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

Main object for 834, contains the member and their health coverage information.

Loop: 2000, Segment: INS

NameDescriptionTypeEDI Element
sponsorSponsorPartyIdNameLoop: 1000A
insurerInsurerPartyIdNameLoop: 1000B
tpasTpasList of PartyIdNameLoop: 1000C
memberIndicatorMember indicatorStringINS01
relationshipCodeRelationship codeStringINS02
maintenanceTypeCodeMaintenance type codeStringINS03
maintenanceReasonCodeMaintenance reason codeStringINS04
benefitStatusCodeBenefit status codeStringINS05
cobraEventCodeCobra event codeStringINS07
employmentStatusCodeEmployment status codeStringINS08
studentStatusCodeStudent status codeStringINS09
handicapIndicatorHandicap indicatorStringINS10
confidentialityCodeConfidentiality codeStringINS13
birthSequenceNumberBirth sequence numberIntegerINS17
identifierMember identifierStringREF02 *0F
groupOrPolicyNumberGroup or policy numberStringREF02 *1L
supplementalIdentifiersSupplemental identifiersList of ReferenceREF
statusInfoEffectiveDatesStatus info effective datesList of DateDTP
memberMemberMemberNM1 *IL
Loop: 2100A
contractAmountsMember policy amounts from the member loop 2100AList of AmountAMT
mailingAddressMember mailing addressAddress
employersEmployersList of PartyLoop: 2100D
schoolsSchoolsList of PartyLoop: 2100E
custodialParentCustodial parentPartyLoop: 2100F
responsiblePersonsResponsible personsList of PartyLoop: 2100G
reportingCategoriesReporting categoriesList of ReportingCategoryLoop: 2750
healthCoveragesHealth coveragesList of HealthCoverageLoop: 2300

Member

Loop: 2100A, Segment: NM1

NameDescriptionTypeEDI Element
entityRoleEntity role
View codes and descriptions
StringNM102, N101
identifierIdentifierStringNM109, N104
lastNameOrOrgNameOrganization name or person last nameStringNM103, N102
firstNameFirst nameStringNM104
middleNameMiddle nameStringNM105
birthDateBirth dateDateDMG02
genderGenderStringDMG03
addressAddressAddress
maritalStatusCodeMarital status codeStringDMG04
ethnicityCodeEthnicity codeStringDMG05
citizenshipCodeCitizenship codeStringDMG06
employmentClassCodesEmployment class codesList of StringEC01,EC02,EC03
wageFrequencyCodeWage frequency codeStringICM01
wageAmountWage amountNumberICM02
workHoursCountWork hours countNumberICM03
employerLocationIdentificationCodeEmployer location identification codeStringICM04
salaryGradeCodeSalary grade codeStringICM05
healthRelatedCodeHealth related codeStringHLH01
heightHeightNumberHLH02
weightWeightNumberHLH03

Health Coverage

Loop: 2300, Segment: HD

NameDescriptionTypeEDI Element
maintenanceTypeCodeMaintenance type codeStringHD01
insuranceLineCodeInsurance line codeStringHD03
planDescriptionPlan descriptionStringHD04
coverageLevelCodeCoverage level codeStringHD05
lateEnrollmentIndicatorLate enrollment indicatorStringHD09
coverageDatesCoverage datesList of DateDTP
contractAmountsContract amountsList of AmountAMT
groupOrPolicyNumbersGroup or policy numbersList of ReferenceREF
priorCoverageMonthCountPrior coverage month countStringREF02 *QQ
providersProvidersList of Party
cobsCoordination of BenefitsList of CoordinationOfBenefits

Organization or Person (Party)

NameDescriptionTypeEDI Element
entityRoleEntity role
View codes and descriptions
StringNM102, N101
entityTypeType of this entity: 'BUSINESS' for organization, 'INDIVIDUAL' for personStringNM102
identificationTypeIdentification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum)StringNM108, N103
identifierIdentifierStringNM109, N104
lastNameOrOrgNameOrganization name or person last nameStringNM103, N102
firstNameFirst nameStringNM104
middleNameMiddle nameStringNM105
addressAddressAddress
contactsContactsList of Contact

Organization ID and Name

NameDescriptionTypeEDI Element
entityRoleEntity role
View codes and descriptions
StringNM102, N101
entityTypeType of this entity: 'BUSINESS' for organization, 'INDIVIDUAL' for personStringNM102
identificationTypeIdentification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum)StringNM108, N103
identifierIdentifierStringNM109, N104
lastNameOrOrgNameOrganization name or person last nameStringNM103, N102
firstNameFirst nameStringNM104
middleNameMiddle nameStringNM105

Coordination of Benefits

Loop: 2320, Segment: COB

NameDescriptionTypeEDI Element
payerResponsibilitySequenceCodePayer responsibility sequence codeStringCOB01
groupOrPolicyNumberGroup or policy numberStringCOB02
coordinationOfBenefitsCodeCoordination of benefits codeStringCOB03
additionalIdentifiersAdditional identifiersList of ReferenceREF
dateFromDate fromDateDTP03 *344
dateToDate toDateDTP03 *345
insurersInsurersList of Party

Address

NameDescriptionTypeEDI Element
lineLineStringN301
line2Line2StringN302
cityCityStringN401
stateCodeState codeStringN402
zipCodeZip codeStringN403
countryCodeCountry codeStringN404

Contact

Segment: PER

NameDescriptionTypeEDI Element
nameNameStringPER02
contactNumbersContact numbersList of ContactNumber

Contact Number

Segment: PER

NameDescriptionTypeEDI Element
typeTypeStringPER03,PER05,PER07
numberNumberStringPER04,PER06,PER08

Reporting Category

NameDescriptionTypeEDI Element
nameNameStringN102
identifierQualifierCodeIdentifier qualifier codeStringREF01
identifierTypeIdentifier typeStringREF01
identifierIdentifierStringREF02
dateEffective dateDateDTP03 *007
dateToEnd dateDateDTP03

Date

Segment: DTP

NameDescriptionTypeEDI Element
dateThe date value or the first date of the date range ('RD8' qualifier)DateDTP03
dateToThe second date if the value is the date range ('RD8' qualifier), otherwise nullDateDTP03

Reference Identifications

Segment: REF

NameDescriptionTypeEDI Element
qualifierCodeCode qualifying the reference identificationStringREF01
typeType of reference; qualifier code as a string constant (enum)StringREF01
identificationReference identificationStringREF02

Amount

Segment: AMT

NameDescriptionTypeEDI Element
qualifierCodeCode specifying the type of amount (amount qualifier code)StringAMT01
typeType of amount; qualifier code translated to a mnemonic string constant (enum)StringAMT01
amountAmountNumberAMT02