EDI 834 Segments and Elements for the Benefit Enrollment And Maintenance Standard


AgencySet IDFGTransaction DescriptionSubcommitteeStandard
ANSI834BEBenefit Enrollment And Maintenance InsuranceDownload


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Research and Development:
See the list of EDI 834 segments and elements in below data grid. The Jobisez.com site has an online translation tool that converts the EDI 834 (Benefit Enrollment And Maintenance) document into a CSV file. For more detailed information, you can view a sample EDI 834 document by analyzing a transaction set example. 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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The EDI 834 Segments and Elements

SegmentDescriptionSectReqMax LoopMax UsagePos
BGNBeginning SegmentHM011
REFReference InformationHO09999992
DTPDate Or Time Or PeriodHO09999993
AMTMonetary Amount InformationHO09999994
QTYQuantity InformationHO09999995
N1Party IdentificationHM99999916
N2Additional Name InformationHO027
N3Party LocationHO028
N4Geographic LocationHO019
PERAdministrative Communications ContactHO0310
ACTAccount IdentificationHO10111
REFReference InformationHO0512
N3Party LocationHO0113
N4Geographic LocationHO0114
PERAdministrative Communications ContactHO0515
DTPDate Or Time Or PeriodHO0116
AMTMonetary Amount InformationHO0117
INSInsured BenefitDO999999118
REFReference InformationDM099999919
DTPDate Or Time Or PeriodDO099999920
NM1Individual Or Organizational NameDO999999121
PERAdministrative Communications ContactDO0122
N3Party LocationDO0123
N4Geographic LocationDO0124
DMGDemographic InformationDO0125
PMElectronic Funds Transfer InformationDO0126
ECEmployment ClassDO099999927
ICMIndividual IncomeDO0128
AMTMonetary Amount InformationDO01029
HLHHealth InformationDO0130
HIHealth Care Information CodesDO01031
LUILanguage UseDO099999932
DSBDisability InformationDO4133
DTPDate Or Time Or PeriodDO01034
AD1Adjustment AmountDO01035
HDHealth CoverageDO99136
DTPDate Or Time Or PeriodDO01037
AMTMonetary Amount InformationDO0338
REFReference InformationDO0539
IDCIdentification CardDO099999940
LXTransaction Set Line NumberDO30141
NM1Individual Or Organizational NameDO0142
N1Party IdentificationDO0343
N2Additional Name InformationDO0144
N3Party LocationDO0245
N4Geographic LocationDO0246
PERAdministrative Communications ContactDO0247
PRVProvider InformationDO0148
DTPDate Or Time Or PeriodDO0649
PLAPlace Or LocationDO0150
COBCoordination Of BenefitsDO5151
REFReference InformationDO099999952
DTPDate Or Time Or PeriodDO0253
NM1Individual Or Organizational NameDO3154
N2Additional Name InformationDO0155
N3Party LocationDO0256
N4Geographic LocationDO0157
PERAdministrative Communications ContactDO0158
LCLife CoverageDO10159
AMTMonetary Amount InformationDO0560
DTPDate Or Time Or PeriodDO0261
REFReference InformationDO099999962
BENBeneficiary Or Owner InformationDO20163
NM1Individual Or Organizational NameDO0164
N1Party IdentificationDO0165
N2Additional Name InformationDO0166
N3Party LocationDO0167
N4Geographic LocationDO0168
DMGDemographic InformationDO0169
FSAFlexible Spending AccountDO5170
AMTMonetary Amount InformationDO01071
DTPDate Or Time Or PeriodDO01072
REFReference InformationDO099999973
RPRetirement ProductDO999999174
DTPDate Or Time Or PeriodDO099999975
REFReference InformationDO099999976
INVInvestment Vehicle SelectionDO099999977
AMTMonetary Amount InformationDO02078
QTYQuantity InformationDO02079
