Interface with Insurance Carriers

We interface data from Lawson to all of our Insurance Carriers.  We use a combination of Cobol programs and IPA depending on the vendor.  Each vendor's requirements are different, so you'd need their specifications.

Karen

 

Do you use any form of EDI?

I have used IPA to create .CBS,. text, and other vendor required formats. Pretty easy to do. Tammy

I have used IPA to create .CBS,. text, and other vendor required formats. Pretty easy to do. Tammy

We too use IPA. Run a query then reformat to vendor needs. For some vendors the file is emailed to the benefits team who audits and drops into the portal. For other benefits the file goes over using SFTP.

There are a bunch of ways to accomplish these interfaces. For the sake of discussion, I assume you're still on S3 HR and not yet on Landmark GHR. The best solution IMO is to use BN106 output and a transformation tool (it used to be called Mercator) to create EDI/HIPAA 834 files which is a (almost) universal standard. My understanding is that the carriers charge more for these, but I think you will save money in the development since they come almost out-of-the-box from Lawson, and usually require just minor tweaking. You can also use custom COBOL, IPA, etc. to create files that meet each carriers unique/proprietary formats. I have even created some that are CSV extracts using Crystal Reports. Most of the time, however, these solutions are costly in terms of development and maintenance (e.g. each year adds new wrinkles) and you have to build in logic for handling new hires, terminations, COBRA, etc. etc.

Thank you for all this great information. After sharing I was asked to reach out again and inquire if you used a consultant to get this going and if so, who?

I’ve done the EDI for Delta, Cigna and United Health in 2011 through a BN 106 file. You’ll need the formatting requirements from your carriers.