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


AgencySet IDFGTrans DescCommittee
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. 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

Entire Segment
ST*834*12345*005010X220A1
BGN*00*12456*19980520*1200****2
N1*P5**FI*999888777
N1*IN**FI*654456654
INS*Y*18*021*20*A***FT
REF*0F*123456789
REF*1L*123456001
DTP*356*D8*19960523
NM1*IL*1*DOE*JOHN*P***34*123456789
PER*IP**HP*7172343334*WP*7172341240
N3*100 MARKET ST*APT 3G
N4*CAMP HILL*PA*17011**CY*CUMBERLAND
DMG*D8*19400816*M
HD*021**HLT
DTP*348*D8*19960601
COB*P*890111*5
HD*021**DEN
DTP*348*D8*19960601
HD*021**VIS
DTP*348*D8*19960601
SE*21*12345

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