The Delta Dental Benefits Interface process (delivered Oracle/PeopleSoft standard industry benefits enrollment and maintenance file HIPAA (Health Insurance Portability & Accountability Act) EDI (Electronic Data Interchange) 834) involves the extraction of a file from CHRS on a monthly basis by each campus and electronic transmittal of the file containing dental benefits enrollment data of employees and their dependent(s) enrolled in either Delta Dental (PPO) or DeltaCare USA (HMO) to Delta Dental via their secure server (SFTP). For a summary of data typically included in the file refer to Appendix A. The file generated by this interface will specifically reflect the entry and transmission of Dental enrollments for “active” employees and their dependents from the campus CHRS application.

The Oracle/PeopleSoft delivered HIPAA EDI 834 file (Delta Dental Benefits Interface file) and a bolt-on modification incorporates additional data required that isn’t included in the Oracle/PeopleSoft delivered process (e.g., Group Division Number, employee Business Unit).

The process to generate and transmit the Delta Dental Benefits Interface file (HIPAA EDI 834 file) adheres to the California State University (CSU) Security policies and standards regarding the handling of Level 1 and Level 2 sensitive data. (Refer to the Security Guidelines section for the definition of Level 1 and Level 2 data).

This CHRS Benefits Delta Dental Benefits Interface User Guide provides a high-level overview of how to review, prepare for and electronically transmit dental enrollments to Delta Dental along with the associated required campus security protocols.

The Delta Dental Benefits Interface file is generated and provided to Delta Dental on a monthly basis by each CHRS campus, no later than the 5th of each month, by 3:00 pm, and contains enrollment information for all “active employee and their dependents” for the prior month (e.g., activity for the period 8/1 through 8/31 will be submitted to Delta Dental in September). In addition to the monthly file, campuses also generate an annual “Open Enrollment Change” file in the month of December that captures changes effective January 1 of each calendar year. The Open Enrollment Dental file will be generated and provided to Delta Dental no later than the 5th of December, by 3:00 pm.

Campuses are strongly encouraged to complete their monthly processes prior to the 15th of the month, in order allow time to review and correct potential errors.

Initial file validation errors stemming from the upload to the Delta Dental secure server (SFTP) must be resolved by the designated campus contact and a new file must be resent to Delta Dental no later than the 15th of the month, by 3:00 pm. Once Delta Dental has received a successful file transmittal from each campus, including the Chancellor’s Office, the files will be merged and populated in Delta Dental’s system for processing. In order for Delta Dental to begin their monthly merge process, they must receive a valid (error free) file from every campus. In the event a campus fails to send Delta Dental a valid (error free) monthly file, all employees (and their dependents) from that campus will be considered terminated, resulting in loss of dental coverage.

Delta Dental uses the combined HIPAA EDI 834 file(s) and the monthly deduction file from the State Controller’s Office (SCO) to reconcile and generate errors. Terminations are determined during this comparison process. For example, if an employee does not have a monthly deduction listed on the SCO file and is not listed on the HIPAA EDI 834 monthly file, Delta Dental considers the employee terminated, resulting in loss of dental coverage. Issues that cannot be resolved at the campus level escalate to Human Resources Management (HRM).

In addition to this business process guide, users can review the following CMS User Guides and job aids related to this process:

• Daily Review CSUBAS Logs and Reports
• Fix Unique Constraint Errors

Use the Fix Unique Constraint Errors job aid to review for and resolve CSU Snapshot Unique Constraint errors. You must review and resolve all CSU Snapshot Unique Constraint errors for your campus daily. CHRS must have a successful run of the nightly Refresh Benefits Snapshot immediately before running the Delta Dental interface.

Below is a high-level overview of the steps involved in the Delta Dental Benefits Interface monthly process.*

1. Verify that there are no CSU Snapshot Unique Constraint errors. Use the Fix Unique Constraint Errors job aid to review for and resolve CSU Snapshot Unique Constraint errors.
2. Verify that the nightly Refresh Benefits Snapshot process ran to success. Refer to section 5.0 for step-by-step instructions.
3. Run the HIPAA EDI 834 (Delta Dental Benefits Interface – CSUBB012 SQR) to success.
4. Using CSU Security protocols, upload the file to Delta Dental’s secure server (SFTP).

