–102 Termination
Reason Code
2
Numeric
01= Resigned
02= Relocated
03= Retired
04= Retired
04= Deceased
12= Child Age
Limit Reached
10= Other
This code identifies the
reason for termination of
a covered employee and or
dependent.
Y 103–114 Social Security
Number
12
Numeric
Right-justified The number in this field
represents the nine-digit
Social Security number
for the individual whose
eligibility information is
to be added, modified or
terminated. It should be
provided in the traditional
nine-digit format with
leading spaces.
Guide to Electronic Enrollment 26 Proprietary and Confidential
Appendix B: Delta Dental of Colorado – 511 Character Format
Required? Position Field
Descriptor
Format Valid Values Programming Requirements
and Notes
Y 115–116 Relationship
Code
2
Numeric
01= Employee
02= Spouse
03= Dependent
Child
04= Domestic
Partner
05= Adult
Dependent
This code must always be
provided as “01” unless the
record being submitted
describes a dependent of a
subscriber in the group plan.
However, all of the codes may
not be applicable per the group
contract. Contact Delta Dental
of Colorado’s EDI department
for more information.
Y 117–146 Last Name 30 Alpha This field should contain the
first thirty characters of the
Last Name of the individual
whose eligibility is being
updated. If the record describes
dependent information, the
data described here should be
for the dependent.
Y 147–176 First Name 30 Alpha This field should contain the
first thirty characters of the First
Name of the individual whose
eligibility is being updated. If
the record describes dependent
information, the data described
here should be for the
dependent. No middle initials
should be housed in this field.
Y 177–206 Middle Name 30 Alpha This field should contain the
first thirty characters of the
Middle Name of the individual
whose eligibility is being
updated. If the record describes
dependent information, the
data described here should be
for the dependent.
Proprietary and Confidential Delta Dental 0f Colorado 27
Appendix B: Delta Dental of Colorado – 511 Character Format
Required? Position Field
Descriptor
Format Valid Values Programming
Requirements
and Notes
Y 207–214 Date of Birth 8 Date/
Numeric
YYYYMMDD
YYYYMMDD
(E.g. May 31, 2005
= “20050531”)
This is the Birth Date of
the individual.
N 215–216 Disabled
Indicator
2 Numeric 00= Not
Disabled
01= Fully
Disabled
02= Temporary
Handicap
This code identifies
handicapped
individuals.
N 217–224 Disabled
Effective Date
8 Date/
Numeric
YYYYMMDD
YYYYMMDD
(E.g. May 31, 2005
= “20050531”)
This is the date the
individual became
classified as disabled.
Y 225–226 Gender 2 Numeric 01= Male
02= Female
03= Unknown
This code is two digits
in length and should
contain one of the
following values.
N 227–228 Marital Status 2 Numeric 01= Single
02= Married
03= Widow(er)
04= Separated
05= Divorced
This code is two digits
in length and should
contain one of the
following values.
Y 229–
258
Street Address
1
30 Alpha/
Numeric
This field contains the
first 30 characters of
Appendix B: Delta Dental of Colorado – 511 Character Format
Required? Position Field
Descriptor
Format Valid Values Programming Requirements
and Notes
N 259–
288
Street Address
2
30 Alpha/
Numeric
This field contains the next
30 characters of the street
address information for the
subscriber, as needed. For
example, apartment number,
suite number, etc.
N 289–318 Street Address
3
30 Alpha/
Numeric
Leave Null
Y 319–348 City 30 Alpha
This field contains the city
of the subscriber whose
information is to be added.
This information should be
presented in the standard US
Postal Service format.
Y 349–350 State 2 Alpha This field contains the
two-letter abbreviation for
the subscriber’s state, as
recognized by the US Postal
Service.
Y 351–355 Zip 5
Numeric
This field should contain the
five-digit zip code of Subscriber.
Please note that all Zip Codes
are validated using the Master
Zip Code file provided by the
US Postal Service.
Y 356–359 Zip + 4 4
Numeric
This field contains the
4-digit zip extension. If this
information is not available, it
should be sent as spaces.
Proprietary and Confidential Delta Dental 0f Colorado 29
Appendix B: Delta Dental of Colorado – 511 Character Format
Required? Position Field
Descriptor
Format Valid
Values
Programming Requirements
and Notes
Y 360-–363 Country Code 4
Numeric
This code is four digits in length.
