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Spearheading Strategic Business Efficiency

 . edi  . EDI 834
EDI 834

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.

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