834Benefit Enrollment and Maintenance

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.

  • ST
    Transaction Set Header
    M必须(Mandatory)
    Repeat 1

    To indicate the start of a transaction set and to assign a control number

  • BGN
    Beginning Segment
    M必须(Mandatory)
    Repeat 1

    To indicate the beginning of a transaction set

  • REF
    Reference Information
    O可选(Optional)
    Repeat > 1

    To specify identifying information

  • DTP
    Date or Time or Period
    O可选(Optional)
    Repeat > 1

    To specify any or all of a date, a time, or a time period

  • AMT
    Monetary Amount Information
    O可选(Optional)
    Repeat > 1

    To indicate the total monetary amount

  • QTY
    Quantity Information
    O可选(Optional)
    Repeat > 1

    To specify quantity information

  • N1Loop1Party Identification LOOPM必须(Mandatory)Repeat > 1
    N1N2N3N4PERACTLoop1
    • N1
      Party Identification
      M必须(Mandatory)
      Repeat 1

      To identify a party by type of organization, name, and code

    • N2
      Additional Name Information
      O可选(Optional)
      Repeat 2

      To specify additional names

    • N3
      Party Location
      O可选(Optional)
      Repeat 2

      To specify the location of the named party

    • N4
      Geographic Location
      O可选(Optional)
      Repeat 1

      To specify the geographic place of the named party

    • PER
      Administrative Communications Contact
      O可选(Optional)
      Repeat 3

      To identify a person or office to whom administrative communications should be directed

    • ACTLoop1Account Identification LOOPO可选(Optional)Repeat 10
      ACTREFN3N4PERDTPAMT
      • ACT
        Account Identification
        M必须(Mandatory)
        Repeat 1

        To specify account information

      • REF
        Reference Information
        O可选(Optional)
        Repeat 5

        To specify identifying information

      • N3
        Party Location
        O可选(Optional)
        Repeat 1

        To specify the location of the named party

      • N4
        Geographic Location
        O可选(Optional)
        Repeat 1

        To specify the geographic place of the named party

      • PER
        Administrative Communications Contact
        O可选(Optional)
        Repeat 5

        To identify a person or office to whom administrative communications should be directed

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat 1

        To specify any or all of a date, a time, or a time period

      • AMT
        Monetary Amount Information
        O可选(Optional)
        Repeat 1

        To indicate the total monetary amount

  • INSLoop1Insured Benefit LOOPO可选(Optional)Repeat > 1
    INSREFDTPNM1Loop1DSBLoop1HDLoop1LCLoop1FSALoop1RPLoop1LSLoop1
    • INS
      Insured Benefit
      M必须(Mandatory)
      Repeat 1

      To provide benefit information on insured entities

    • REF
      Reference Information
      M必须(Mandatory)
      Repeat > 1

      To specify identifying information

    • DTP
      Date or Time or Period
      O可选(Optional)
      Repeat > 1

      To specify any or all of a date, a time, or a time period

    • NM1Loop1Individual or Organizational Name LOOPO可选(Optional)Repeat > 1
      NM1PERN3N4DMGPMECICMAMTHLHHILUI
      • NM1
        Individual or Organizational Name
        M必须(Mandatory)
        Repeat 1

        To supply the full name of an individual or organizational entity

      • PER
        Administrative Communications Contact
        O可选(Optional)
        Repeat 1

        To identify a person or office to whom administrative communications should be directed

      • N3
        Party Location
        O可选(Optional)
        Repeat 1

        To specify the location of the named party

      • N4
        Geographic Location
        O可选(Optional)
        Repeat 1

        To specify the geographic place of the named party

      • DMG
        Demographic Information
        O可选(Optional)
        Repeat 1

        To supply demographic information

      • PM
        Electronic Funds Transfer Information
        O可选(Optional)
        Repeat 1

        To supply information on the electronic funds transfer (EFT) method of payment

      • EC
        Employment Class
        O可选(Optional)
        Repeat > 1

        To provide class of employment information

      • ICM
        Individual Income
        O可选(Optional)
        Repeat 1

        To supply information to determine benefit eligibility, deductibles, and retirement and investment contributions

