Benefit Enrollment and Maintenance

American Specialty Health submitter/receiver ID: 36-2805852

ASH Requirements for this transaction:

All required segments/elements as identified in the transaction.

Additional Situational segments/elements that are required: (If the situational segment is present all required elements within the segment must be populated)

Loop 2000 – Member Level Detail

• Member Policy Number
  • Reference Identification - REF Qualifier - 1L
• Member Identification Number
  • Reference Identification - REF - Qualifier - 23L
    (Can be repeated 5 times if additional information is determined to be necessary by the submitter).

Loop 2300 – Health Coverage

• Health Coverage - HD - (Maintenance Type Code)
  (Required when enrolling a new member or adding, updating, or removing coverage from an existing member.
• Health Coverage Policy
  • Reference Identification - AMT - Monetary Amount

Contact: Cathy Sanchez at cathys@ashn.com