EDI 834 Enrollment Transaction
The EDI 834 file format is used primarily in the healthcare industry for the electronic exchange of enrollment information between various parties involved in benefits administration. Here’s how it’s commonly used:
- Employers: Employers use the EDI 834 format to communicate employee enrollment information to insurance carriers or benefit administrators. This includes details such as employee demographics, dependent information, coverage start dates, and plan selections.
- Insurance Carriers: Insurance carriers receive the EDI 834 files from employers or benefit administrators to process enrollments, update member records, and manage coverage information for individuals and their dependents.
- Benefit Administrators: Benefit administrators, such as third-party administrators (TPAs) or health plan administrators, use the EDI 834 format to receive enrollment data from employers and transmit it to insurance carriers. They may also perform data validation, reconciliation, and reporting functions.
- Government Agencies: Government agencies, such as Medicaid or Medicare programs, may use the EDI 834 format to enroll individuals in government-sponsored health insurance plans. These agencies receive enrollment data from individuals, employers, or other entities, and process it electronically using the EDI 834 standard.
EDI 834 File Format Example
This is a basic example, and actual files may contain more segments and data elements depending on the specific requirements of the organizations involved in the exchange of enrollment information.
ISA*00* *00* *ZZ*SenderID *01*ReceiverID *200101*1200*^*00501*000000001*0*T*:~
GS*BE*SenderID*ReceiverID*200101*1200*1*X*005010X220A1~
ST*834*0001~
BGN*00*123456*20010101*20010101*01~
REF*38*123456789~
DTP*356*D8*20010101~
QTY*PT*2~
N1*P5*Health Plan Name~
N1*IN*Insurer Name~
INS*Y*18*030*XN*A*E*H*Medicaid~
REF*2U*123456~
REF*F6*030~
DTP*348*D8*20010101~
LUI*18*LT~
LUI*19*LE~
LUI*20*LE~
LUI*21*LA~
III*ZZ*InsurerFEIN~
REF*1L*123456789~
DTP*303*D8*20010101~
NM1*IL*1*Last Name*First Name*M*~
REF*1W*123456789~
DTP*348*D8*20010101~
LUI*19*LT~
LUI*20*LE~
LUI*21*LE~
INS*Y*19*030*XN*A*E*H*Medicaid~
REF*2U*123456~
REF*F6*030~
DTP*348*D8*20010101~
LUI*18*LT~
LUI*19*LE~
LUI*20*LE~
LUI*21*LA~
III*ZZ*InsurerFEIN~
REF*1L*123456789~
DTP*303*D8*20010101~
NM1*IL*1*Last Name*First Name*M*~
REF*1W*123456789~
DTP*348*D8*20010101~
LUI*19*LT~
LUI*20*LE~
LUI*21*LE~
SE*33*0001~
GE*1*1~
IEA*1*000000001~
The EDI 834 streamlines the enrollment process by facilitating the electronic exchange of enrollment data, reducing manual paperwork, minimizing errors, and improving efficiency in benefits administration within the healthcare industry.
To learn more about EDI transactions and become a CEDIAP® (Certified EDI Academy Professional), please visit our course schedule page.