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EDI 834 Benefit Enrollment and Maintenance - EDI 834 Transaction

EDI 834 Benefit Enrollment and Maintenance

EDI 834 Benefit Enrollment and Maintenance 

The EDI 834 transaction is an electronic Benefit Enrollment and Maintenance (also known as ANSI X12 EDI 834). An EDI 834 Benefit Enrollment and Maintenance is used by by employers, insurance agencies, goverment agencies or healthcare companies to enroll members in a healthcare benefit plan. An EDI 834 is in compliance with HIPAA standards for the electronic exchange of member enrollment information, benefits, plan subscription and employee demographic details. 


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  • Enhances operational efficiencies for HIPAA claims processing
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EDI 834 Benefit Enrollment and Maintenance specifications and key data elements include:

  • Subscriber name and identification 
  • Plan network indentificiation
  • Subscriber eligibility and/or benefit information
  • Products/services identification
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Benefits of using EDI 834 Benefit Enrollment and Maintenance

  • Improves accuracy of information exchanged, improving the quality of healthcare delivery and its supporting process
  • Enhances operational efficiencies for HIPAA claims processing
  • Improves data accuracy of information exchanged between trading partners
  • Ensures accurate, secure, reliable exchange of information between healthcare organizations, payors and clearinghouses

EDI 834 transaction can be used for the following:

  • New enrollments
  • Plan changes in member's enrollment
  • Reinstatement of member's benefit enrollment
  • Termination of plan membership






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