*Prior to running the initial monthly process listed above in CHRS, CMS-Benefits will configure the one-time configuration requirements.

**Note that in CHRS you do not need to manually run the Refresh Benefits Snapshot process before running the Delta Dental Interface. In CHRS, the Refresh Benefits Snapshot process automatically runs each night for all campuses.

Use this process to verify that the nightly Refresh Benefits Snapshot process ran to success the night before.

• Navigation: Click on the NavBar Icon
  • Menu > PeopleTools > Process Scheduler > Process Monitor.

1. On the Process List page, delete your User ID from the User ID field.
2. Enter the User ID of CHR_SCHEDUCSU.
3. Verify that it says 1 and Days in the frequency fields.
4. Click on the Refresh button.
5. Locate the BEN100AD job.
6. Verify that the Run Status says Success.
7. If the Run Status does not say Success, for example, if the Run Status says Error, work with your technical resource to create a Service Now ticket for CMS-Benefits.
8. If the Run Status says Error, do not run the HIPAA EDI 834 process to create the Delta Dental interface. Do not run the HIPAA EDI 834 process to create the Delta Dental interface until CMS-Benefits resolves the error and BEN100AD runs successfully.

Use the Review Snapshot Information page to review the records included in a successful run of the Refresh Benefits Snapshot process.

• Navigation: Click on the NavBar Icon
• Menu > Benefits > Interface with Providers > Review Snapshot Information.

1. Enter the Empl ID to and then click on the Search button review specific employee detail information.

2. The Review Snapshot Information page appears.

3. Click on the Detail link associated with the dental plan to review specific plan information on the Enrollment Snapshot Detail page.

The Delta Dental Benefits Interface file is used to transmit employee and dependent data to Delta Dental. This process produces a text file and interface history detail which is used to review employee dental data.

This section provides the steps necessary to generate the HIPAA EDI 834 file (Delta Dental Benefits Interface file).

1. Prior to generating the running the HIPAA EDI 834 file (Delta Dental Benefits Interface file) a Run Control needs to be created for your User ID. Note that this task is generally a one-time setup.

• Navigation: Click on the NavBar Icon
• Menu > Benefits > Interface with Providers > Create HIPAA EDI 834 File.

1. If you already have a Run Control ID, enter the existing Run Control ID. If you do not have a Run Control ID, click on the Add a New Value tab and enter a new Run Control ID called [Campus_Name]_Delta_Dental_Interface_File and then click on the Add button.
2. The Create HIPAA EDI 834 File page appears.

1. Populate the fields above as directed below:

1. Click on the Save button. The next time you run the file, you will only be required to update the File Effective Date and File Enrollment Date fields.
2. Click on the Run button.

1. If able, select PSUNX for the Server Name.
2. Select the checkbox for the Delta Dental Interface, process name CSUDELTA.
3. Click on the OK button.
4. The Process List page appears.
5. Click on the Refresh button until the CSUDELTA process completes.

1. Verify that the CSUDELTA run status is Success. Work with your technical resource to review and if needed create a Service Now ticket if the run status is Error.
2. If the Run Status is Success, click on the CSUDELTA link.
3. The Process Detail page appears.

1. Click the CSUBB012 link.
2. The Process Detail page appears. Click on View Log/Trace.

1. The View Log/Trace page appears.

1. The file ending in .TXT is the Delta Dental interface file. The file ending in .OUT contains the record count of the interface file. The file ending in .LOG is the process log file.
2. Download the file ending in .TXT to a secured server and prepare it for transmission.

The Delta Dental Benefits Interface involves the transmission of sensitive data. (The Security protocols for the Delta Dental Benefits Interface project are described in this section.) Per the CSU Data and Classification Standards, this includes information deemed as:

Level 1 (L1) – Confidential Data: Confidential Information is information maintained by the University that is exempt from disclosure under the provisions of the California Public Records Act or other applicable state or federal laws. Confidential information is information whose unauthorized use, access, disclosure, acquisition, modification, loss, or deletion could result is severe damage to the CSU, its students, employees, or customers. Financial loss, damage to the CSU’s reputation, and legal action could occur. Level 1 information is intended solely for use within the CSU and limited to those with a “business need-to know.” Statutes, regulations, other legal obligations or mandates protect much of this information. Disclosure of Level 1 information to persons outside of the University is governed by specific standards and controls designed to protect the information. Examples include Birth date combined with last four digits of SSN and name, Social Security number and name, and Health insurance information.