      • AMT
        Monetary Amount Information
        O可选(Optional)
        Repeat 10

        To indicate the total monetary amount

      • HLH
        Health Information
        O可选(Optional)
        Repeat 1

        To provide health information

      • HI
        Health Care Information Codes
        O可选(Optional)
        Repeat 10

        To supply information related to the delivery of health care

      • LUI
        Language Use
        O可选(Optional)
        Repeat > 1

        To specify language, type of usage, and proficiency or fluency

    • DSBLoop1Disability Information LOOPO可选(Optional)Repeat 4
      DSBDTPAD1
      • DSB
        Disability Information
        M必须(Mandatory)
        Repeat 1

        To supply disability information

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat 10

        To specify any or all of a date, a time, or a time period

      • AD1
        Adjustment Amount
        O可选(Optional)
        Repeat 10

        To specify the characteristics of an adjustment

    • HDLoop1Health Coverage LOOPO可选(Optional)Repeat 99
      HDDTPAMTREFIDCLXLoop1COBLoop1
      • HD
        Health Coverage
        M必须(Mandatory)
        Repeat 1

        To provide information on health coverage

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat 10

        To specify any or all of a date, a time, or a time period

      • AMT
        Monetary Amount Information
        O可选(Optional)
        Repeat 3

        To indicate the total monetary amount

      • REF
        Reference Information
        O可选(Optional)
        Repeat 5

        To specify identifying information

      • IDC
        Identification Card
        O可选(Optional)
        Repeat > 1

        To provide notification to produce replacement identification card(s)

      • LXLoop1Transaction Set Line Number LOOPO可选(Optional)Repeat 30
        LXNM1N1N2N3N4PERPRVDTPPLA
        • LX
          Transaction Set Line Number
          M必须(Mandatory)
          Repeat 1

          To reference a line number in a transaction set

        • NM1
          Individual or Organizational Name
          O可选(Optional)
          Repeat 1

          To supply the full name of an individual or organizational entity

        • N1
          Party Identification
          O可选(Optional)
          Repeat 3

          To identify a party by type of organization, name, and code

        • N2
          Additional Name Information
          O可选(Optional)
          Repeat 1

          To specify additional names

        • N3
          Party Location
          O可选(Optional)
          Repeat 2

          To specify the location of the named party

        • N4
          Geographic Location
          O可选(Optional)
          Repeat 2

          To specify the geographic place of the named party

        • PER
          Administrative Communications Contact
          O可选(Optional)
          Repeat 2

          To identify a person or office to whom administrative communications should be directed

        • PRV
          Provider Information
          O可选(Optional)
          Repeat 1

          To specify the identifying characteristics of a provider

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat 6

          To specify any or all of a date, a time, or a time period

        • PLA
          Place or Location
          O可选(Optional)
          Repeat 1

          To indicate action to be taken for the location specified and to qualify the location specified

      • COBLoop1Coordination of Benefits LOOPO可选(Optional)Repeat 10
        COBREFDTPNM1Loop2
        • COB
          Coordination of Benefits
          M必须(Mandatory)
          Repeat 1

          To supply information on coordination of benefits

        • REF
          Reference Information
          O可选(Optional)
          Repeat > 1

          To specify identifying information

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat 2

          To specify any or all of a date, a time, or a time period

        • NM1Loop2Individual or Organizational Name LOOPO可选(Optional)Repeat 3
          NM1N2N3N4PER
          • NM1
            Individual or Organizational Name
            M必须(Mandatory)
            Repeat 1

            To supply the full name of an individual or organizational entity

          • N2
            Additional Name Information
            O可选(Optional)
            Repeat 1

            To specify additional names

          • N3
            Party Location
            O可选(Optional)
            Repeat 2

            To specify the location of the named party

          • N4
            Geographic Location
            O可选(Optional)
            Repeat 1

            To specify the geographic place of the named party

          • PER
            Administrative Communications Contact
            O可选(Optional)
            Repeat 1

