Support for using ANSI 834 Format for Electronic Enrollment
ELECTRONIC ENROLLMENT WITH PRESBYTERIAN
If you are an employer group looking for a more streamlined way to send your membership data, Presbyterian Health Plan, Inc. offers standard electronic member enrollment options through an electronic data interchange (EDI) process. To determine if your group is eligible for this process, consider the following questions:
IS MY GROUP LARGE ENOUGH TO IMPLEMENT AN ELECTRONIC MEMBER FILE EXCHANGE?
Presbyterian will review all requests to implement an electronic file exchange process, but we recommend that groups of 50 or less members continue with a manual enrollment process or utilize Presbyterian's Employer Group Online Enrollment Portal. Employer access to myPRES is required and the form to request access is below:
For more information about Electronic File Exchange or Employer Group myPRES Access, contact the Presbyterian Employer/Producer hotline: Weekdays, 8:00 a.m. to 5:00 p.m.
IS MY INTERNAL SYSTEM ABLE TO CREATE AND DELIVER A PRESBYTERIAN APPROVED SECURE MEMBER FILE?
Presbyterian Health Plan offers the following formats for electronic member enrollment submissions and encryption.
HIPPA ANSI X12 834
Presbyterian Proprietary Standard Layout
Note: ASO/Self-funded groups must submit the HIPPA ANSI X12 834 standard format.
All electronic member files, regardless of format, will be required to be submitted to Presbyterian using an SFTP (Secure File Transfer Protocol) electronic file transfer process with PGP encryption.
WHAT INFORMATION DO I NEED TO SHARE WITH PRESBYTERIAN TO DETERMINE IF MY GROUP CAN BE CONSIDERED FOR EDI?
To start the evaluation process, contact your Presbyterian Account Manager for additional details.
IF MY GROUP IS APPROVED TO IMPLEMENT AN EDI EXCHANGE WITH PRESBYTERIAN, WHEN CAN I EXPECT THE IMPLEMENTATION TO BE COMPLETED?
Presbyterian will process approved requests on a first-come first-serve basis. The documentation that you submit will assist us in determining more defined timelines for implementing your group's EDI process.
Presbyterian's Health Information Development Team works directly with your Presbyterian Account Manager to determine the best time to begin the implementation process. Implementation can take up to four months depending on the complexity of your group's business requirements, the ability to build a secure test file, and turnaround times for corrections during the testing phase of the process.
Presbyterian looks forward to working with you to satisfy your EDI needs. If you have any questions that were not addressed on this page, please contact your Presbyterian Account Manager.