Level 2 (L2) -- Data used by CSU for Internal purposes: Internal use information is information which must be protected due to proprietary, ethical, or privacy considerations. Although not specifically protected by statute, regulations, or other legal obligations or mandates, unauthorized use, access, disclosure, acquisition, modification, loss, or deletion of information at this level could cause financial loss, damage to the CSU’s reputation, violate an individual’s privacy rights, or make legal action necessary. Non-directory educational information may not be released except under certain prescribed conditions. Examples include Identity Validation Keys (name with) Birth date (full: mm-dd-yy) and or Birth date (partial: mm-dd only).

As such, only authorized campus personnel, where designated roles and responsibilities have been assigned to administer the Delta Dental Benefits Interface, are to be involved in the processing and transmission of the Delta Dental Benefits Interface file. In addition, campuses must process and transmit the Delta Dental Benefits Interface file in a manner that adheres to CSU Security policies and standards/HIPAA guidelines. These security requirements outlined below must be in place at each campus.

Step 3: Data Transmission and File Upload to Delta

The Delta Dental Benefits Interface file must be securely transmitted to Delta Dental via their secure server (SFTP). At implementation each campus user was assigned a User ID, and password for this process. To upload the file, log on to Delta’s website (https://ftp.delta.org), using the User ID and password assigned. For specific information regarding uploading the file, refer to the “MOVEitDMZ Manual” accessible from Delta’s website.

Data Storage and Retention

The Delta Dental Benefits Interface will be run on a monthly basis and the file will be transmitted by the 15th of each month to Delta Dental. The file will be maintained in order to troubleshoot errors identified by Delta Dental. If errors are encountered, the campus will be advised to update their records. Employee identifiable information will not be used. Delta Dental will indicate the segment/line item to correct on the file. The campus will rerun their process and resubmit a Full File Replacement to Delta Dental for processing. Once all errors have been resolved to Delta Dental’s satisfaction, the campus files will be combined by Delta Dental for further processing. Errors identified after the CSU files are combined, will be addressed by HRM.

The secure disposition and disposal of L1 & L2 data must be followed through the life cycle of the data. The Delta Dental Benefits Interface file must always be handled in a secure manner and limited to only those who have been authorized by the campus to be involved in the administration of benefits. While the file may be securely maintained at the campus, it should be purged within 60 days after the date it is run to ensure secure measures are in place.

Delta Dental’s system is configured to automatically validate the file fields of each campus’ file and send an e-mail to campus-identified contacts with confirmation that a valid file was received. If errors are found, the designated contacts will receive a secure e-mail from Delta Dental that contains file validation errors. These errors must be corrected in Oracle/PeopleSoft and a newly generated file must be resent to Delta Dental no later than 3:00 pm prior to the 20th of the month in which the errors were reported. A Delta Dental Enrollment Analyst has been assigned to the CSU.

Note: Once all 23 campuses, including the Chancellor’s Office, have completed the upload process and passed the initial file validation process, the files will be merged on the 20th of each month and discrepancies will be forwarded to HRM. It is critical that each campus ensure a valid file is submitted with no errors as the entire CSU will be impacted if there are delays in campus file transmittals. The system will process the merged CSU file and any missed campus records will result in a termination of benefits for the employee and their dependents. Internally, Delta Dental will audit dependent data against the monthly file of deductions provided by the State Controller’s Office (SCO).

The information extracted on the HIPAA EDI 834 (Delta Dental Benefits Interface) file is driven by the information entered on the Create HIPAA EDI 834 File Page Run Control. Depending on the values selected, the following information may be included:

Campuses will generate an annual “Changes Only” file once a year during the month of December that will capture transactions with an effective date of January 1 of the following calendar year (e.g. January 1, 2013). Please see the screen shots below of the Oracle/PeopleSoft page that campuses must update in order to generate the “changes only” file. Note that for the Open Enrollment file, the As Of Date, File Effective Date, File Enrollment Date and From Date must be 1/1/XX of the following year and that the File Type is Update Only File.

End of BPG