EDI 834
Are you running a large scale company or a company which has a lot of employees and workers? If you are running a large scale company then you know the pain of managing and transacting the data from one format to another. But after a successful drill of Electronic Data Interchange you can do it with ease. There are plenty of transaction codes in EDI and some of them are dedicated to health plans as well. Out of which, one is EDI 834. So what is 843 EDI Transaction?
What is EDI 834?
Electronic Data interchange 834 i.e. EDI 834 is a transaction code from the transaction set manual of EDI based on X12 Transaction Set. This code is used by the unions, employers, insurance agencies or government agencies. EDI 834 transaction set is basically used for enrolling the members and employees into a health care benefit plan usually called as EDI 834 healthcare program. This program is specified by the HIPAA 5010 Standards which will help in the electronic enrollments. This will include members plan benefits, subscription etc.
So in short EDI 834 is used for these below listed health initiatives
- New or fresh enrollments
- Changes to be made in existing enrollment
- Reinstatement in any members enrollment
- Cancelling the enrollment of any member
- Terminating the planned membership
EDI 834 Format
ISA*01*0000000000*01*0000000000*ZZ*ABCDEFGHIJKLMNO*ZZ*123456789012345*101127*1719*U*00400*000003438*0*P*>
GS*PO*4405197800*999999999*20101127*1719*1421*X*004010VICS
ST*834*0179
BGN*00*1*20050315*110650****4
REF*38*SAMPLE_POLICY_NUMBER
DTP*303*D8*20080321
N1*P5*COMPAN_NAME*FI*000000000
INS*Y*18*030*20*A
REF*0F*SUBSCRIBER_NUMBER
NM1*IL*1*JOHN DOE*R***34*1*0000000
PER*IP**HP*2138051111
N3*123 SAMPLE RD
N4*CITY*ST*12345
DMG*D8*19690101 *F
HD*030
DTP*348*D8*20080101
REF*1L*INDIV_POLICY_NO
SE*16*0179
GE*1*1421
IEA*1*000003438
EDI 834 Example
ST*834*0001*005010X220A1
BGN*00*1*20120106*010510****4
REF*38*170175
DTP*303*D8*20120107
QTY*TO*2
N1*P5*DISNEY INC*FI*953630868
N1*IN*BCBS DISNEY*FI*953761231
INS*Y*18*030*20*A
REF*0F*055090001
NM1*IL*1*MOUSE*MICKEY****34*055090001
PER*IP**HP*7146790999
N3*1565 DISNEYLAND DRIVE*SUITE 101
N4*ANAHEIM*CA*92802
DMG*D8*19281118*M
HD*030
DTP*348*D8*20120107
REF*1L*170805M001
INS*N*01*030*20*A
REF*0F*056090001
NM1*IL*1*MOUSE*MINNIE****34*056090001
PER*IP**HP*7146790999
N3*1565 DISNEYLAND DRIVE*SUITE 101
N4*ANAHEIM*CA*92802
DMG*D8*19301226*F
HD*030
DTP*348*D8*20120101
DTP*349*D8*20120813
REF*1L*170805M001
SE*29*0001
Detailed explanation of above EDI 834 example
BGN*00*1*20120106*010510****4
Beginning Segment:
Transaction Set Purpose Code : Original
Reference Identification : 1
Date : 1/6/2012
Time : 1:05:10 AM
Action Code : Verify
Reference Identification: REF*38*170175
Master Policy Number : 170175
Date or Time or Period: DTP*303*D8*20120107
Date/Time Qualifier : Maintenance Effective
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120107
Quantity Information: QTY*TO*2
Quantity Qualifier : Total
Quantity : 2
Plan Sponsor: N1*P5*DISNEY INC*FI*953630868
DISNEY INC (Federal Taxpayer’s Identification Number: 953630868)
Insurer: N1*IN*BCBS DISNEY*FI*953761231
BCBS DISNEY (Federal Taxpayer’s Identification Number: 953761231)
Insured Benefit: INS*N*01*030*20*A
Yes/No Condition or Response Code : N (N indicates the insured is a dependent.)
