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.
To indicate the start of a transaction set and to assign a control number
To indicate the beginning of a transaction set
To specify identifying information
To specify any or all of a date, a time, or a time period
To indicate the total monetary amount
To specify quantity information
To identify a party by type of organization, name, and code
To specify additional names
To specify the location of the named party
To specify the geographic place of the named party
To identify a person or office to whom administrative communications should be directed
To specify account information
To specify identifying information
To specify the location of the named party
To specify the geographic place of the named party
To identify a person or office to whom administrative communications should be directed
To specify any or all of a date, a time, or a time period
To indicate the total monetary amount
To provide benefit information on insured entities
To specify identifying information
To specify any or all of a date, a time, or a time period
To supply the full name of an individual or organizational entity
To identify a person or office to whom administrative communications should be directed
To specify the location of the named party
To specify the geographic place of the named party
To supply demographic information
To supply information on the electronic funds transfer (EFT) method of payment
To provide class of employment information
To supply information to determine benefit eligibility, deductibles, and retirement and investment contributions
To indicate the total monetary amount
To provide health information
To supply information related to the delivery of health care
To specify language, type of usage, and proficiency or fluency
To supply disability information
To specify any or all of a date, a time, or a time period
To specify the characteristics of an adjustment
To provide information on health coverage
To specify any or all of a date, a time, or a time period
To indicate the total monetary amount
To specify identifying information
To provide notification to produce replacement identification card(s)
To reference a line number in a transaction set
To supply the full name of an individual or organizational entity
To identify a party by type of organization, name, and code
To specify additional names
To specify the location of the named party
To specify the geographic place of the named party
To identify a person or office to whom administrative communications should be directed
To specify the identifying characteristics of a provider
To specify any or all of a date, a time, or a time period
To indicate action to be taken for the location specified and to qualify the location specified
To supply information on coordination of benefits
To specify identifying information
To specify any or all of a date, a time, or a time period
To supply the full name of an individual or organizational entity
To specify additional names
To specify the location of the named party
To specify the geographic place of the named party
To identify a person or office to whom administrative communications should be directed
To provide information on life coverage
To indicate the total monetary amount
To specify any or all of a date, a time, or a time period
To specify identifying information
To supply beneficiary, co-participant, and owner information
To supply the full name of an individual or organizational entity
To identify a party by type of organization, name, and code
To specify additional names
To specify the location of the named party
To specify the geographic place of the named party
To supply demographic information
To supply flexible spending account information
To indicate the total monetary amount
To specify any or all of a date, a time, or a time period
To specify identifying information
To specify the retirement product characteristics
To specify any or all of a date, a time, or a time period
To specify identifying information
To specify type of investment vehicle or account and other basic data about the investment
To indicate the total monetary amount
To specify quantity information
To transmit a fixed-format record or matrix contents
To specify relationship and birth order of entity
To supply the full name of an individual or organizational entity
To specify additional names
To supply demographic information
To supply beneficiary, co-participant, and owner information
To specify identifying information
To define the attributes of a property or an entity
To specify the location of the named party
To specify the geographic place of the named party
To specify any or all of a date, a time, or a time period
To specify the financial contribution information
To specify any or all of a date, a time, or a time period
To specify type of investment vehicle or account and other basic data about the investment
To specify any or all of a date, a time, or a time period
To specify quantity information
To designate the entities which are parties to a transaction and specify a reference meaningful to those entities
To specify identifying information
To indicate the total monetary amount
To transmit a fixed-format record or matrix contents
To provide type and amount of income obtained
To specify quantity information
To specify any or all of a date, a time, or a time period
To indicate that the next segment begins a loop
To reference a line number in a transaction set
To identify a party by type of organization, name, and code
To specify identifying information
To specify any or all of a date, a time, or a time period
To indicate that the loop immediately preceding this segment is complete
To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)
