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*134211520*005010X220A1
BGN*00*134211519*20170711*1934*PT***4
DTP*007*D8*20170711
N1*P5*EVENTBRITE INC*FI*14-1888467
N1*IN*CIGNA*FI*06-0303370
INS*Y*18*030*XN*A***FT
REF*0F*608010530
DTP*336*D8*20100409
NM1*IL*1*Duhring*Courtney*G***34*608010530
PER*IP**EM*courtney@eventbrite.com
N3*1725a 14th Avenue South
N4*Nashville*TN*37212
DMG*D8*19870524*F*I
HD*030**DEN**EMP
DTP*348*D8*20170101
REF*1L*3339372ACTIVEDPPO4
INS*Y*18*030*XN*A***FT
REF*0F*417175373
DTP*336*D8*20150330
NM1*IL*1*Pharr*Zackary*L***34*417175373
PER*IP**EM*zack@eventbrite.com
N3*1707 Newton St
N4*Austin*TX*78704
DMG*D8*19800928*M*I
HD*030**DEN**EMP
DTP*348*D8*20170101
REF*1L*3339372ACTIVEDPPO1
INS*Y*18*030*XN*A***FT
REF*0F*001648807
DTP*336*D8*20150615
NM1*IL*1*Cohen*Samuel*D***34*001648807
PER*IP**EM*davec@eventbrite.com
N3*1810 A Hether St
N4*Austin*TX*78704
DMG*D8*19810212*M*M
HD*030**DEN**EMP
DTP*348*D8*20170101
REF*1L*3339372ACTIVEDPPO1
INS*Y*18*030*XN*A***FT
REF*0F*211705123
DTP*336*D8*20170620
NM1*IL*1*Biddle*Nicholas****34*211705123
PER*IP**EM*nbiddle@eventbrite.com
N3*5315 Simpkins Rd
N4*Whites Creek*TN*37189
DMG*D8*19891212*M*I
HD*030**DEN**EMP
DTP*348*D8*20170620
REF*1L*3339372ACTIVEDPPO1
INS*Y*18*030*XN*A***FT
REF*0F*253695444
DTP*336*D8*20170601
NM1*IL*1*Hoffner*Mary*C***34*253695444
PER*IP**EM*mchoffner@eventbrite.com
N3*2906 Belmont Blvd*Apt A1
N4*Nashville*TN*37212
DMG*D8*19880306*F
HD*030**DEN**EMP
DTP*348*D8*20170601
REF*1L*3339372ACTIVEDPPO1
SE*61*134211520


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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