ANSI 834 Enrollment Implementation Format
ANSI 834 EDI Enrollment Implementation Format is a standard format for electronically exchanging health plan enrollment data between employers and health insurance carriers. An 834 file contains a string of data elements and each data element represents a fact, such as a subscriber’s name, hire date, etc. The entire string is called a data segment. The Health Insurance Portability and Accountability Act (HIPAA) requires that all health plans or health insurance carriers accept a standard enrollment format, ANSI 834A Version 5010. The ANSI 834A is the national standard for electronic enrollment and maintenance health plan.
The 834 is used to transfer enrollment information from the sponsor of the insurance coverage, benefits, or policy to a payer. The intent of this implementation guide is to meet the health care industry's specific need for the initial enrollment and subsequent maintenance of individuals who are enrolled in insurance products. This implementation guide specifically addresses the enrollment and maintenance of health care products only. One or more separate guides may be developed for life, flexible spending, and retirement products.
The layout of the ANSI 834A Version 5010 file is drawn out below with an explanation of each row and what information it should contain.
Sample File Output
INS*Y*18*030*XN*A*E**FT~
REF*OF*152239999~
REF*1L*Blue~
DTP*336*D8*20070101~
NM1*IL*1*BLUTH*LUCILLE****34*152239999~
N3*224 N DES PLAINES*6TH FLOOR~
N4*CHICAGO*IL*60661*USA~
DMG*D8*19720121*F*M~
HD*030**VIS**EMP~
DTP*348*D8*20111016~
INS*N*19*030*XN*A*E***N*N~
REF*OF*152239999~
REF*1L*Blue~
DTP*357*D8*20111015~
NM1*IL*1*BLUTH*BUSTER~
N3*224 N DES PLAINES*6TH FLOOR~
N4*CHICAGO*IL*60661*USA~
DMG*D**19911015*M-HD*030**VIS~
DTP*348*D8*20110101~
DTP*349*D8*20111015~