K3File InformationDO0380
RELRelationshipDO0181
NM1Individual Or Organizational NameDO999999182
N2Additional Name InformationDO0183
DMGDemographic InformationDO0184
BENBeneficiary Or Owner InformationDO0185
REFReference InformationDO099999986
NX1Property Or Entity IdentificationDO999999187
N3Party LocationDO0188
N4Geographic LocationDO0189
DTPDate Or Time Or PeriodDO099999990
FCFinancial ContributionDO999999191
DTPDate Or Time Or PeriodDO099999992
INVInvestment Vehicle SelectionDO999999193
DTPDate Or Time Or PeriodDO099999994
QTYQuantity InformationDO099999995
ENTEntityDO099999996
REFReference InformationDO099999997
AMTMonetary Amount InformationDO02098
K3File InformationDO0399
AINIncomeDO9999991100
QTYQuantity InformationDO0999999101
DTPDate Or Time Or PeriodDO0999999102
LSLoop HeaderDO01103
LXTransaction Set Line NumberDO9999991104
N1Party IdentificationDM9999991105
REFReference InformationDM01106
DTPDate Or Time Or PeriodDO01107
LELoop TrailerDO01108


SegmentElementDescriptionReqMin LengthMax LengthType
BGN1Transaction Set Purpose CodeM22ID
BGN2Reference IdentificationM150AN
BGN3DateM88DT
BGN4TimeC48TM
BGN5Time CodeO22ID
BGN6Reference IdentificationO150AN
BGN7Transaction Type CodeO22ID
BGN8Action CodeO12ID
BGN9Security Level CodeO22ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
N11Entity Identifier CodeM23ID
N12NameC160AN
N13Identification Code QualifierC12ID
N14Identification CodeC280AN
N15Entity Relationship CodeO22ID
N16Entity Identifier CodeO23ID
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
ACT1Account NumberM135AN
ACT2NameO160AN
ACT3Identification Code QualifierC12ID
ACT4Identification CodeC280AN
ACT5Account Number QualifierC13ID
ACT6Account NumberC135AN
ACT7DescriptionO180AN
ACT8Payment Method Type CodeO12ID
ACT9Benefit Status CodeO11ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
INS1Yes/No Condition Or Response CodeM11ID
INS2Individual Relationship CodeM22ID
INS3Maintenance Type CodeO33ID
INS4Maintenance Reason CodeO23ID
INS5Benefit Status CodeO11ID
INS6Medicare Plan CodeO11ID
INS7Eligibility Reason CodeO11ID
INS8Eligibility Reason CodeO11ID
INS9Eligibility Reason CodeO11ID
INS10Consolidated Omnibus Budget Reconciliation Act (Cobra) QualifyingO12ID
INS11Employment Status CodeO22ID
INS12Student Status CodeO11ID
INS13Yes/No Condition Or Response CodeO11ID
INS14Date Time Period Format QualifierC23ID
INS15Date Time PeriodC135AN
INS16Confidentiality CodeO11ID
INS17City NameO230AN
INS18State Or Province CodeO22ID
INS19Country CodeO23ID
INS20NumberO19N0
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
PM1(Dfi) Identification NumberM312AN
PM2Account NumberM135AN
PM3Yes/No Condition Or Response CodeM11ID
PM4Yes/No Condition Or Response CodeM11ID
PM5Account Number QualifierO13ID
PM6(Dfi) Id Number QualifierO22ID
EC1Employment Class CodeO23ID
EC2Employment Class CodeO23ID
EC3Employment Class CodeO23ID
EC4Percentage As DecimalO110R
EC5Information Status CodeO11ID
EC6Occupation CodeO46ID
ICM1Frequency CodeM11ID
ICM2Monetary AmountM118R
ICM3QuantityO115R
ICM4Location IdentifierO130AN
ICM5Salary GradeO15AN
ICM6Currency CodeO33ID
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
HLH1Health-Related CodeO11ID
HLH2HeightO18R8
HLH3WeightO110R
HLH4WeightO110R
HLH5DescriptionO180AN
HLH6Current Health Condition CodeO11ID
HLH7DescriptionO180AN
HI1Code List Qualifier CodeM13ID
HI2Industry CodeM130AN
HI3Date Time Period Format QualifierM23ID
HI4Date Time PeriodM135AN
HI5Monetary AmountM118R
