X12 HIPAA 834 Benefit Enrollment

The EDI 834 transaction set represents a Benefit Enrollment and Maintenance document. It is used by employers, as well as unions, government agencies, or insurance agencies, to enroll members in a healthcare benefit plan. The EDI 834 has been specified by HIPAA 5010 standards for the electronic exchange of member enrollment information, including benefits, plan subscription, and employee demographic information. The 834 transaction may be used for any of the following functions relative to health plans:

• New enrollments
• Changes in a member’s enrollment
• Reinstatement of a member’s benefit enrollment
• Disenrollment of members (i.e., termination of plan membership)

The information is submitted, typically by the employer, to healthcare payer organizations who are responsible for payment of health claims and administering insurance and/or benefits. This may include insurance companies, healthcare professional organizations such as HMOs or PPOs, government agencies such as Medicare and Medicaid.

X12 HIPAA 834 Specification

X12 HIPAA 834 specification is available at:

• EdiNation

X12 HIPAA 834 Code Example

X12 HIPAA 834 code example is available at:

• EDI Tools for .NET X12 HIPAA 834 parse & generate C# example

X12 HIPAA 834 Sample File

ISA*00*          *00*          *ZZ*386028429      *30*382328142      *050221*0602*U*00501*000012345*0*P*:~
GS*BE*386028429*382328142*20050221*0602*000012345*X*005010X220A1~
ST*834*12345*005010X220A1~
BGN*00*12456*19980520*1200****2~
N1*P5**FI*999888777~
N1*IN**FI*654456654~
INS*Y*18*021*20*A***FT~
REF*0F*123456789~
REF*1L*123456001~
DTP*356*D8*19960523~
NM1*IL*1*DOE*JOHN*P***34*123456789~
PER*IP**HP*7172343334*WP*7172341240~
N3*100 MARKET ST*APT 3G~
N4*CAMP HILL*PA*17011**CY*CUMBERLAND~
DMG*D8*19400816*M~
HD*021**HLT~
DTP*348*D8*19960601~
COB*P*890111*5~
HD*021**DEN~
DTP*348*D8*19960601~
HD*021**VIS~
DTP*348*D8*19960601~
SE*21*12345~
GE*1*000012345~
IEA*1*000012345~