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

Element DetailsEntire Segment
ViewST*834*100000000
ViewBGN*00*1*20180312*0000*CT***4
ViewDTP*303*D8*20180312
ViewN1*P5*HEALTHSCOPE BENEFITS INC*FI*710847266
ViewN1*IN*HEALTHSCOPE BENEFITS INC*FI*710847266
ViewN1*TV*HEALTHSCOPE BENEFITS INC*FI*710847266
ViewINS*Y*18*030*XN*A
ViewREF*0F*264135029
ViewREF*23*A01104274
ViewREF*ZZ*01
ViewREF*1L*HHCCN
ViewDTP*336*D8*
ViewNM1*IL*1*GADDIE*MARY****34*264135029
ViewN3*4209 OAKCREST AVE
ViewN4*ENID*OK*73703
ViewDMG*D8*19540811*F
ViewHD*030**HLT*HHCCN.MED*EMP
ViewDTP*348*D8*20180101
ViewINS*Y*18*030*XN*A
ViewREF*0F*342442754
ViewREF*23*A01104275
ViewREF*ZZ*01
ViewREF*1L*HHCCN
ViewDTP*336*D8*
ViewNM1*IL*1*SCHNEIDER*BEVERLY****34*342442754
ViewN3*4114 GRAHAM AVE
ViewN4*ENID*OK*73703
ViewDMG*D8*19511108*F
ViewHD*030**HLT*HHCCN.MED*ESP
ViewDTP*348*D8*20180101
ViewDTP*349*D8*20180112
ViewINS*Y*18*030*XN*A
ViewREF*0F*369682801
ViewREF*23*A01104276
ViewREF*ZZ*01
ViewREF*1L*HHCCN
ViewDTP*336*D8*
ViewNM1*IL*1*SHEWEY*SUSAN****34*369682801
ViewN3*1418 SENECA AVE
ViewN4*ENID*OK*73703
ViewDMG*D8*19670319*F
ViewHD*030**HLT*HHCCN.MED*FAM
ViewDTP*348*D8*20180101
ViewINS*N*01*030**A
ViewREF*0F*369682801
ViewREF*23*A01104276
ViewREF*ZZ*02
ViewREF*1L*HHCCN
ViewNM1*IL*1*SHEWEY*WILLIAM****34*442745318
ViewN3*1418 SENECA AVE
ViewN4*ENID*OK*73703
ViewDMG*D8*19640227*M
ViewHD*030**HLT*HHCCN.MED*FAM
ViewDTP*348*D8*20180101
ViewINS*N*19*030**A
ViewREF*0F*369682801
ViewREF*23*A01104276
ViewREF*ZZ*03
ViewREF*1L*HHCCN
ViewNM1*IL*1*SHEWEY*MEGAN****34*447041980
ViewN3*1418 SENECA AVE
ViewN4*ENID*OK*73703
ViewDMG*D8*19931108*F
ViewHD*030**HLT*HHCCN.MED*FAM
ViewDTP*348*D8*20180101
ViewINS*N*19*030**A
ViewREF*0F*369682801
ViewREF*23*A01104276
ViewREF*ZZ*04
ViewREF*1L*HHCCN
ViewNM1*IL*1*SHEWEY*KATHERINE****34*446088290
ViewN3*1418 SENECA AVE
ViewN4*ENID*OK*73703
ViewDMG*D8*19960813*F
ViewHD*030**HLT*HHCCN.MED*FAM
ViewDTP*348*D8*20180101
ViewINS*N*19*030**A
ViewREF*0F*369682801
ViewREF*23*A01104276
ViewREF*ZZ*05
ViewREF*1L*HHCCN
ViewNM1*IL*1*SHEWEY*RACHAEL****34*448115498
ViewN3*1418 SENECA AVE
ViewN4*ENID*OK*73703
ViewDMG*D8*19980926*F
ViewHD*030**HLT*HHCCN.MED*FAM
ViewDTP*348*D8*20180101
ViewINS*Y*18*030*XN*A
ViewREF*0F*411255835
ViewREF*23*A01104277
ViewREF*ZZ*01
ViewREF*1L*HHCCN
ViewDTP*336*D8*
ViewNM1*IL*1*BOLES*RICHARD****34*411255835
ViewN3*1305 S 126TH
ViewN4*FAIRMONT*OK*73736
ViewDMG*D8*19610808*M
ViewHD*030**HLT*HHCCN.MED*EMP
ViewDTP*348*D8*20180101
ViewINS*Y*18*030*XN*A
ViewREF*0F*428557392
ViewREF*23*A01104278
ViewREF*ZZ*01
ViewREF*1L*HHCCN
ViewDTP*336*D8*
ViewNM1*IL*1*MCKAY*SUMMER****34*428557392
ViewN3*802 W JACK CHOATE