Default value of “0001” should be
set for the United States. Contact our
EDI department for a complete listing
of valid country codes if you have
employees domiciled in a country other
than the United States.
Please use the below format
for out of country addresses:
Street Address One:
All address information
(e.g.: 21, rue de l’eglises, Paris,
750026)
Street Address Two:
Street Address Three:
City: Out of Country
State: XX
Zip: 00000
Zip + 4: Right fill with spaces
Country Code:
Correct four-digit Country Code ex:
0014
Please use the below format
for APO addresses:
Street Address One:
All address information
(e.g.: 111th Maint Co Unit 342)
Street Address Two:
Street Address Three:
City: APO
State: AA
Zip: 00932
Zip + 4: Right fill with spaces
Country Code: 0001
Guide to Electronic Enrollment 30 Proprietary and Confidential
Appendix B: Delta Dental of Colorado – 511 Character Format
Required? Position Field
Descriptor
Format Valid Values Programming Requirements
and Notes
N 364–393 Phone Number Alpha/
Numeric 30
e.g. 800-237-
6060 for
USA.
This field should contain the
subscriber’s phone number in
a country specific format e.g.
800-237-6060 for USA.
N 394–404 Dentist
Number
Alpha/
Numeric 11
Leave Null
N 405–408 Dentist
Location
Numeric 4 Leave Null
N 409–417 Dentist Tax
Number
Numeric 9 Leave Null
N 418–418 Spouse Dental
Plan
Numeric 1 0= None
1= Yes
N 419–419 Dependent
Dental Plan
Numeric 1 0= None
1= Yes
N 420–479 COB Carrier
Name
Alpha 60 0= None
1= Yes
This 60 position field should
contain the company name of
the other carrier if field 42 or
43 is “1”.
N 480–509 Dentist Name Alpha 60
Leave Null
N 510–511 Student Code Numeric 2
00= Not a
Student
01= Student
This field identifies if the
dependent is a full-time
student or not.
Proprietary and Confidential Delta Dental 0f Colorado 31
Appendix C: HIPAA 834
Guide to Electronic Enrollment 32 Proprietary and Confidential
Appendix C: HIPAA 834
Electronic Data Interchange
Transaction Set Implementation Guide
Health Care
Benefit Enrollment and Maintenance
834-4010 — Available upon request
834 -5010 (Full files)
Loop ID Reference Name Codes Length notes/Comments
Control ISA Mandatory Header Segment, only one
per file
ISA01 Authorization
Information Qualifier
00 2 No authorization information present
ISA02 Authorization
information
10 Blanks. Mandatory 10 length
ISA03 Authorization
Information Qualifier
00 2 No security information present
ISA04 Security Information 10 Blanks. Mandatory 10 length
ISA05 Interchange 30 or
ZZ*
2 30-Senders FTIN number in ISA06
ZZ-Mutually Defined
ISA06 Interchange 15 Sender ID as per the qualifier ISA05.
Mandatory 15 length
ISA07 Interchange ID
Qualifier
30 or
ZZ*
30-Senders FTIN number in ISA06
ZZ-Mutually Defined
ISA08 Interchange Receiver
ID
15 Receiver ID is 840568337.
Mandatory 15 length
ISA09 Interchange Date 6 Date in YYMMDD format
ISA10 Interchange Time 4 Time in HHMM format
ISA11 Repetition Separator ^ 1 To be used for Repetitive functionality
at the element level. Must be
different from data element
separator, component element
separator, and the segment
terminator
Delta Dental 0f Colorado 33
*Delta Dental Prefers ZZ Proprietary and Confidential
Appendix C: HIPAA 834
Loop ID Reference Name Codes Length notes/Comments
ISA12 Interchange control
Version Number
501 5 Approved ANSI version
ISA13 Interchange Control
Number
9 Control number assigned by the
sender. Mandatory 9 length
ISA14 Acknowledgement
Request
0,1 1 0=No acknowledgement requested
1=Acknowledgement requested
ISA15 Interchange Usage
Indicator
P,T 1 P=Production transactions
T=Test transactions
ISA16 Component Element
Separator
: 1 Delimiter for Composite Data
Structure in an Element. Must be
different from the data element
separator, repetition separator, and
the segment terminator
Control GS Functional Group
Header
Mandatory segment
GS01 Functional Identifier
Code
BE 2 Functional Identifier Code for Benefit
Enrollment and Maintenance
GS02 Application Sender’s
Code
15 Senders Code, mutually agreed, can
be same as ISA06
GS03 Application Receivers
Code
15 Receivers code is 840568337
GS04 Date 8 Date in CCYYMMDD format
GS05 Time 8 Time in HHMM format
GS06 Group Control Number 9 Must match the control number in
GS02
GS07 Responsible Agency
Code
2 XXXXX
GS08 Version/Release/
Industry Identifier
12 005010X220 if reporting
005010X220AI must also report
same under ST03 segment
Guide to Electronic Enrollment 34 Proprietary and Confidential
Appendix C: HIPAA 834
Loop ID Reference Name Codes Length notes/Comments
Control ST Transaction Header Mandatory. Can be multiple in a
transmission file
ST01 Transaction Set
Identifier Code
834 3 For Benefit Enrollment and
Maintenance
ST02 Transaction Set
Control Number
9 The transaction set control
numbers in ST02 and SE02 must
be identical. This unique number
also aids in error resolution
research. Start with the number, for
example “0001”. And increment
from there. This number must be
unique within the specific group
and interchanges, but can repeat
in other groups and interchanges.
