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


AgencySet IDFGTransaction DescriptionSubcommittee
ANSI834BEBenefit Enrollment And Maintenance Insurance


EDI 834 Main Page   Online EDI 834 Translation     Need Help?

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*020211221*005010X220A1
BGN*00*020211221*20211221*0303*ET***4
QTY*ET*492
QTY*DT*266
QTY*TO*758
N1*P5*DentalPlans*FI*111111111
N1*IN*Dentegra*FI*751233841
INS*Y*18*030*XN*A***AC
REF*0F*803933250
REF*17*803933250
NM1*IL*1*WILSON*MONA
PER*IP**TE*3467606213*EM*PERDIOT45@GMAIL.COM
N3*21310 SLATE CROSSING LANE
N4*KATY*TX*77449
DMG*D8*19660817*F
HD*030**DEN
DTP*348*D8*20210325
DTP*349*D8*20220525
REF*1L*1DP19TX037SAVE
INS*N*G8*030*XN*A
REF*0F*803933250
REF*17*4060495
NM1*IL*1*Wilson*FREDDIE
PER*IP**TE*3467606213*EM*PERDIOT45@GMAIL.COM
N3*21310 SLATE CROSSING LANE
N4*KATY*TX*77449
DMG*D8*19610915*M
HD*030**DEN
DTP*348*D8*20210325
REF*1L*1DP19TX037SAVE
INS*N*G8*030*XN*A
REF*0F*803933250
REF*17*4060496
NM1*IL*1*Wilson*Freddie
PER*IP**TE*3467606213*EM*PERDIOT45@GMAIL.COM
N3*21310 SLATE CROSSING LANE
N4*KATY*TX*77449
DMG*D8*20020918*M
HD*030**DEN
DTP*348*D8*20210325
REF*1L*1DP19TX037SAVE
INS*N*G8*030*XN*A
REF*0F*803933250
REF*17*4060497
NM1*IL*1*WILSON*MYLES
PER*IP**TE*3467606213*EM*PERDIOT45@GMAIL.COM
N3*21310 SLATE CROSSING LANE
N4*KATY*TX*77449
DMG*D8*20040831*M
HD*030**DEN
DTP*348*D8*20210325
REF*1L*1DP19TX037SAVE
INS*N*G8*030*XN*A
REF*0F*803933250
REF*17*4060498
NM1*IL*1*AMES*MICHOLAS
PER*IP**TE*3467606213*EM*PERDIOT45@GMAIL.COM
N3*21310 SLATE CROSSING LANE
N4*KATY*TX*77449
DMG*D8*19910604*M
HD*030**DEN
DTP*348*D8*20210325
REF*1L*1DP19TX037SAVE
INS*Y*18*030*XN*A***AC
REF*0F*804089765
REF*17*804089765
NM1*IL*1*Gant*Chantae
PER*IP**TE*7869565818*EM*samntae2011@hotmail.com
N3*204 sw 1st st*#3
N4*DANIA*FL*33004
DMG*D8*19840908*F
HD*030**DEN
DTP*348*D8*20211201
DTP*349*D8*20211231
REF*1L*1DP19FL008SAVE
INS*N*G8*030*XN*A
REF*0F*804089765
REF*17*3586927
NM1*IL*1*Bigelow*Taki
PER*IP**TE*7869565818*EM*samntae2011@hotmail.com
N3*204 sw 1st st*#3
N4*DANIA*FL*33004
DMG*D8*19770521*M
HD*030**DEN
DTP*348*D8*20211201
REF*1L*1DP19FL008SAVE
INS*Y*18*030*XN*A***AC
REF*0F*804264247
REF*17*804264247
NM1*IL*1*Wall*Robert
PER*IP**TE*8433605940*EM*3636hunterwall@gmail.com
N3*4207 LITTLE RIVER RD
N4*MYRTLE BEACH*SC*29577
DMG*D8*19640423*M
HD*030**DEN
DTP*348*D8*20200630
DTP*349*D8*20211228
