The X12 834 EDI Enrollment Implementation Format is a standard

file format A file format is a Computer standard, standard way that information is encoded for storage in a computer file. It specifies how bits are used to encode information in a digital storage medium. File formats may be either proprietary format, pr ...

in the United States for electronically exchanging health plan enrollment data between employers and

health insurance Health insurance or medical insurance (also known as medical aid in South Africa) is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among ma ...

carriers. The Health Insurance Portability and Accountability Act (HIPAA) requires that all health plans or health insurance carriers accept a standard enrollment format:

ANSI The American National Standards Institute (ANSI ) is a private nonprofit organization that oversees the development of voluntary consensus standards for products, services, processes, systems, and personnel in the United States. The organiz ...

834A Version 5010. An 834 file contains a string of data elements, with each representing a fact, such as a subscriber’s name, hire date, etc. The entire string is called a transaction set. The 834 is used to transfer enrollment information from the sponsor of the

insurance Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to protect ...

coverage, benefits, or policy to a payer. The format attempts to meet the

health care Health care, or healthcare, is the improvement or maintenance of health via the preventive healthcare, prevention, diagnosis, therapy, treatment, wikt:amelioration, amelioration or cure of disease, illness, injury, and other disability, physic ...

industry's specific need for the initial enrollment and subsequent maintenance of individuals who are enrolled in insurance products.

Layout

An example layout of an X12 834 Version 005010 file is shown below. Each line starts with a code to identify the type of data that follows, with individual pieces of data separated by an asterisk. The

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indicates the end of that section.

INS*Y*18*030*XN*A*E**FT~
REF*0F*881019999~
REF*1L*Blue~
DTP*336*D8*20070101~
NM1*IL*1*BLUTH*LUCILLE****34*881019999~
N3*224 N DES PLAINES*6TH FLOOR~
N4*CHICAGO*IL*60661*USA~
DMG*D8*19720121*F*M~
HD*030**VIS**EMP~
DTP*348*D8*20111016~
INS*N*19*030*XN*A*E***N*N~
REF*0F*881019999~
REF*1L*Blue~
DTP*357*D8*20111015~
NM1*IL*1*BLUTH*BUSTER~
N3*224 N DES PLAINES*6TH FLOOR~
N4*CHICAGO*IL*60661*USA~
DMG*D8*19911015*M~
HD*030**VIS~
DTP*348*D8*20110101~
DTP*349*D8*20111015~

References

{{reflist
EDI 834 Benefit Enrollment and MaintenanceGuardian Electronic User Guide 834 Enrollment and Maintenance
Data management Computer file formats Health insurance in the United States American National Standards Institute standards

Layout

See also

References