ViewN4*HENNESSEY*OK*73742
ViewDMG*D8*19790822*F
ViewHD*030**HLT*HHCCN.MED*EMP
ViewDTP*348*D8*20180101
ViewINS*Y*18*030*XN*A
ViewREF*0F*429151302
ViewREF*23*A01104279
ViewREF*ZZ*01
ViewREF*1L*HHCCN
ViewDTP*336*D8*
ViewNM1*IL*1*DURKEE*MELINDA****34*429151302
ViewN3*1417 INDIAN DAM RD
ViewN4*LAHOMA*OK*73754
ViewDMG*D8*19580415*F
ViewHD*030**HLT*HHCCN.MED*ESP
ViewDTP*348*D8*20180101
ViewINS*N*01*030**A
ViewREF*0F*429151302
ViewREF*23*A01104279
ViewREF*ZZ*02
ViewREF*1L*HHCCN
ViewNM1*IL*1*DURKEE*GREGG****34*430170341
ViewN3*1417 INDIAN DAM RD
ViewN4*LAHOMA*OK*73754
ViewDMG*D8*19580307*M
ViewHD*030**HLT*HHCCN.MED*ESP
ViewDTP*348*D8*20180101
ViewINS*Y*18*030*XN*A
ViewREF*0F*433948067
ViewREF*23*A01104280
ViewREF*ZZ*01
ViewREF*1L*HHCCN
ViewDTP*336*D8*
ViewNM1*IL*1*CRAFT*JERRY****34*433948067
ViewN3*1133 S CARRIAGE AVE
ViewN4*SPRINGFIELD*MO*65809
ViewDMG*D8*19550429*M
ViewHD*030**HLT*HHCCN.MED*FAM
ViewDTP*348*D8*20180101
ViewINS*N*01*030**A
ViewREF*0F*433948067
ViewREF*23*A01104280
ViewREF*ZZ*02
ViewREF*1L*HHCCN
ViewNM1*IL*1*CRAFT*MARY****34*428417449
ViewN3*1133 S CARRIAGE AVE
ViewN4*SPRINGFIELD*MO*65809
ViewDMG*D8*19661231*F
ViewHD*030**HLT*HHCCN.MED*FAM
ViewDTP*348*D8*20180101
ViewINS*N*19*030**A
ViewREF*0F*433948067
ViewREF*23*A01104280
ViewREF*ZZ*03
ViewREF*1L*HHCCN
ViewNM1*IL*1*CRAFT*KAYLA****34*494190594
ViewN3*1133 S CARRIAGE AVE
ViewN4*SPRINGFIELD*MO*65809
ViewDMG*D8*20020620*F
ViewHD*030**HLT*HHCCN.MED*FAM
ViewDTP*348*D8*20180101
ViewINS*Y*18*030*XN*A
ViewREF*0F*440040482
ViewREF*23*A01104281
ViewREF*ZZ*01
ViewREF*1L*HHCCN
ViewDTP*336*D8*
ViewNM1*IL*1*WOOD*JESSICA****34*440040482
ViewN3*PO BOX 265
ViewN4*OKEENE*OK*73763
ViewDMG*D8*19920603*F
ViewHD*030**HLT*HHCCN.MED*EMP
ViewDTP*348*D8*20180101
ViewINS*Y*18*030*XN*A
ViewREF*0F*440560353
ViewREF*23*A01104282
ViewREF*ZZ*01
ViewREF*1L*HHCCN
ViewDTP*336*D8*
ViewNM1*IL*1*COTTOM*DARREN****34*440560353
ViewN3*211644 E COUNTY ROAD 54
ViewN4*MUTUAL*OK*73853
ViewDMG*D8*19650301*M
ViewHD*030**HLT*HHCCN.MED*FAM
ViewDTP*348*D8*20180101
ViewINS*N*19*030**A
ViewREF*0F*440560353
ViewREF*23*A01104282
ViewREF*ZZ*02
ViewREF*1L*HHCCN
ViewNM1*IL*1*COTTOM*CODY****34*446061166
ViewN3*211644 E COUNTY ROAD 54

Solutions:
Are you looking to trade the EDI 834 transaction with one of your trading partners? Do you need an EDI VAN Savings solution to exchange the 834? Or perhaps you would like to use a Cloud-Based application, so you can plug your 834 transaction directly into your ERP and TMS systems. Even small companies have the ability to trade the EDI 834 by using the EDI Mobile Device solution.



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