HI6QuantityM115R
HI7Version IdentifierM130AN
HI8Industry CodeM130AN
HI9Yes/No Condition Or Response CodeM11ID
HI10Code List Qualifier CodeO13ID
HI11Industry CodeO130AN
HI12Date Time Period Format QualifierO23ID
HI13Date Time PeriodO135AN
HI14Monetary AmountO118R
HI15QuantityO115R
HI16Version IdentifierO130AN
HI17Industry CodeO130AN
HI18Yes/No Condition Or Response CodeO11ID
HI19Code List Qualifier CodeO13ID
HI20Industry CodeO130AN
HI21Date Time Period Format QualifierO23ID
HI22Date Time PeriodO135AN
HI23Monetary AmountO118R
HI24QuantityO115R
HI25Version IdentifierO130AN
HI26Industry CodeO130AN
HI27Yes/No Condition Or Response CodeO11ID
HI28Code List Qualifier CodeO13ID
HI29Industry CodeO130AN
HI30Date Time Period Format QualifierO23ID
HI31Date Time PeriodO135AN
HI32Monetary AmountO118R
HI33QuantityO115R
HI34Version IdentifierO130AN
HI35Industry CodeO130AN
HI36Yes/No Condition Or Response CodeO11ID
HI37Code List Qualifier CodeO13ID
HI38Industry CodeO130AN
HI39Date Time Period Format QualifierO23ID
HI40Date Time PeriodO135AN
HI41Monetary AmountO118R
HI42QuantityO115R
HI43Version IdentifierO130AN
HI44Industry CodeO130AN
HI45Yes/No Condition Or Response CodeO11ID
HI46Code List Qualifier CodeO13ID
HI47Industry CodeO130AN
HI48Date Time Period Format QualifierO23ID
HI49Date Time PeriodO135AN
HI50Monetary AmountO118R
HI51QuantityO115R
HI52Version IdentifierO130AN
HI53Industry CodeO130AN
HI54Yes/No Condition Or Response CodeO11ID
HI55Code List Qualifier CodeO13ID
HI56Industry CodeO130AN
HI57Date Time Period Format QualifierO23ID
HI58Date Time PeriodO135AN
HI59Monetary AmountO118R
HI60QuantityO115R
HI61Version IdentifierO130AN
HI62Industry CodeO130AN
HI63Yes/No Condition Or Response CodeO11ID
HI64Code List Qualifier CodeO13ID
HI65Industry CodeO130AN
HI66Date Time Period Format QualifierO23ID
HI67Date Time PeriodO135AN
HI68Monetary AmountO118R
HI69QuantityO115R
HI70Version IdentifierO130AN
HI71Industry CodeO130AN
HI72Yes/No Condition Or Response CodeO11ID
HI73Code List Qualifier CodeO13ID
HI74Industry CodeO130AN
HI75Date Time Period Format QualifierO23ID
HI76Date Time PeriodO135AN
HI77Monetary AmountO118R
HI78QuantityO115R
HI79Version IdentifierO130AN
HI80Industry CodeO130AN
HI81Yes/No Condition Or Response CodeO11ID
HI82Code List Qualifier CodeO13ID
HI83Industry CodeO130AN
HI84Date Time Period Format QualifierO23ID
HI85Date Time PeriodO135AN
HI86Monetary AmountO118R
HI87QuantityO115R
HI88Version IdentifierO130AN
HI89Industry CodeO130AN
HI90Yes/No Condition Or Response CodeO11ID
HI91Code List Qualifier CodeO13ID
HI92Industry CodeO130AN
HI93Date Time Period Format QualifierO23ID
HI94Date Time PeriodO135AN
HI95Monetary AmountO118R
HI96QuantityO115R
HI97Version IdentifierO130AN
HI98Industry CodeO130AN
HI99Yes/No Condition Or Response CodeO11ID
HI100Code List Qualifier CodeO13ID
HI101Industry CodeO130AN
HI102Date Time Period Format QualifierO23ID
HI103Date Time PeriodO135AN
HI104Monetary AmountO118R
HI105QuantityO115R
HI106Version IdentifierO130AN
HI107Industry CodeO130AN
HI108Yes/No Condition Or Response CodeO11ID
LUI1Identification Code QualifierC12ID
LUI2Identification CodeC280AN
LUI3DescriptionC180AN
LUI4Use Of Language IndicatorO12ID
LUI5Language Proficiency IndicatorO11ID
DSB1Disability Type CodeM11ID
DSB2QuantityO115R
DSB3Occupation CodeO46ID
DSB4Work Intensity CodeO11ID
DSB5Product Option CodeO12ID
DSB6Monetary AmountO118R
DSB7Product/Service Id QualifierC22ID
DSB8Medical Code ValueC115AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
