834 (FFE Issuer to FFE) 834 Benefit Enrollment and Maintenance (X220A1) v7.0
Centers for Medicare & Medicaid Services (CMS) · X12 005010X220A1
La spécification 834 publiée par Centers for Medicare & Medicaid Services (CMS), présentée sous forme de guide interactif. Déployez n’importe quel segment pour voir ses éléments, types de données, longueurs et codes acceptés, puis validez votre propre document ci-dessous.
Spécification
22 segments sur 22
HEADING
ST
Transaction Set Header
pos. 0100
Facultatif
max. —
BGN
Beginning Segment
pos. 0200
Obligatoire
max. —
REF
Transaction Set Policy Number
- The definition of the Master Policy Number is determined by the issuer of the policy, the Payer/Plan Administrator. The Master Policy Number may be used to meet various business needs such as indicating the line of business under which the policy is defined.
- Required when the insurance contract or trading partner agreement identifies a Master Policy Number for use with electronic enrollment. If not required may be provided at the sender's discretion if a unique ID Number for a group applies to the entire transaction set.
pos. 0300
Facultatif
max. —
DTP
File Effective Date
- Required when specified in the contract. If not required by this implementation guide, do not send.
pos. 0400
Facultatif
max. —
QTY
Transaction Set Control Totals
- Required when the contract or trading partner agreement specifies that this information be included in the transaction set. If not required by this implementation guide, do not send.
pos. 0600
Facultatif
max. 3
Boucle 1000ASponsor Name Loopobligatoire
N1
Sponsor Name
- This loop identifies the sponsor. See section 1.5 for the definition of Sponsor.
pos. 0700
Obligatoire
max. —
Boucle 1000BPayer Loopobligatoire
N1
Payer
- This loop identifies the payer. See section 1.5 for the definition of payer.
pos. 0700
Obligatoire
max. —
DETAIL
Boucle 2000Member Level Detail Loopobligatoire
INS
Member Level Detail
- Subscriber information must preceed dependent information in a transmission, or the subscriber information must have been submitted to the receiver in a previous transmission.
pos. 0100
Obligatoire
max. —
REF
Member Policy Numbervariante 1 de 3
- The policy number passed in this segment is an attribute of the contract relationship between the plan sponsor (sender) and the payer (receiver) and not an attribute of an individual's participation in any coverage passed in an HD loop.
- Required when the policy or group number applies to all coverage data (all 2300 loops for this member). If not required by this implementation guide, do not send.
pos. 0200
Facultatif
max. —
REF
Member Supplemental Identifiervariante 2 de 3
- Required when sending additional identifying information on the member. If not required by this implementation guide, do not send.
pos. 0200
Facultatif
max. 13
REF
Subscriber Identifiervariante 3 de 3
- This segment must contain a unique SUBSCRIBER identification number (SSN or other). This occurrence is identified by the 0F qualifier (REF01). This identifier is used for linking the subscriber with dependents as required under many policies.
- The developers recommend using the identifier developed under the HIPAA legislation, when that becomes available.
pos. 0200
Obligatoire
max. —
DTP
Member Level Dates
- Required when enrolling a member or when the sponsor is informed of a change to any applicable date listed in DTP01. Only those dates that apply to the particular insurance contract need to be sent. If not required by this implementation guide, do not send.
- While many of the dates listed for DTP01 are related to termination, the only code that is used to actually terminate a Member is 357 (Eligibility End). Similarly, the Eligibility Begin Date (code 356) is the date the individual is eligible for coverage, not the date coverage is effective.
pos. 0250
Facultatif
max. 24
Boucle 2100AMember Name Loopobligatoire
NM1
Member Name
pos. 0300
Obligatoire
max. —
DMG
Member Demographics
- Required when enrolling a new member, changing a member's demographic information, or terminating a member. If not required by this implementation guide, do not send.
pos. 0800
Facultatif
max. —
Boucle 2300Health Coverage Looprépétitions : 99
HD
Health Coverage
- Required when enrolling a new member or when adding, updating, removing coverage or auditing an existing member. If not required by this implementation guide, do not send.
- Refer to section 1.4.4 "Termination" for additional information relative to removing a member's coverage.
pos. 2600
Obligatoire
max. —
DTP
Health Coverage Dates
pos. 2700
Obligatoire
max. 6
REF
Health Coverage Policy Number
- Required when such transmission is required under the Trading Partner Agreement between the sponsor and the payer. If not required by this implementation guide, do not send.
pos. 2900
Facultatif
max. 14
Boucle 2700Member Reporting Categories Loop
LX
Member Reporting Categories
- Required when needed to provide additional reporting categories about the member. If not required by this implementation guide, do not send.
pos. 6881
Obligatoire
max. —
Boucle 2750Reporting Category Loop
N1
Reporting Category
- Required to specify the name of the reporting category of the member's participating entity.
pos. 6882
Obligatoire
max. —
REF
Reporting Category Reference
- Required to specify the reference identifier associated with the reporting category of the member's participating entity.
pos. 6883
Facultatif
max. —
DTP
Reporting Category Date
- Required when called for in the insurance contract between the sponsor and payer. If not required by this implementation guide, do not send.
- Use this segment to associate a date or date range with a reporting category.
pos. 6884
Facultatif
max. —
SE
Transaction Set Trailer
pos. 6900
Facultatif
max. —
Validez un 834
Collez ou téléversez un document et vérifiez-le par rapport aux règles publiées par Centers for Medicare & Medicaid Services (CMS) : ordre et répétition des segments, éléments obligatoires, longueurs de champs, types de données et codes acceptés. Rien n’est conservé.
Passez en production sur le 834 de Centers for Medicare & Medicaid Services (CMS) en quelques jours, pas en quelques mois
Weredi établit le schéma entre ce guide et votre ERP, mène le cycle de tests avec Centers for Medicare & Medicaid Services (CMS) et maintient la spécification à jour au fil de ses changements.