834 example – raw data and human readable presentation
834 example described in the post is a full file audit sent from a corporation to an insurance company. Although the TR3 Implementation Guides do not recommend sending the Full File Audit to perform changes, most insurance companies will accept them as changes if there is mismatch.
For example, an employee that is sent on the 834 example full file that is not currently active on the insurance side will generate an add transaction. See the 834 example below:
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
834 example in a human readable form
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 Academy HIPAA EDI course is the ultimate source for all the details about EDI transactions including 834 Benefit Enrollment and Maintenance. The examples used at the seminars make it easier to understand the purpose of the HIPAA transactions.