AD11Adjustment Reason CodeM22ID
AD12Monetary AmountO118R
AD13Adjustment Reason Code CharacteristicO12ID
AD14Frequency CodeO11ID
AD15Late Reason CodeO22ID
HD1Maintenance Type CodeM33ID
HD2Maintenance Reason CodeO23ID
HD3Insurance Line CodeO23ID
HD4Plan Coverage DescriptionO150AN
HD5Coverage Level CodeO33ID
HD6CountO19N0
HD7CountO19N0
HD8Underwriting Decision CodeO11ID
HD9Yes/No Condition Or Response CodeO11ID
HD10Drug House CodeO23ID
HD11Yes/No Condition Or Response CodeO11ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
IDC1Plan Coverage DescriptionM150AN
IDC2Identification Card Type CodeM11ID
IDC3QuantityO115R
IDC4Action CodeO12ID
LX1Assigned NumberM16N0
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N11Entity Identifier CodeM23ID
N12NameC160AN
N13Identification Code QualifierC12ID
N14Identification CodeC280AN
N15Entity Relationship CodeO22ID
N16Entity Identifier CodeO23ID
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
PRV1Provider CodeM13ID
PRV2Reference Identification QualifierC23ID
PRV3Reference IdentificationC150AN
PRV4State Or Province CodeO22ID
PRV5Provider Specialty CodeO13AN
PRV6Agency Qualifier CodeO22ID
PRV7Yes/No Condition Or Response CodeO11ID
PRV8Provider Organization CodeO33ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
PLA1Action CodeM12ID
PLA2Entity Identifier CodeM23ID
PLA3DateM88DT
PLA4TimeO48TM
PLA5Maintenance Reason CodeO23ID
COB1Payer Responsibility Sequence Number CodeO11ID
COB2Reference IdentificationO150AN
COB3Coordination Of Benefits CodeO11ID
COB4Service Type CodeO12ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
LC1Maintenance Type CodeM33ID
LC2Maintenance Reason CodeO23ID
LC3Insurance Line CodeO23ID
LC4Plan Coverage DescriptionO150AN
LC5QuantityO115R
LC6Product Option CodeO12ID
LC7Yes/No Condition Or Response CodeO11ID
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
BEN1Primary Or Contingent CodeO11ID
BEN2Percentage As DecimalO110R
BEN3Individual Relationship CodeO22ID
BEN4Yes/No Condition Or Response CodeO11ID
BEN5Yes/No Condition Or Response CodeO11ID
BEN6Type Of Account CodeO22ID
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N11Entity Identifier CodeM23ID
N12NameC160AN
N13Identification Code QualifierC12ID
N14Identification CodeC280AN
N15Entity Relationship CodeO22ID
N16Entity Identifier CodeO23ID
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
FSA1Maintenance Type CodeM33ID
FSA2Flexible Spending Account Selection CodeO11ID
FSA3Maintenance Reason CodeO23ID
FSA4Account NumberO135AN
FSA5Frequency CodeO11ID
FSA6Plan Coverage DescriptionO150AN
FSA7Product Option CodeO12ID
FSA8Product Option CodeO12ID
FSA9Product Option CodeO12ID
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
RP1Maintenance Type CodeM33ID
RP2Insurance Line CodeO23ID
RP3Maintenance Reason CodeO23ID
RP4DescriptionO180AN
RP5Participant Status CodeO12ID
RP6Yes/No Condition Or Response CodeO11ID
RP7Special Processing TypeO16AN
RP8AuthorityO120AN
RP9Plan Coverage DescriptionO150AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
INV1DescriptionM180AN
INV2Percentage As DecimalC110R
INV3Monetary AmountC118R
INV4QuantityC115R
INV5State Or Province CodeO22ID
INV6DescriptionO180AN
INV7Monetary AmountO118R
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
K31Fixed Format InformationM180AN
K32Record Format CodeO12ID
K33Unit Or Basis For Measurement CodeO22ID
K34ExponentO115R
K35MultiplierO110R
K36Unit Or Basis For Measurement CodeO22ID