REF*1L*1DP19SC035SAVE
INS*Y*18*030*XN*A***AC
REF*0F*804196011
REF*17*804196011
NM1*IL*1*Callender*Wadean
PER*IP**TE*3186630347*EM*callenderwadean@gmail.com
N3*182 OAK RIDGE LN
N4*WINNFIELD*LA*71483
DMG*D8*19411202*F
HD*030**DEN
DTP*348*D8*20200714
DTP*349*D8*20220127
REF*1L*1DP19LA016SAVE
INS*Y*18*030*XN*A***AC
REF*0F*803761579
REF*17*803761579
NM1*IL*1*Toland*Annie
PER*IP**TE*8645471290*EM*annie.toland@ymail.com
N3*504 West Main St
N4*CLINTON*SC*29325
DMG*D8*19541008*F
HD*030**DEN
DTP*348*D8*20200821
DTP*349*D8*20220821
REF*1L*1DP19SC035SAVE
INS*Y*18*030*XN*A***AC
REF*0F*802860732
REF*17*802860732
NM1*IL*1*Droste*Rita
PER*IP**TE*2017688473*EM*RitaDroste@dentalplans.com
N3*13 Mac Arthur Ave
N4*CLOSTER*NJ*07624
DMG*D8*19380629*F
HD*030**DEN
DTP*348*D8*20200914
DTP*349*D8*20220103
REF*1L*1DP19NJ026SAVE
INS*N*G8*030*XN*A
REF*0F*802860732
REF*17*1824142
NM1*IL*1*Droste*Micheal
PER*IP**TE*2017688473*EM*RitaDroste@dentalplans.com
N3*13 Mac Arthur Ave
N4*CLOSTER*NJ*07624
DMG*D8*19361109*M
HD*030**DEN
DTP*348*D8*20200914
REF*1L*1DP19NJ026SAVE
INS*Y*18*030*XN*A***AC
REF*0F*804087136
REF*17*804087136
NM1*IL*1*Gardiner*Catherine
PER*IP**TE*7039948441*EM*cat.a.gardiner@gmail.com
N3*10251 Thistle Glen Lane
N4*Great Falls*VA*22066
DMG*D8*19891006*F
HD*030**DEN
DTP*348*D8*20200915
DTP*349*D8*20220915
REF*1L*1DP19VA040SAVE
INS*Y*18*030*XN*A***AC
REF*0F*804149340
REF*17*804149340
NM1*IL*1*Farrell*Brian
PER*IP**TE*6107514307*EM*brian72@ptd.net
N3*5474 Northwood Dr
N4*CENTER VALLEY*PA*18034
DMG*D8*19621019*M
HD*030**DEN
DTP*348*D8*20201006
DTP*349*D8*20221104
REF*1L*1DP19PA033SAVE
INS*N*G8*030*XN*A
REF*0F*804149340
REF*17*3675575
NM1*IL*1*Farrell*Patricia
PER*IP**TE*6107514307*EM*brian72@ptd.net
N3*5474 Northwood Dr
N4*CENTER VALLEY*PA*18034
DMG*D8*19640119*F
HD*030**DEN
DTP*348*D8*20201006
REF*1L*1DP19PA033SAVE
INS*Y*18*030*XN*A***AC
REF*0F*803556052
REF*17*803556052
NM1*IL*1*Courtney*Peter
PER*IP**TE*7063342533*EM*pscourtney@gmail.com
N3*6496 Mill Flats La
N4*KING GEORGE*VA*22485
DMG*D8*19480508*M
HD*030**DEN
DTP*348*D8*20201023
DTP*349*D8*20230306
REF*1L*1DP19VA040SAVE
INS*Y*18*030*XN*A***AC
REF*0F*804219708
REF*17*804219708
NM1*IL*1*Stump*Leslie
PER*IP**TE*4846603857*EM*cheeze66@aol.com
N3*509 HIGHLAND AVE
N4*KUTZTOWN*PA*19530

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.



© Jobisez LLC - Contact Us  About Us  Privacy Statement  Sitemap  Jobisez Blog