The EDI 834 file is organized into segments and data elements, where data elements contain a data field while the segment contains one data element. What makes a Benefits Enrollment and Maintenance Document? Disenrollment of any member (termination of plan membership).Reinstating a member’s benefits enrollment.Other than new enrollments and plan subscriptions, 834 transactions may be used for – Not to mention, that the EDI 834 file format was specified by the HIPAA 5010 standard for electronic exchange. To clarify, a sponsor is a party that pays for the benefits plan, and the payer (insurance company) administers the insurance product. This transaction set is used by employers, government agencies, enrolling members, insurance agencies, union agencies, and others included in a healthcare benefits plan.ĮDI 834 establishes a seamless communication between the sponsor of an insurance product and the payer. Defining EDI Benefit Enrollment and MaintenanceĮDI 834 is a transaction set representing the Benefits Enrollment and Maintenance document. Most health insurance carriers follow the set format and accept the 834 formats for delivering health insurance enrollment and maintenance data. The very next year, EDI standard sets were dictated to be adopted by the American National Standards Institute (ANSI). The question that comes to mind is, why do we use certain file formats when we have common protocols like XML? To answer this, let us go back to EDI 834’s inception.ĮDI 834 came in 1991, with the formation of the Workgroup for Electronic Data Interchange (WEDI). This article focuses on the standard way to exchange the enrollment data via ASC and HIPAA EDI 834 – Benefit Enrollment and Maintenance File format. But that’s not it! There is a lot of work that goes behind the curtains, such as enrollment files, member maintenance files, plan data, billing data, and rating data. When thinking of a private health insurance exchange, you just think of a marketplace full of options. What makes a Benefits Enrollment and Maintenance Document?.
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