K37ExponentO115R
K38MultiplierO110R
K39Unit Or Basis For Measurement CodeO22ID
K310ExponentO115R
K311MultiplierO110R
K312Unit Or Basis For Measurement CodeO22ID
K313ExponentO115R
K314MultiplierO110R
K315Unit Or Basis For Measurement CodeO22ID
K316ExponentO115R
K317MultiplierO110R
REL1Individual Relationship CodeM22ID
REL2NumberO19N0
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
N21NameM160AN
N22NameO160AN
DMG1Date Time Period Format QualifierC23ID
DMG2Date Time PeriodC135AN
DMG3Gender CodeO11ID
DMG4Marital Status CodeO11ID
DMG5Race Or Ethnicity CodeC11ID
DMG6Code List Qualifier CodeC13ID
DMG7Industry CodeC130AN
DMG8Citizenship Status CodeO12ID
DMG9Country CodeO23ID
DMG10Basis Of Verification CodeO12ID
DMG11QuantityO115R
DMG12Code List Qualifier CodeC13ID
DMG13Industry CodeC130AN
BEN1Primary Or Contingent CodeO11ID
BEN2Percentage As DecimalO110R
BEN3Individual Relationship CodeO22ID
BEN4Yes/No Condition Or Response CodeO11ID
BEN5Yes/No Condition Or Response CodeO11ID
BEN6Type Of Account CodeO22ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
NX11Entity Identifier CodeM23ID
NX12Entity Identifier CodeO23ID
NX13Entity Identifier CodeO23ID
NX14Entity Identifier CodeO23ID
NX15Entity Identifier CodeO23ID
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
FC1Contribution CodeM22ID
FC2Percentage As DecimalO110R
FC3Monetary AmountO118R
FC4NumberO19N0
FC5Yes/No Condition Or Response CodeO11ID
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
INV1DescriptionM180AN
INV2Percentage As DecimalC110R
INV3Monetary AmountC118R
INV4QuantityC115R
INV5State Or Province CodeO22ID
INV6DescriptionO180AN
INV7Monetary AmountO118R
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
ENT1Assigned NumberO16N0
ENT2Entity Identifier CodeC23ID
ENT3Identification Code QualifierC12ID
ENT4Identification CodeC280AN
ENT5Entity Identifier CodeC23ID
ENT6Identification Code QualifierC12ID
ENT7Identification CodeC280AN
ENT8Reference Identification QualifierC23ID
ENT9Reference IdentificationC150AN
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
K31Fixed Format InformationM180AN
K32Record Format CodeO12ID
K33Unit Or Basis For Measurement CodeO22ID
K34ExponentO115R
K35MultiplierO110R
K36Unit Or Basis For Measurement CodeO22ID
K37ExponentO115R
K38MultiplierO110R
K39Unit Or Basis For Measurement CodeO22ID
K310ExponentO115R
K311MultiplierO110R
K312Unit Or Basis For Measurement CodeO22ID
K313ExponentO115R
K314MultiplierO110R
K315Unit Or Basis For Measurement CodeO22ID
K316ExponentO115R
K317MultiplierO110R
AIN1Type Of Income CodeM22ID
AIN2Frequency CodeM11ID
AIN3Monetary AmountM118R
AIN4QuantityO115R
AIN5Yes/No Condition Or Response CodeO11ID
AIN6Reference IdentificationO150AN
AIN7Amount Qualifier CodeO13ID
AIN8Tax Treatment CodeO11ID
AIN9Earnings Rate Of PayC115R
AIN10Unit Or Basis For Measurement CodeC22ID
AIN11QuantityC115R
AIN12Industry CodeO130AN
AIN13DescriptionO180AN
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
LS1Loop Identifier CodeM14AN
LX1Assigned NumberM16N0
N11Entity Identifier CodeM23ID
N12NameC160AN
N13Identification Code QualifierC12ID
N14Identification CodeC280AN
N15Entity Relationship CodeO22ID
N16Entity Identifier CodeO23ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
DTP1Date/Time QualifierM33ID
DTP2Date Time Period Format QualifierM23ID
DTP3Date Time PeriodM135AN
LE1Loop Identifier CodeM14AN


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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