ST03 Implementation
Reference
005010
X220
35 005010X220 if reporting
005010X220AI must also report
same under GS08 segment
HDR BGN Beginning Segment Beginning Segment: Indicates the
start of the transaction set Usage:
Required by DDCO
BGN01 Transaction Set
Purpose Code
00 2 DDCO expects only “00” for the
original
BGN02 Reference
Identification
50 Unique Identification Reference
Number from the Sender. Not used
by DDCO
BGN03 Date 8 CCYYMMDD
BGN04 Time 8 HHMM or HHMMSS
BGN05 Time Code 2 Not used by DDCO
BGN06 Reference
Indentification
50 Not used by DDCO
BGN07 Transaction Type
Code
2 Not used by DDCO
BGN08 Action Code 2 2 Not used by DDCO must be
reported, as its mandatory in the
HIPAA guidelines even though not
used by DDCO
BGN09 Security Level Code 2 Not used by DDCO
Proprietary and Confidential Delta Dental 0f Colorado 35
Appendix C: HIPAA 834
Loop ID Reference Name Codes Length notes/Comments
HDR Reference Reference
Indentification
Not used by DDCO
HDR DTP Date or Time or Period Not used by DDCO
HDR QTY Quantity Information Not used by DDCO
1000A N1 Sponsor Name Usage- Required by DDCO
N101 Entity Identifier Code P5 3 Constant value
N102 Name 60 Sponsor
N103 Identification Code
Qualifier
FI 2 Federal Tax payers identification
number qualifier
N104 Identification Code 80 Federal Tax payers identification
number SSN
N105 Entity Relationship
Code
2 Not used by DDCO
N106 Entity Indentifier Code Not used by DDCO
1000B N1 Payor Name Required by Delta Dental
N101 Entity Identifier Code IN 3 Constant value
N102 Name 60 Payor Name Delta Dental of Colorado
N103 Identification Code
Qualifier
FI 2 Federal Taxpayers ID Number
Qualifier
N104 Identification Code 80 Federal Tax Payers ID Number
381791480
N105 Entity Relationship
Code
2 Not used by DDCO
N106 Entity Identifier Code 3 Not used by DDCO
Guide to Electronic Enrollment 36 Proprietary and Confidential
Appendix C: HIPAA 834
Loop ID Reference Name Codes Length notes/Comments
1000C N1 Tpa/Broker Name
N101 Entity Identifier Code TV 3 Constant value
N102 Name 60 TPA/Broker
N103 Identification Code
Qualifier
FI 2 Federal Tax Payers ID Number
qualifier
N104 Identification Code 80 Federal Tax Payers ID number
N105 Entity Relationship
Code
2 Not used by DDCO
N106 Entity Identifier Code 3 Not used by DDCO
2000 INS Insured Benefit USAGE: Required by DDCO
INS01 Yes/No Condition or
Response Code
1 Y=Insured/Subscriber
N=Dependent/Member
INS02 Individual
Relationship Code
2 Relationship Code
18=Self
01=Spouse/Domestic Partner
19=Child
INS03 Maintenance Type
Code
030 3 DDCO Normally expects a full file
unless other wise discussed
INS04 Maintenance Reason
Code
3 Not used By DDCO
INS05 Benefit Status Code A 1 Must be reported, as its mandatory
in the HIPAA guidelines even
though not used by DDCO
INS06 Medicare Code Not used by DDCO
INS07 Consolidated
Ominbus Budget
Reconcililation Act
2 Not used by DDCO
INS08 Employment Status
Code
2 ONLY USED IF SYSTEM IS SET UP
WITH MULTIPLE PAYROLL STATUS.
