Simple Health Plan to Provider EDI Report

Modified on Sat, May 30 at 12:05 PM

This is a report designed to send member data to a health care provider.

This report was written to the specifications provided by Delta Dental.

This report will produce a CSV, Tab Delimited, Excel or Google Sheets file.

The report can be run for a single plan of any type (Health, Dental, Vision etc...)

Column	Vendor Description	SchoolFi Notes
GROUP	This is the main group number assigned by Delta Dental to the client for all members	Main Group field on the Plan
SSN	This is the SSN of the primary policy holder and is reflected on all family members covered by this policy holder. This is a text field and does not contain any dashes	SSN from the Employee's demographics tab.
LAST NAME	This is the last name of the individual member. Field does not contain punctuation (except hyphen) or suffix values (ie: Jr, Sr, II, etc)
FIRST NAME	This is the first name of the individual member
MID INI	This the middle name or middle initial of the individual member
RELSHP	This is the relationship of the member to the subscriber. Valid values are: 1 - self 2 - spouse 3 - child
DOB	The individual member's date of birth. This is a date field formatted as MMDDYYYY and does not contain any dashes or slashes
SUB LOC	Identifies member's benefit election based on group's structure (ie: location, union vs non-union, etc). This field uses a text format.	Sub Group field on the Plan
DATE OF HIRE	Subscriber's date of hire with the group. This is a date field formatted as MMDDYYYY and contains no dashes or slashes	Date of hire field on the employee's demographics tab
GENDER	The member's gender. Valid values are: M - Male F - Female U - unknown
ADDRESS LINE 1	The subscriber's mailing address	The employee's address that has "Legal Residence" checked.
ADDRESS LINE 2
CITY
STATE
ZIP
EFF_DATE	The date the member's benefit begins. Formatted as MMDDYYYY with no dashes or slashes	Start date on the employee's Health Tracking Record
COVERAGE_TYPE	This defines the covered members in a subscriber's family. Valid values are: 1 - single coverage 2 - employee and spouse coverage 3 - family coverage 5 - employee and 1 child coverage 6 - employee and 2 or more children coverage	The membership dropdown on the plan from the Employee's health tracking record.
COVERAGE_TYPE_DATE	The date the member's coverage level begins. Formatted as MMDDYYYY with dashes or slashes	Same as EFF_DATE
EMAIL	Member email address - at subscriber level only	Employee's email of type Work.