            To identify a person or office to whom administrative communications should be directed

    • LCLoop1Life Coverage LOOPO可选(Optional)Repeat 10
      LCAMTDTPREFBENLoop1
      • LC
        Life Coverage
        M必须(Mandatory)
        Repeat 1

        To provide information on life coverage

      • AMT
        Monetary Amount Information
        O可选(Optional)
        Repeat 5

        To indicate the total monetary amount

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat 2

        To specify any or all of a date, a time, or a time period

      • REF
        Reference Information
        O可选(Optional)
        Repeat > 1

        To specify identifying information

      • BENLoop1Beneficiary or Owner Information LOOPO可选(Optional)Repeat 20
        BENNM1N1N2N3N4DMG
        • BEN
          Beneficiary or Owner Information
          M必须(Mandatory)
          Repeat 1

          To supply beneficiary, co-participant, and owner information

        • NM1
          Individual or Organizational Name
          O可选(Optional)
          Repeat 1

          To supply the full name of an individual or organizational entity

        • N1
          Party Identification
          O可选(Optional)
          Repeat 1

          To identify a party by type of organization, name, and code

        • N2
          Additional Name Information
          O可选(Optional)
          Repeat 1

          To specify additional names

        • N3
          Party Location
          O可选(Optional)
          Repeat 1

          To specify the location of the named party

        • N4
          Geographic Location
          O可选(Optional)
          Repeat 1

          To specify the geographic place of the named party

        • DMG
          Demographic Information
          O可选(Optional)
          Repeat 1

          To supply demographic information

    • FSALoop1Flexible Spending Account LOOPO可选(Optional)Repeat 5
      FSAAMTDTPREF
      • FSA
        Flexible Spending Account
        M必须(Mandatory)
        Repeat 1

        To supply flexible spending account information

      • AMT
        Monetary Amount Information
        O可选(Optional)
        Repeat 10

        To indicate the total monetary amount

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat 10

        To specify any or all of a date, a time, or a time period

      • REF
        Reference Information
        O可选(Optional)
        Repeat > 1

        To specify identifying information

    • RPLoop1Retirement Product LOOPO可选(Optional)Repeat > 1
      RPDTPREFINVAMTQTYK3RELNM1Loop3FCLoop1AINLoop1
      • RP
        Retirement Product
        M必须(Mandatory)
        Repeat 1

        To specify the retirement product characteristics

      • DTP
        Date or Time or Period
        O可选(Optional)
        Repeat > 1

        To specify any or all of a date, a time, or a time period

      • REF
        Reference Information
        O可选(Optional)
        Repeat > 1

        To specify identifying information

      • INV
        Investment Vehicle Selection
        O可选(Optional)
        Repeat > 1

        To specify type of investment vehicle or account and other basic data about the investment

      • AMT
        Monetary Amount Information
        O可选(Optional)
        Repeat 20

        To indicate the total monetary amount

      • QTY
        Quantity Information
        O可选(Optional)
        Repeat 20

        To specify quantity information

      • K3
        File Information
        O可选(Optional)
        Repeat 3

        To transmit a fixed-format record or matrix contents

      • REL
        Relationship
        O可选(Optional)
        Repeat 1

        To specify relationship and birth order of entity

      • NM1Loop3Individual or Organizational Name LOOPO可选(Optional)Repeat > 1
        NM1N2DMGBENREFNX1Loop1
        • NM1
          Individual or Organizational Name
          M必须(Mandatory)
          Repeat 1

          To supply the full name of an individual or organizational entity

        • N2
          Additional Name Information
          O可选(Optional)
          Repeat 1

          To specify additional names

        • DMG
          Demographic Information
          O可选(Optional)
          Repeat 1

          To supply demographic information

        • BEN
          Beneficiary or Owner Information
          O可选(Optional)
          Repeat 1

          To supply beneficiary, co-participant, and owner information

        • REF
          Reference Information
          O可选(Optional)
          Repeat > 1

          To specify identifying information

        • NX1Loop1Property or Entity Identification LOOPO可选(Optional)Repeat > 1
          NX1N3N4DTP
          • NX1
            Property or Entity Identification
            M必须(Mandatory)
            Repeat 1

