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
Name | Description | Type | EDI Element |
---|---|---|---|
sponsor | Sponsor | PartyIdName | Loop: 1000A |
insurer | Insurer | PartyIdName | Loop: 1000B |
tpas | Tpas | List of PartyIdName | Loop: 1000C |
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 |
supplementalIdentifiers | Supplemental identifiers | List of Reference | REF |
statusInfoEffectiveDates | Status info effective dates | List of Date | DTP |
member | Member | Member | NM1 *IL Loop: 2100A |
contractAmounts | Member policy amounts from the member loop 2100A | List of Amount | AMT |
mailingAddress | Member mailing address | Address | |
employers | Employers | List of Party | Loop: 2100D |
schools | Schools | List of Party | Loop: 2100E |
custodialParent | Custodial parent | Party | Loop: 2100F |
responsiblePersons | Responsible persons | List of Party | Loop: 2100G |
reportingCategories | Reporting categories | List of ReportingCategory | Loop: 2750 |
healthCoverages | Health coverages | List of HealthCoverage | Loop: 2300 |
Member
Loop: 2100A, Segment: NM1
Name | Description | Type | EDI Element |
---|---|---|---|
entityRole | Entity role View codes and descriptions | String | NM102, N101 |
identifier | Identifier | String | NM109, N104 |
lastNameOrOrgName | Organization name or person last 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 | |
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 |
Health Coverage
Loop: 2300, Segment: HD
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 of Date | DTP |
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 |
Organization or Person (Party)
Name | Description | Type | EDI Element |
---|---|---|---|
entityRole | Entity role View codes and descriptions | String | NM102, N101 |
entityType | Type of this entity: 'BUSINESS' for organization, 'INDIVIDUAL' for person | String | NM102 |
identificationType | Identification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum) | String | NM108, N103 |
identifier | Identifier | String | NM109, N104 |
lastNameOrOrgName | Organization name or person last name | String | NM103, N102 |
firstName | First name | String | NM104 |
middleName | Middle name | String | NM105 |
address | Address | Address | |
contacts | Contacts | List of Contact |
Organization ID and Name
Name | Description | Type | EDI Element |
---|---|---|---|
entityRole | Entity role View codes and descriptions | String | NM102, N101 |
entityType | Type of this entity: 'BUSINESS' for organization, 'INDIVIDUAL' for person | String | NM102 |
identificationType | Identification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum) | String | NM108, N103 |
identifier | Identifier | String | NM109, N104 |
lastNameOrOrgName | Organization name or person last name | String | NM103, N102 |
firstName | First name | String | NM104 |
middleName | Middle name | String | NM105 |
Coordination of Benefits
Loop: 2320, Segment: COB
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 | DTP03 *344 |
dateTo | Date to | Date | DTP03 *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 |
Contact
Segment: PER
Name | Description | Type | EDI Element |
---|---|---|---|
name | Name | String | PER02 |
contactNumbers | Contact numbers | List of ContactNumber |
Contact Number
Segment: PER
Name | Description | Type | EDI Element |
---|---|---|---|
type | Type | String | PER03,PER05,PER07 |
number | Number | String | PER04,PER06,PER08 |
Reporting Category
Name | Description | Type | EDI Element |
---|---|---|---|
name | Name | String | N102 |
identifierQualifierCode | Identifier qualifier code | String | REF01 |
identifierType | Identifier type | String | REF01 |
identifier | Identifier | String | REF02 |
date | Effective date | Date | DTP03 *007 |
dateTo | End date | Date | DTP03 |
Date
Segment: DTP
Name | Description | Type | EDI Element |
---|---|---|---|
date | The date value or the first date of the date range ('RD8' qualifier) | Date | DTP03 |
dateTo | The second date if the value is the date range ('RD8' qualifier), otherwise null | Date | DTP03 |
Reference Identifications
Segment: REF
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
Segment: AMT
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 |