What is EDI 834 transaction?

What is EDI 834 transaction?

The EDI 834 transaction set represents a Benefit Enrollment and Maintenance document. It is used by employers, as well as unions, government agencies or insurance agencies, to enroll members in a healthcare benefit plan. Reinstatement of a member’s benefit enrollment.

What is EDI 834 in healthcare?

Simply, an EDI 834 file is a benefit enrollment and maintenance document that must abide by HIPAA 5010 standards. The 834 file includes demographic information on the employee, including the plan subscriber’s name, plan network information, eligibility and benefit information.

What are the benefits of electronic transaction standards?

Overview document of electronic transactions used in health care to increase efficiencies in operations, improve the quality and accuracy of information, and reduce the overall costs to the system. Under HIPAA, HHS adopted certain standard transactions for the electronic exchange of health care data.

What does health insurance eligibility mean?

Eligibility Date: The date on which a person becomes eligible for insurance benefits. A dependent (usually spouse or child) of an insured person who is eligible for insurance coverage. Eligible Employee: An employee who is eligible for insurance coverage based upon the stipulations of the group health insurance plan.

What are standard transactions?

In general, the standard transactions prescribe the form, format, and content for the transmission of information in certain contexts, with the goal being to reduce the administrative costs of such transactions.

What are eligible dependents?

For a dependent to be eligible, they need to be claimed as such by the employee for tax purposes, reside in the US, and have a valid Social Security Number or equivalent. Examples of eligible dependents can include: Spouses. Children (under the age of 26) Siblings.

What is an insurance eligibility period?

Eligibility Period — that period during which members of a given group may enroll in a group benefits program (e.g., 401(k) plan, health insurance, disability insurance, or life insurance).

What is enrollment and disenrollment?

The enrollment/disenrollment transaction is the transmission of subscriber enrollment information from the sponsor of the insurance coverage, benefits, or policy to a health plan to establish or terminate insurance coverage.

What is the purpose of the 834 transaction set?

For the purpose of the 834 transaction set, a third party administrator (TPA) can be contracted by a sponsor to handle data gathering from those covered by the sponsor if the sponsor does not elect to perform this function itself. Accredited Standards Committee X12. ASC X12 Standard [Table Data].

What is Edi 834 format?

EDI 834 Specification This X12 Transaction Set contains the format and establishes the data contents of the Benefit Enrollment and Maintenance Transaction Set (834) for use within the context of an Electronic Data Interchange (EDI) environment.

What is an ANSI X12N 834 transaction?

The 834 transaction is used to transfer enrollment information from the sponsor of the insurance coverage, benefits, or policy to a payer. Only sponsors that have been deemed “covered entities” are required to use the ANSI X12N 834 transaction.

How do I use the 834 Benefit Enrollment and maintenance transaction?

The 834 Benefit Enrollment and Maintenance transaction can be used in two different ways, as an update or as a full audit file. The Action Code (BGN08) identifies the use of the transaction set: 2 Change (Update) 4 Verify (full audit)

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