By | 2019-10-09T12:12:24+00:00 October 9th, 2019|

What is EDI 834 Benefit Enrollment and Maintenance? 

One of the X12 transactions, EDI 834 is used for conveying member enrollment details, such as plan subscription and employee demographic information. This transaction set is also used to transmit information related to:

  • New enrollments
  • Changes in the member’s existing enrollment information
  • Disenrollment of members

EDI X12 834 Benefit Enrollment and Maintenance Sample

The following example details the format of an EDI 834 document[1].

ST*834*0001*005010X220A1~
BGN*00*XXX20110524C002*20110524*2215****2~
REF*38*G02408~
DTP*007*D8*20110524~
N1*P5*SUMMACARE ENROLL*FI*99-9999999~
N1*IN*SUMMACARE*FI*999999999~
INS*Y*18*021*28*A***FT~
REF*0F*111224444~
REF*1L*G04559SB~
DTP*336*D8*20110501~
NM1*IL*1*DOE*JOHN*I~
PER*IP**HP*3305551111~
N3*486 SOME STREET~
N4*AKRON*OH*44313~
DMG*D8*19640101*M~
HD*021**HLT~
DTP*348*D8*20110601~
LX*1~
NM1*P3*1******SV*170*25~
SE*20*0001~

Workflow for the Exchange of EDI 834 Benefit Enrollment and Maintenance

Upon receiving an EDI 834 document, the recipient responds with an EDI 999 Implementation Acknowledgement to confirm that the file was received and provide feedback on the acceptance of the document.

Achieve EDICompliance with Astera EDIConnect

With a built-in message parser, validator, and transaction builder, Astera EDIConnect can handle transaction sets in X12, EDIFACT, and HL7 formats. This helps businesses exchange EDI documents seamlessly with their trading partners. Moreover, Astera EDIConnect allows its users to automate file uploads and downloads, create workflows, and transform files into the required format to streamline the B2B data exchange process.

[1] https://www.summacare.com/-/media/project/summacare/website/document-library/edi-and-hippa/hippa-summacare-834-5010-companion-guide.pdf?la=en

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