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


AgencySet IDFGTransaction DescriptionSubcommittee
ANSI834BEBenefit Enrollment And Maintenance Insurance


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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.

Sample of an EDI 834 Transaction Set

ST*834*100000000
BGN*00*1*20180312*0000*CT***4
DTP*303*D8*20180312
N1*P5*HEALTHSCOPE BENEFITS INC*FI*710847266
N1*IN*HEALTHSCOPE BENEFITS INC*FI*710847266
N1*TV*HEALTHSCOPE BENEFITS INC*FI*710847266
INS*Y*18*030*XN*A
REF*0F*264135029
REF*23*A01104274
REF*ZZ*01
REF*1L*HHCCN
DTP*336*D8*
NM1*IL*1*GADDIE*MARY****34*264135029
N3*4209 OAKCREST AVE
N4*ENID*OK*73703
DMG*D8*19540811*F
HD*030**HLT*HHCCN.MED*EMP
DTP*348*D8*20180101
INS*Y*18*030*XN*A
REF*0F*342442754
REF*23*A01104275
REF*ZZ*01
REF*1L*HHCCN
DTP*336*D8*
NM1*IL*1*SCHNEIDER*BEVERLY****34*342442754
N3*4114 GRAHAM AVE
N4*ENID*OK*73703
DMG*D8*19511108*F
HD*030**HLT*HHCCN.MED*ESP
DTP*348*D8*20180101
DTP*349*D8*20180112
INS*Y*18*030*XN*A
REF*0F*369682801
REF*23*A01104276
REF*ZZ*01
REF*1L*HHCCN
DTP*336*D8*
NM1*IL*1*SHEWEY*SUSAN****34*369682801
N3*1418 SENECA AVE
N4*ENID*OK*73703
DMG*D8*19670319*F
HD*030**HLT*HHCCN.MED*FAM
DTP*348*D8*20180101
INS*N*01*030**A
REF*0F*369682801
REF*23*A01104276
REF*ZZ*02
REF*1L*HHCCN
NM1*IL*1*SHEWEY*WILLIAM****34*442745318
N3*1418 SENECA AVE
N4*ENID*OK*73703
DMG*D8*19640227*M
HD*030**HLT*HHCCN.MED*FAM
DTP*348*D8*20180101
INS*N*19*030**A
REF*0F*369682801
REF*23*A01104276
REF*ZZ*03
REF*1L*HHCCN
NM1*IL*1*SHEWEY*MEGAN****34*447041980
N3*1418 SENECA AVE
N4*ENID*OK*73703
DMG*D8*19931108*F
HD*030**HLT*HHCCN.MED*FAM
DTP*348*D8*20180101
INS*N*19*030**A
REF*0F*369682801
REF*23*A01104276
REF*ZZ*04
REF*1L*HHCCN
NM1*IL*1*SHEWEY*KATHERINE****34*446088290
N3*1418 SENECA AVE
N4*ENID*OK*73703
DMG*D8*19960813*F
HD*030**HLT*HHCCN.MED*FAM
DTP*348*D8*20180101
INS*N*19*030**A
REF*0F*369682801
REF*23*A01104276
REF*ZZ*05
REF*1L*HHCCN
NM1*IL*1*SHEWEY*RACHAEL****34*448115498
N3*1418 SENECA AVE
N4*ENID*OK*73703
DMG*D8*19980926*F
HD*030**HLT*HHCCN.MED*FAM
DTP*348*D8*20180101
INS*Y*18*030*XN*A
REF*0F*411255835
REF*23*A01104277
REF*ZZ*01
REF*1L*HHCCN
DTP*336*D8*
NM1*IL*1*BOLES*RICHARD****34*411255835
N3*1305 S 126TH
N4*FAIRMONT*OK*73736
DMG*D8*19610808*M
HD*030**HLT*HHCCN.MED*EMP
DTP*348*D8*20180101
INS*Y*18*030*XN*A

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