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Healthcare Leader X12 834 Benefit Enrollment and Maintenance

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Guideline Overview

A high-level outline of segments, elements, and structure. Full implementation details and code lists are available when you sign up.
ISAInterchange Control Header
16 elements

To start and identify an interchange of zero or more functional groups and interchange-related control segments

GSFunctional Group Header
8 elements

To indicate the beginning of a functional group and to provide control information

transactionSets

7 seg
STTransaction Set Header
2 elements

To indicate the start of a transaction set and to assign a control number

BGNBeginning Segment
9 elements

To indicate the beginning of a transaction set

REFReference Information
3 elements

To specify identifying information

DTPDate or Time or Period
3 elements

To specify any or all of a date, a time, or a time period

N1_loop

>1x3 seg
N1Party Identification
4 elements

To identify a party by type of organization, name, and code

N3Party Location
2 elements

To specify the location of the named party

N4Geographic Location
4 elements

To specify the geographic place of the named party

INS_loop

>1x6 seg
INSInsured Benefit
20 elements

To provide benefit information on insured entities

REFReference Information
3 elements

To specify identifying information

DTPDate or Time or Period
3 elements

To specify any or all of a date, a time, or a time period

NM1_loop

>1x8 seg
NM1Individual or Organizational Name
11 elements

To supply the full name of an individual or organizational entity

PERAdministrative Communications Contact
8 elements

To identify a person or office to whom administrative communications should be directed

N3Party Location
2 elements

To specify the location of the named party

N4Geographic Location
4 elements

To specify the geographic place of the named party

DMGDemographic Information
6 elements

To supply demographic information

ICMIndividual Income
6 elements

To supply information to determine benefit eligibility, deductibles, and retirement and investment contributions

AMTMonetary Amount Information
3 elements

To indicate the total monetary amount

HLHHealth Information
7 elements

To provide health information

DSB_loop

4x2 seg
DSBDisability Information
8 elements

To supply disability information

DTPDate or Time or Period
3 elements

To specify any or all of a date, a time, or a time period

HD_loop

99x5 seg
HDHealth Coverage
11 elements

To provide information on health coverage

DTPDate or Time or Period
3 elements

To specify any or all of a date, a time, or a time period

REFReference Information
3 elements

To specify identifying information

LX_loop

30x2 seg
LXTransaction Set Line Number
1 element

To reference a line number in a transaction set

NM1Individual or Organizational Name
12 elements

To supply the full name of an individual or organizational entity

COB_loop

5x2 seg
COBCoordination of Benefits
4 elements

To supply information on coordination of benefits

DTPDate or Time or Period
3 elements

To specify any or all of a date, a time, or a time period

SETransaction Set Trailer
2 elements

To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)

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