Individual Relationship Code :Spouse
Maintenance Type Code : Audit or Compare
Maintenance Reason Code : Active
Benefit Status Code : Active
Reference Identification: REF*0F*055090001
Subscriber Number : 055090001
Individual or Organizational Name: NM1*IL*1*MOUSE*MICKEY****34*055090001
Entity Identifier Code : Insured or Subscriber
Entity Type Qualifier : Person
Name Last or Organization Name : MOUSE
Name First : MICKEY
Identification Code Qualifier : Social Security Number
Identification Code : 055090001
Contact Information: PER*IP**HP*7146790999
Insured Party :
Home Phone Number : 7146790999
Address Information: N3*1565 DISNEYLAND DRIVE*SUITE 101
Street : 1565 DISNEYLAND DRIVE – SUITE 101
Address Information: N4*ANAHEIM*CA*92802
CITY: Anaheim, STATE: CA ZIP: 92802
Demographic Information: DMG*D8*19281118*M
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 19281118
Gender Code : Male
Health Coverage: HD*030
Maintenance Type Code : Audit or Compare
Date or Time or Period: DTP*348*D8*20120107
Date/Time Qualifier : Benefit Begin
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120107
Reference Identification: REF*1L*170805M001
Group or Policy Number : 170805M001
Insured Benefit: INS*Y*18*030*20*A
Yes/No Condition or Response Code : Yes (‘Y’ indicates the insured is a subscriber: an ‘NO’ value would indicate the insured is a dependent)
Individual Relationship Code : Self
Maintenance Type Code : Audit or Compare
Maintenance Reason Code : Active
Benefit Status Code : Active
Reference Information:
Subscriber Number : 056090001 (Social Security #)
Individual or Organizational Name: NM1*IL*1*MOUSE*MINNIE****34*056090001
Entity Identifier Code : Insured or Subscriber
Entity Type Qualifier : Person
Name Last or Organization Name : MOUSE
Name First : MINNIE
Identification Code Qualifier : Social Security Number
Identification Code : 056090001
Contact Information: PER*IP**HP*7146790999
Insured Party :
Home Phone Number : 7146790999
N3*1565 DISNEYLAND DRIVE*SUITE 101
N4*ANAHEIM*CA*92802
1565 DISNEYLAND DRIVE SUITE 101
ANAHEIM, CA 92802
Demographic Information: DMG*D8*19301226*F
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 19301226
Gender Code : Female
Health Coverage: HD*030
Maintenance Type Code : Audit or Compare
Date or Time or Period: DTP*348*D8*20120101
Date/Time Qualifier : Benefit Begin
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120101
Date or Time or Period: DTP*349*D8*20120813
Date/Time Qualifier : Benefit End
Date Time Period Format Qualifier : Date Expressed in Format CCYYMMDD
Date Time Period : 20120813
Reference Information: REF*1L*170805M001
Group or Policy Number : 170805M001
EDI 834 Process Flow Layout
INS*Y*18*030*XN*A*E**FT~
REF*0F*152239999~
REF*1L*Blue~
DTP*336*D8*20070101~
NM1*IL*1*JANE*JONES****34*152239999~
N3*224 N LOS LANDINGS*7TH FLOOR~
N4*CHICAGO*IL*60661*USA~
DMG*D8*19720121*F*M~
HD*030**VIS**EMP~
DTP*348*D8*20111016~
INS*N*19*030*XN*A*E***N*N~
REF*0F*152239999~
REF*1L*Blue~
DTP*357*D8*20111015~
NM1*IL*1*JANE*BUSTER~
N3*224 N LOS LANDINGS*7TH FLOOR~
N4*CHICAGO*IL*60661*USA~
DMG*D**19911015*M-HD*030**VIS~
DTP*348*D8*20110101~
DTP*349*D8*20111015~
EDI 834 Specifications
All the EDI transaction codes including EDI 834 are based on X12 Transaction Set which contains the standard format and will establish the content of data for the basic enrollment of any worker, employee or member of any organisation and will abide by all the contexts of Electronic Data Interchange.
If you are looking for the best EDI Consultant for EDI 834 then, you can visit our website and talk to our EDI professionals.
