Product: X12 EDI

Transaction: 834

Article Link: http://help.truecommerce.com/en/articles/10258293-x12-834-benefit-enrollment-and-maintenance

834 - Benefit Enrollment and Maintenance
FUNCTIONAL GROUP=BE

This X12 Transaction Set contains the format and establishes the data contents of the Benefit Enrollment and Maintenance Transaction Set (834) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to establish communication between the sponsor of the insurance product and the payer. Such transaction(s) may or may not take place through a third party administrator (TPA).

For the purpose of this standard, the sponsor is the party or entity that ultimately pays for the coverage, benefit or product. A sponsor can be an employer, union, government agency, association, or insurance agency.

The payer refers to an entity that pays claims, administers the insurance product or benefit, or both. A payer can be an insurance company, health maintenance organization (HMO), preferred provider organization (PPO), government agency (Medicare, Medicaid, Champus, etc.), or an entity that may be contracted by one of these former groups.

For the purpose of the 834 transaction set, a third party administrator (TPA) can be contracted by a sponsor to handle data gathering from those covered by the sponsor if the sponsor does not elect to perform this function itself.

SCHEMA

ST

Segment	Name	Position
ST	Transaction Set Header	0100
BGN	Beginning Segment	0200
REF	Reference Information	0300
DTP	Date or Time or Period	0400
AMT	Monetary Amount Information	0500
QTY	Quantity Information	0600

1000

Segment	Name	Position
N1	Party Identification	0700
N2	Additional Name Information	0800
N3	Party Location	0900
N4	Geographic Location	1000
PER	Administrative Communications Contact	1100

1100

Segment	Name	Position
ACT	Account Identification	1200
REF	Reference Information	1300
N3	Party Location	1400
N4	Geographic Location	1500
PER	Administrative Communications Contact	1600
DTP	Date or Time or Period	1700
AMT	Monetary Amount Information	1800

2000

Segment	Name	Position
INS	Insured Benefit	0100
REF	Reference Information	0200
DTP	Date or Time or Period	0250

2100

Segment	Name	Position
NM1	Individual or Organizational Name	0300
PER	Administrative Communications Contact	0400
N3	Party Location	0500
N4	Geographic Location	0600
DMG	Demographic Information	0800
PM	Electronic Funds Transfer Information	0900
EC	Employment Class	1000
ICM	Individual Income	1100
AMT	Monetary Amount Information	1200
HLH	Health Information	1300
HI	Health Care Information Codes	1400
LUI	Language Use	1500

2200

Segment	Name	Position
DSB	Disability Information	2000
DTP	Date or Time or Period	2100
AD1	Adjustment Amount	2200

2300

Segment	Name	Position
HD	Health Coverage	2600
DTP	Date or Time or Period	2700
AMT	Monetary Amount Information	2800
REF	Reference Information	2900
IDC	Identification Card	3000

2310

Segment	Name	Position
LX	Transaction Set Line Number	3100
NM1	Individual or Organizational Name	3200
N1	Party Identification	3300
N2	Additional Name Information	3400
N3	Party Location	3500
N4	Geographic Location	3600
PER	Administrative Communications Contact	3700
PRV	Provider Information	3800
DTP	Date or Time or Period	3900
PLA	Place or Location	3950

2320

Segment	Name	Position
COB	Coordination of Benefits	4000
REF	Reference Information	4050
DTP	Date or Time or Period	4070

2330

Segment	Name	Position
NM1	Individual or Organizational Name	4100
N2	Additional Name Information	4200
N3	Party Location	4300
N4	Geographic Location	4400
PER	Administrative Communications Contact	4500

2400

Segment	Name	Position
LC	Life Coverage	4600
AMT	Monetary Amount Information	4700
DTP	Date or Time or Period	4800
REF	Reference Information	4850

2410

Segment	Name	Position
BEN	Beneficiary or Owner Information	4900
NM1	Individual or Organizational Name	5000
N1	Party Identification	5100
N2	Additional Name Information	5200
N3	Party Location	5300
N4	Geographic Location	5400
DMG	Demographic Information	5420

2500

Segment	Name	Position
FSA	Flexible Spending Account	5500
AMT	Monetary Amount Information	5600
DTP	Date or Time or Period	5700
REF	Reference Information	5750

2600

Segment	Name	Position
RP	Retirement Product	5800
DTP	Date or Time or Period	5900
REF	Reference Information	5920
INV	Investment Vehicle Selection	5940
AMT	Monetary Amount Information	5960
QTY	Quantity Information	5970
K3	File Information	5980
REL	Relationship	6000

2610

Segment	Name	Position
NM1	Individual or Organizational Name	6100
N2	Additional Name Information	6300
DMG	Demographic Information	6510
BEN	Beneficiary or Owner Information	6520
REF	Reference Information	6530

2620

Segment	Name	Position
NX1	Property or Entity Identification	6540
N3	Party Location	6550
N4	Geographic Location	6560
DTP	Date or Time or Period	6570

2630

Segment	Name	Position
FC	Financial Contribution	6600
DTP	Date or Time or Period	6700

2640

Segment	Name	Position
INV	Investment Vehicle Selection	6780
DTP	Date or Time or Period	6790
QTY	Quantity Information	6800
ENT	Entity	6810
REF	Reference Information	6820
AMT	Monetary Amount Information	6830
K3	File Information	6840

2650

Segment	Name	Position
AIN	Income	6850
QTY	Quantity Information	6860
DTP	Date or Time or Period	6870
LS	Loop Header	6880

2700

Segment	Name	Position
LX	Transaction Set Line Number	6881

2750

Segment	Name	Position
N1	Party Identification	6882
REF	Reference Information	6883
DTP	Date or Time or Period	6884
LE	Loop Trailer	6885

SE

Segment	Name	Position
SE	Transaction Set Trailer	6900

COMMENTS

Notes
1/0500	The AMT segment is used to record the total Flexible Spending Account contributions in the transaction set.
1/0600	The QTY segment is used to record the total number of subscribers and dependents in the transaction set.
1/0700	At least one iteration of loop 1000 is required to identify the sender or receiver.
2/0100	A Subscriber is a person who elects the benefits and is affiliated with the employer or the insurer. A Dependent is a person who is affiliated with the subscriber, such as a spouse, child, etc., and is therefore entitled to benefits. Subscriber information must come before dependent information. The INS segment is used to note if information being submitted is subscriber information or dependent information.
2/0200	The REF segment is required to link the dependent(s) to the subscriber.
2/3100	Loop 2310 contains information about the primary care providers for the subscriber or the dependent, and about the beneficiaries of any employer-sponsored life insurance for the subscriber.
2/3200	Either NM1 or N1 will be included depending on whether an individual or organization is being specified.
2/5500	Loop 2500 may only appear for the Subscriber.

rev 05/12/2024

834 - Benefit Enrollment and MaintenanceFUNCTIONAL GROUP=BE