Please request options if your
group is using
INS09 Student Status Code F,P, N 1 F=Full time
P=Part time
N=Not attending school
Only used when group does not
have dependent to age 26 clause
Proprietary and Confidential Delta Dental 0f Colorado 37
Appendix C: HIPAA 834
Loop ID Reference Name Codes Length notes/Comments
INS10 Yes/No Condition or
Response Code
Y,N 1 Handicapped Indicator
Y=Deemed Disabled By SSI
N= Not Handicapped
INS11 Date/Time Period
Format Qualifier
3 Not used by DDCO
2000 REF Reference
Identification
REF01 Reference
Identification Qualifier
0F 3 Subscriber Identifier
REF02 Reference ID 50 SSN/ID Is Used With No Punctuation
2000 REF Reference
Identification
Optional—Same Info Can Be
Provided At The 2300 Loop
REF01 Reference
Identification Qualifier
1L 3 Group Number
REF02 Reference
Identification
50 Group Number Provided By DDCO
REF01 Reference
Identification Qualifier
17 3 Sub Location
REF02 Reference
Identification
50 Sub Location Provided By DDCO
2000 DTP Date or Time or Period Usage:Optional (Same Info Can Be
Provided In The 2300 Loop)
DTP01 Date/Time Qualifier 336 3 Employment begin date
DTP02 Date/Time Period
Format Qualifier
D8 3 Date Format In Ccyymmdd
2000 DTP Date Or Time Or
Period
Usage: Optional (Same Info Can Be
Provided At The 2300 Loop)
DTP01 Date/Time Qualifier 3 Employment Begin Date
DTP02 Date/Time Period
Format Qualifier
3 Date Format In Ccyymmdd
DTP03 Date/Time Period 35 Prior Carrier Effective Date
2000 DTP Usage: Optional (Same Info Can Be
Provided At The 2300 Loop)
Guide to Electronic Enrollment 38 Proprietary and Confidential
Appendix C: HIPAA 834
Loop ID Reference Name Codes Length notes/Comments
DTP01 Date/Time Qualifier 3 COBRA Effective date
DTP02 Date/Time Period
Format Qualifier
3 Date Format in CCYYMMDD
DTP03 Date/Time Period 35 COBRA Effective date
2100A NM101 Member Name Usage: Required by DDCO
NM102 Entity Identifier IL 1 Person
NM103 Last Name 60 Member Last Name
NM104 First Name 35 Member First Name
NM105 Name Middle or
Middle Initial
25 Middle Name
NM106 Name Prefix 10 Not used by DDCO
NM107 Name Suffix 10 Not used by DDCO
NM108 Identification Code
Qualifier
34 2 Social Security Number
NM109 Identification Code 8 SSN is used with no punctuation
2100A PER Administrative
Communications
Contact
Usage: Optional
PER01 Contact Function
Code
IP 2 Insured Party
PER02 Name Not Used By DDCO
PER03 Communication
Number Qualifier
TE,EM 2 Telephone or Email
PER04 Communication
Number
256 Phone or Email Contact
PER05 Communication
Number Qualifier
TE,EM 2 Em=Email
Required if PER06 is reported
PER06 Communication
Number
Y/N 256 Email Opt In or Opt Out
Proprietary and Confidential Delta Dental 0f Colorado 39
Appendix C: HIPAA 834
Loop ID Reference Name Codes Length notes/Comments
2100A N3 Address Information Usage: Required by DDCO
N301 Address Information Address Line 1
N302 Address Information 55 Address Line 2
2100A N401 City Name USAGE: Required by DDCO
N402 State or Province Code 2 Subscriber/Dependent State
US States only
N403 Postal Code 15 Subscriber/Dependent Postal Code
US States only
N404 Country Code 3 Subscriber/Dependent Country
Code
2100A DMG Demographic
Information
USAGE: Required by DDCO
DMG01 Date Time Period
Format Qualifier
D8 3 Date Value
DMG02 Date Time Period 35 Subscriber/Member Date Of Birth
DMG03 Gender Code M, F 1 Gender Code
DMG04 Marital Status Code 1 Marital Status
S=Single
M=Married
D=Divorced
DMG05 Race Or Ethnicity Code 1 Not used by DDCO
