834 Fields

This document provides definitions of header-level CSV columns and properties of MemberCoverage and related objects in JSON.

The “EDI Element” column contains the X12 “Reference Designator,” such as CLP01. Where appropriate, we also provide an X12 qualifier code, such as *435 from the DTP*435*D8*20030108~ string (admission date).

“EDI Element” is blank for the fields that are not populated from EDI data. These fields are calculated based on other fields (e.g., totalAdjAmount) or generated by the converter (id).

Member Coverage (INS)

Name	Description	Type	EDI Element
memberIndicator	Member indicator	String	INS01
relationshipCode	Relationship code	String	INS02
maintenanceTypeCode	Maintenance type code	String	INS03
maintenanceReasonCode	Maintenance reason code	String	INS04
benefitStatusCode	Benefit status code	String	INS05
cobraEventCode	Cobra event code	String	INS07
employmentStatusCode	Employment status code	String	INS08
studentStatusCode	Student status code	String	INS09
handicapIndicator	Handicap indicator	String	INS10
confidentialityCode	Confidentiality code	String	INS13
birthSequenceNumber	Birth sequence number	Integer	INS17
identifier	Member identifier	String	REF02 *0F
groupOrPolicyNumber	Group or policy number	String	REF02 *1L
member	Member	Member	NM1 *IL
contractAmounts	Member policy amounts from the member loop 2100A	List of Amount	AMT
mailingAddress	Member mailing address	Address
healthCoverages	Health coverages	List of HealthCoverage

Member

Name	Description	Type	EDI Element
maritalStatusCode	Marital status code	String	DMG04
ethnicityCode	Ethnicity code	String	DMG05
citizenshipCode	Citizenship code	String	DMG06
employmentClassCodes	Employment class codes	List of String	EC01,EC02,EC03
wageFrequencyCode	Wage frequency code	String	ICM01
wageAmount	Wage amount	Number	ICM02
workHoursCount	Work hours count	Number	ICM03
employerLocationIdentificationCode	Employer location identification code	String	ICM04
salaryGradeCode	Salary grade code	String	ICM05
healthRelatedCode	Health related code	String	HLH01
height	Height	Number	HLH02
weight	Weight	Number	HLH03
entityRole	Entity role View codes and descriptions	String	NM102, N101
identificationType	Identifier type, usually NPI for providers. This is a qualifier code translated to a string constant (enum)	String	NM108, N103
identifier	Identifier	String	NM109, N104
lastNameOrOrgName	Last name or org name	String	NM103, N102
firstName	First name	String	NM104
middleName	Middle name	String	NM105
birthDate	Birth date	Date	DMG02
gender	Gender	String	DMG03
address	Address	Address
additionalIds	Other identifications	List of Reference	REF

Health Coverage

Name	Description	Type	EDI Element
maintenanceTypeCode	Maintenance type code	String	HD01
insuranceLineCode	Insurance line code	String	HD03
planDescription	Plan description	String	HD04
coverageLevelCode	Coverage level code	String	HD05
lateEnrollmentIndicator	Late enrollment indicator	String	HD09
coverageDates	Coverage dates	List	DTP03
contractAmounts	Contract amounts	List of Amount	AMT
groupOrPolicyNumbers	Group or policy numbers	List of Reference	REF
priorCoverageMonthCount	Prior coverage month count	String	REF02 *QQ
providers	Providers	List of Party
cobs	Coordination of Benefits	List of CoordinationOfBenefits

Provider

Name	Description	Type	EDI Element
entityRole	Entity role View codes and descriptions	String	NM102, N101
identificationType	Identifier type, usually NPI for providers. This is a qualifier code translated to a string constant (enum)	String	NM108, N103
identifier	Identifier	String	NM109, N104
lastNameOrOrgName	Last name or org name	String	NM103, N102
firstName	First name	String	NM104
middleName	Middle name	String	NM105
address	Address	Address
additionalIds	Other identifications	List of Reference	REF

Coordination of Benefits

Name	Description	Type	EDI Element
payerResponsibilitySequenceCode	Payer responsibility sequence code	String	COB01
groupOrPolicyNumber	Group or policy number	String	COB02
coordinationOfBenefitsCode	Coordination of benefits code	String	COB03
additionalIdentifiers	Additional identifiers	List of Reference	REF
dateFrom	Date from	Date	DTP02 *344
dateTo	Date to	Date	DTP02 *345
insurers	Insurers	List of Party

Address

Name	Description	Type	EDI Element
line	Line	String	N301
line2	Line2	String	N302
city	City	String	N401
stateCode	State code	String	N402
zipCode	Zip code	String	N403
countryCode	Country code	String	N404

Reference Identifications

Name	Description	Type	EDI Element
qualifierCode	Code qualifying the reference identification	String	REF01
type	Type of reference; qualifier code as a string constant (enum)	String	REF01
identification	Reference identification	String	REF02

Amount

Name	Description	Type	EDI Element
qualifierCode	Code specifying the type of amount (amount qualifier code)	String	AMT01
type	Type of amount; qualifier code translated to a mnemonic string constant (enum)	String	AMT01
amount	Amount	Number	AMT02