            To define the attributes of a property or an entity

          • N3
            Party Location
            O可选(Optional)
            Repeat 1

            To specify the location of the named party

          • N4
            Geographic Location
            O可选(Optional)
            Repeat 1

            To specify the geographic place of the named party

          • DTP
            Date or Time or Period
            O可选(Optional)
            Repeat > 1

            To specify any or all of a date, a time, or a time period

      • FCLoop1Financial Contribution LOOPO可选(Optional)Repeat > 1
        FCDTPINVLoop1
        • FC
          Financial Contribution
          M必须(Mandatory)
          Repeat 1

          To specify the financial contribution information

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat > 1

          To specify any or all of a date, a time, or a time period

        • INVLoop1Investment Vehicle Selection LOOPO可选(Optional)Repeat > 1
          INVDTPQTYENTREFAMTK3
          • INV
            Investment Vehicle Selection
            M必须(Mandatory)
            Repeat 1

            To specify type of investment vehicle or account and other basic data about the investment

          • DTP
            Date or Time or Period
            O可选(Optional)
            Repeat > 1

            To specify any or all of a date, a time, or a time period

          • QTY
            Quantity Information
            O可选(Optional)
            Repeat > 1

            To specify quantity information

          • ENT
            Entity
            O可选(Optional)
            Repeat > 1

            To designate the entities which are parties to a transaction and specify a reference meaningful to those entities

          • REF
            Reference Information
            O可选(Optional)
            Repeat > 1

            To specify identifying information

          • AMT
            Monetary Amount Information
            O可选(Optional)
            Repeat 20

            To indicate the total monetary amount

          • K3
            File Information
            O可选(Optional)
            Repeat 3

            To transmit a fixed-format record or matrix contents

      • AINLoop1Income LOOPO可选(Optional)Repeat > 1
        AINQTYDTP
        • AIN
          Income
          M必须(Mandatory)
          Repeat 1

          To provide type and amount of income obtained

        • QTY
          Quantity Information
          O可选(Optional)
          Repeat > 1

          To specify quantity information

        • DTP
          Date or Time or Period
          O可选(Optional)
          Repeat > 1

          To specify any or all of a date, a time, or a time period

    • LSLoop1Loop Header LOOPO可选(Optional)Repeat 1
      LSLXLoop2LE
      • LS
        Loop Header
        M必须(Mandatory)
        Repeat 1

        To indicate that the next segment begins a loop

      • LXLoop2Transaction Set Line Number LOOPO可选(Optional)Repeat > 1
        LXN1Loop2
        • LX
          Transaction Set Line Number
          M必须(Mandatory)
          Repeat 1

          To reference a line number in a transaction set

        • N1Loop2Party Identification LOOPM必须(Mandatory)Repeat > 1
          N1REFDTP
          • N1
            Party Identification
            M必须(Mandatory)
            Repeat 1

            To identify a party by type of organization, name, and code

          • REF
            Reference Information
            M必须(Mandatory)
            Repeat 1

            To specify identifying information

          • DTP
            Date or Time or Period
            O可选(Optional)
            Repeat 1

            To specify any or all of a date, a time, or a time period

      • LE
        Loop Trailer
        M必须(Mandatory)
        Repeat 1

        To indicate that the loop immediately preceding this segment is complete

  • SE
    Transaction Set Trailer
    M必须(Mandatory)
    Repeat 1

    To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)

Segment
X12 EDI Release 00601
To indicate the start of a transaction set and to assign a control number
Elements
  • ST01143Transaction Set Identifier Code
    ID
    M必须(Mandatory)
    Min 3 / Max 3

    Code uniquely identifying a Transaction Set

    Codes (320)
  • ST02329Transaction Set Control Number
    AN
    M必须(Mandatory)
    Min 4 / Max 9

    Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set

  • ST031705Implementation Convention Preference
    AN
    O可选(Optional)
    Min 1 / Max 9

    Reference assigned to identify Implementation Convention