834 Healthcare EDI Transaction – Benefit Enrollment and Maintenance
834 Healthcare EDI Transaction (Benefit Enrollment and Maintenance) is used to provide enrollment information from sponsors to insurance companies. Sponsors are typically corporations or other institutions that provide health care benefits to their employees. The 834 Healthcare EDI can be used to provide initial enrollment and also provide maintenance (changes, additions, deletions) for existing enrollment. The 834 Healthcare EDI can be sent from the sponsor to the insurance company or via a third party intermediary.
834 Healthcare EDI Termination Information
- Termination date sent at INS level for a subscriber will terminate all coverage for that subscriber and dependent. All subscribers and dependents can be terminated by terminating all insurance products at the HD level.
- Termination date sent at INS level for a dependent will terminate coverage for that dependent only not any other dependent or subscriber.
- Termination Date sent at HD level (loop 2300) coverage for that specific insurance product will be terminated from that specific member.
- You can terminate all insurance products for the subscriber only and keep insurance for dependents by sending terminating all insurance products for the subscriber at the HD level (this is for “dependent-only plans”).
- In case of a transfer from one coverage to another it’s necessary to terminate old coverage and then add new coverage.
834 Healthcare EDI Updates vs. Full File Audits
- BGN-08 has two available action codes:
- “2” for change which includes additions, terminations, and change to current enrollment.
- “4” for verification – this includes full enrollment transaction to verify that sponsor’s and payer’s systems are synchronized.
- A best practice is to send “Change (update transactions)” on a regular basis and conduct “4” for verification periodically to keep the systems in synch.
834 Raw Data Example (Update)
The following example enrolls an employee into health and dental coverage.
N3*1565 DISNEYLAND DRIVE*SUITE 101
834 Related Transactions
Some sponsors send the 820 Remittance Advice / EFT document to pay the insurance company. The 270/271 Eligibility Inquiry / Response is sent by the health care provider to the insurance company to request eligibility coverage information.
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