Summa Care 834

Summa Care 834 Eligibility Enrollment and Maintenance Guides

All Trading Partners must complete the EDI registration process before sending any transactions to SummaCare. Furthermore, all sponsors are required to file a change in registration with SummaCare when the following occurs:

  • Changes in Clearinghouse, Billing Service, Software Vendor or any Vendor handling the Sponsor’s electronic data information
  • Change in mailing address
  • Change or addition of your Tax Identification Number (TIN)
  • Change in Sponsor name or Clearinghouse name.

All files will potentially be checked for HIPAA compliance. Incoming files are processed daily.

EDI Testing Prior to Production

All Trading Partners must complete transaction testing prior to submission of transactions in production. This process is detailed separately in the Communication Companion Guide and on the SummaCare Website. Prior to submitting production enrollment information electronically, all sponsors or their designated vendor must complete successful transaction testing. Sponsors must maintain a successful level of transaction submission to remain in production

Relationship Coding

The relationship codes acceptable for enrollment are:

  • Employee,
  • Spouse,
  • Life Partner,
  • Dependent,
  • Full Time Student and
  • Incapacitated Dependent.

If the employee has custody of another child such as niece, nephew or an adopted child, they will be added as a dependent. SummaCare reserves the right to request supporting documentation on these dependents as well as Incapacitated Dependents when appropriate. Life Partner can be used for plans that cover that benefit.

To learn more about EDI and become a certified EDI Professional please visit our course schedule page.

Leave a Reply

Your email address will not be published.

Post Navigation