Summa Care 834 Eligibility Enrollment and Maintenance Example
All Trading Partners must complete transaction testing prior to submission of transactions in production. Prior to submitting production enrollment information electronically, all sponsors or their designated vendor must complete successful transaction testing. Sponsors must maintain a successful level of transaction submission to remain in production.
There should be no more than 10,000 INS (Member) segments within a single transaction. You will need to use multiple Transaction Set Header/Trailer segments within a single interchange when there are more than 10,000 INS segments.
834 EDI Transaction Example
John Doe is enrolling into the plan as a new hire with coverage effective on 6/1/2011 and a hire date of 5/1/2011.
Transaction Sample X12 Scenario 1- Adding a member
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~
Jane Doe coverage is terminating due to a career change. Her coverage will terminate on 3/31/2011.
Transaction Sample X12 Scenario 2 – Terminating a member
ST*834*0001*005010X220A1~
BGN*00*XXX20110524C002*20110325*1115****2~
REF*38*G02472~
DTP*007*D8*20110325~
N1*P5*SUMMACARE ENROLL*FI*99-9999999~
N1*IN*SUMMACARE*FI*999999999~
INS*Y*18*024*08*C**1*TE~
REF*0F*111224443~
REF*1L*G04559SB~
DTP*337*D8*20110331~
NM1*IL*1*DOE*JANE*I~
PER*IP**HP*3305551212~
N3*486 SOME STREET~
N4*AKRON*OH*44313~
DMG*D8*19670315*F~
HD*024**HLT~
DTP*349*D8*20110331~
SE*18*0001~
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