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. 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

SegmentEntire Segment
ViewST*834*0179
ViewBGN*00*1*20050315*110650****4
ViewREF*38*SAMPLE_POLICY_NUMBER
ViewDTP*303*D8*20080321
ViewN1*P5*COMPAN_NAME*FI*000000000
ViewINS*Y*18*030*20*A
ViewREF*0F*SUBSCRIBER_NUMBER
ViewNM1*IL*1*JOHN DOE*R***34*1*0000000
ViewPER*IP**HP*2138051111
ViewN3*123 SAMPLE RD
ViewN4*CITY*ST*12345
ViewDMG*D8*19690101 *F
ViewHD*030
ViewDTP*348*D8*20080101
ViewREF*1L*INDIV_POLICY_NO
ViewSE*16*0179

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