Setting Up Benefit Providers

A benefit provider is a vendor. It is the entity that sponsors the benefit plan that your company offers your employees. For example, if your company offers a Blue Cross/Blue Shield health insurance plan, Blue Cross/Blue Shield is the provider. If your organization has a self-funded medical plan but uses a third-party administrator (TPA) to handle administrative functions such as eligibility and claims, the TPA can be considered a vendor.

You use the Provider/Vendor Table component (PROVIDER_TABLE) to set up an ID for each vendor.

To include a benefit provider in the HIPAA (Health Insurance Portability and Accountability Act) EDI File Creation process, you must specify the vendor's Federal Employer Identification Number (FEIN).