2300 HD Health Coverage USAGE: Required by DDCO
HD01 Maintenance Type
Code
3 Must be reported, as its mandatory
in the HIPAA guidelines even
though not used by DDCO
HD02 Maintenance Reason
Code
030 3 Not used by DDCO
HD03 Insurance Line Code DEN 3 DEN=Dental Insurance
HD04 Plan Coverage
Description
50 Not used by DDCO
HD05 Coverage Level 3 Coverage Level Examples (please
inquire for your plan specifics):
Emp=Single
Esp=Emp+Spouse
E5d=Emp+Child(ren)
Fam=Family coverage
Guide to Electronic Enrollment 40 Proprietary and Confidential
Appendix C: HIPAA 834
Loop ID Reference Name Codes Length notes/Comments
2300 DTP Date or Time or
Period
USAGE: Required by DDCO
DTP01 Date/Time Qualifier 303/
348
3 Coverage Effective Date
348=Coverage Begin Date
303=Coverage Change Date
DTP02 Date/Time Format
Qualifier
D*
DTP03 Date/Time Period 35 Coverage Effective Date Format-
CCYYMMDD
DTP01 Date/Time Qualifier 349 3 Coverage Termination Date
DTP02 Date/Time Format
Qualifier
D8 3
DTP03 Date/Time Period 35 Coverage Termination Date Format-
CCYYMMDD
2300 REF Usage: Optional (Can be sent at the
2000 Loop)
REF01 Reference
Identification
Qualifier
1L 3
REF02 Reference
Identification
50 Group number provided by DDCO
REF01 Reference
Identification
Qualifier
17 3 Sub Location
REF02 Reference
Identification
50 Sub Location provided by DDCO
CONTROL SE Transaction Set
Trailer
Mandatory One For Each St
(Transaction Set Header)
SE01 Number of included
Segments
Number Assigned By The Sender.
Usually A Counter For The Number
Of ST Segments, Including ST & SE,
ST02 & STE02 must be identical
SE02 Transaction Set
Control Number
9 Number Assigned By The Sender.
Usually A Counter For The Number
Of ST Segments, Including ST & SE,
ST02 & STE02 must be identical
Proprietary and Confidential Delta Dental 0f Colorado 41
Appendix C: HIPAA 834
Loop ID Reference Name Codes Length notes/Comments
CONTROL GE Functional Group
Trailer
Mandatory
GE01 Number of
Transaction Sets
Included
6 Number of Transaction Sets
Included
GE02 Group Control Number 9 Group Control Number
CONTROL IEA Interchange Control
Trailer
Mandatory
IEA01 Number of Functional
Groups Included
5 Number of Included Functional
Groups
IEA02 Interchange Control
Number
9 Interchange Control Number
2310A NM1 Member Name Usage: This segment is only used if
group has a patient direct plan. If
there is no patient direct plan this
segment should be disregarded
NM101 Entity Identifier Code QN 3 Dentist
NM102 Entity Type Qualifier 1 Person
NM103 Last Name or
Organization Name
60 Provider last name or practice
name
NM104 Name First Not used By DDCO
NM105 Name Middle Not used By DDCO
NM106 Name Prefix Not used By DDCO
NM107 Name Suffix Not used By DDCO
NM108 Identification Code
Qualifier
XX 2 NPI
NM109 Identification Code 80 Provider Patient Direct Number
2330 PER Communications
Contact
Not used By DDCO
Patient Direct Plans only
Guide to Electronic Enrollment 42 Proprietary and Confidential
deltadentalco.com
Proprietary and Confidential
the street address of
the subscriber whose
eligibility is being
added. This information
should be presented in
the standard US Postal
Service format.
Guide to Electronic Enrollment 28 Proprietary and Confidential
Y 59–66 Hire Date 8 Date/
Numeric
YYYYMMDD
YYYYMMDD
(E.g. May 31, 2005 =
“20050531”)
This is the date that the
employee was hired by the
group.
N 67–74 Group
Termination
Date
Leave Null
N 75–82 Benefit
Eligibility
Date
Leave Null
Guide to Electronic Enrollment 24 Proprietary and Confidential