Sample EDI 834 Data for the Benefit Enrollment And Maintenance Transaction Set


AgencySet IDFGTransaction DescriptionSubcommitteeStandard
ANSI834BEBenefit Enrollment And Maintenance InsuranceDownload


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Research and Development:
Below is a sample EDI 834 transaction set. The Jobisez.com site has an online translation tool that converts the EDI 834 (Benefit Enrollment And Maintenance) document into a CSV file. If you are researching the 834s, you can view other trading partner's mapping specifications. You can also gain knowledge by researching all EDI document types. Jobisez LLC can also provide assistance if you need additional help.

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Sample of an EDI 834 Transaction Set

ST*834*0001*005010X220A1
BGN*00*LN20180307050951*20180307*0509****4
REF*38*1580253
QTY*DT*9
QTY*ET*10
QTY*TO*19
N1*P5*TEST*FI*272972135
N1*IN*Lincoln Financial Group*FI*620395665
INS*Y*18*030**A***FT
REF*0F*1
REF*1L*00095D036870
REF*17*1580253
DTP*336*D8*20171030
DTP*300*D8*20180101
NM1*IL*1*POULOS*Test****34*1
N3*TESTVILLE
N4*TEST*MD*20723
DMG*D8*19691229*M*M
ICM*7*150000*40
AMT*A*150000
HD*030**DEN*P1C1*EMP
DTP*348*D8*20180101
INS*Y*18*030**A***FT
REF*0F*2
REF*1L*00095D036870
REF*17*1580253
DTP*336*D8*20170702
DTP*300*D8*20180101
NM1*IL*1*GRANT*Test****34*2
N3*TESTVILLE
N4*TEST*MD*21030
DMG*D8*19881215*F*I
ICM*7*45760*40
AMT*A*45760
HD*030**DEN*P1C1*EMP
DTP*348*D8*20180101
INS*Y*18*030**A***FT
REF*0F*3
REF*1L*00095D036870
REF*17*1580253
DTP*336*D8*20160129
DTP*300*D8*20180101
NM1*IL*1*DAVIS V*Test*A***34*3
PER*IP**HP*1
N3*TESTVILLE
N4*TEST*MD*21239
DMG*D8*19541017*M*M
ICM*7*115000*40
AMT*A*115000
HD*030**DEN*P1C1*ESP
DTP*348*D8*20180101
INS*N*01*030**A*****N
REF*0F*3
REF*1L*00095D036870
REF*17*1580253
DTP*300*D8*20180101
NM1*IL*1*DAVIS*PAMELA*S***34*216567402
PER*IP**HP*1
N3*TESTVILLE
N4*TEST*MD*21239
DMG*D8*19500610*F
AMT*A*0
HD*030**DEN*P1C1*ESP
DTP*348*D8*20180101
INS*Y*18*030**A***FT
REF*0F*4
REF*1L*00095D036870
REF*17*1580253
DTP*336*D8*20161017
DTP*300*D8*20180101
NM1*IL*1*KOBETT*Test*R***34*4
PER*IP**HP*2
N3*TESTVILLE
N4*TEST*MD*21012
DMG*D8*19690125*M*M
ICM*7*153000*40
AMT*A*153000
HD*030**DEN*P1C1*FAM
DTP*348*D8*20180101
INS*N*01*030**A*****N
REF*0F*4
REF*1L*00095D036870
REF*17*1580253
DTP*300*D8*20180101
NM1*IL*1*KOBETT*PAMELA****34*262973290
PER*IP**HP*2
N3*TESTVILLE
N4*TEST*MD*21012
DMG*D8*19660702*F
AMT*A*0
HD*030**DEN*P1C1*FAM
DTP*348*D8*20180101
INS*N*19*030**A*****N
REF*0F*4
REF*1L*00095D036870
REF*17*1580253
DTP*300*D8*20180101
NM1*IL*1*KOBETT*VICTORIA****34*214752248
PER*IP**HP*2
N3*TESTVILLE


Official Definition:
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).



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