Reading 834 Files

How to read an 834 File.

The ANSI 834 EDI Enrollment Implementation Format is a standard file format in the United States for electronically exchanging health plan enrollment data between employers and health insurance carriers.

834 files are the only standard format across different carriers. They are good news for Namely and Namely clients because they can often be built more quickly, being that they are based on a standard format. In an ideal situation, we can copy a 834 Carrier Feed for a particular Carrier from client to client. Carriers are currently working in organizations like LIMRA to develop more standardized formats, which makes operations more seamless in the benefits industry.

Each carrier can be slightly different from each other depending on what type of plans we are sending. It is consistent in this format that we send a file like this: 

Header

         Employee Information

                     Employee Plans

                     Dependent Information

                                 Dependent Plans

Footer 

The Header contains company-level information to differentiate between each file that is sent to the carrier. The following contains employee and dependent demographics along with each of the plans they have for the carrier. The Footer contains the count of type of entry within the file. 

Here is an example of an 834 format file:

ISA*00*          *00* *ZZ*123456789  *ZZ*135123390  *190807*1440*^*00501*000000001*1*T~

GS*BE*123456789*135123390*20190807*1440*1*X*005010X220A1~

ST*834*0001*005010X220A1~

BGN*00*0001*20190807*1440****4~

REF*38*00123456~

DTP*007*D8*20190807~

N1*P5*The Tea Cup*FI*123456789~

N1*IN*GUARDIAN*FI*135123390~

INS*Y*18*030*XN*A***FT*N*N*D8*20190807*U~

REF*0F*111111118~

REF*1L*00123456~

REF*3H*0000~

REF*ZZ*0001~

DTP*336*D8*20110712~

NM1*1L*1*Lee*Eric****34*111111118~

PER*IP**EM*ericlee@example.com*HP*9455550987~

N3*10 W 34th St*Apt 8~

N4*New York*NY*10118~

DMG*D8*19880210*M*I~

ICM*7*64999.92*40*20140712~

HD*030**DEN**ESP~

DTP*348*D8*20171001~

REF*1L*00123456~

HD*030**VIS**ESP~

DTP*348*D8*20171001~

REF*1L*00123456~

HD*030**ADD**EMP~

DTP*348*D8*20171001~

REF*1L*00123456~

INS*N*01*030*XN*A****N*N*D8*20190807*U~

REF*0F*111111118~

REF*1L*00123456~

DTP*356*D8*20171001~

NM1*1L*1*Yuen*Kei****34*987654376~

N3*10 W 34th St*Apt 8~

N4*New York*NY*10118~

DMG*D8*19660519*F~

HD*030**DEN**ESP~

DTP*348*D8*20171001~

REF*1L*00123456~

HD*030**VIS**ESP~

DTP*348*D8*20171001~

REF*1L*00123456~

SE*43*0001~

GE*1*1~

IEA*1*000000001
 

This Would Be Broken Down Like This:

Header  

ISA*00*          *00* *ZZ*123456789  *ZZ*135123390  *190807*1440*^*00501*000000001*1*T~

GS*BE*123456789*135123390*20190807*1440*1*X*005010X220A1~

ST*834*0001*005010X220A1~

BGN*00*0001*20190807*1440****4~

REF*38*00123456~

DTP*007*D8*20190807~

N1*P5*The Tea Cup*FI*123456789~

N1*IN*GUARDIAN*FI*135123390~
 

Employee Information  

INS*Y*18*030*XN*A***FT*N*N*D8*20190807*U~

REF*0F*111111118~

REF*1L*00123456~

DTP*336*D8*20110712~

NM1*1L*1*Lee*Eric****34*111111118~

PER*IP**EM*ericlee@example.com*HP*9455550987~

N3*10 W 34th St*Apt 8~

N4*New York*NY*10118~

DMG*D8*19880210*M*I~

ICM*7*64999.92*40*20140712~

HD*030**DEN**ESP~
 

Employee Benefits  

HD*030**DEN**ESP~

DTP*348*D8*20171001~

REF*1L*00123456~

HD*030**VIS**ESP~

DTP*348*D8*20171001~

REF*1L*00123456~

HD*030**ADD**EMP~

DTP*348*D8*20171001~

REF*1L*00123456~
 

Dependent Information

INS*N*01*030*XN*A****N*N*D8*20190807*U~

REF*0F*111111118~

REF*1L*00123456~

DTP*356*D8*20171001~

NM1*1L*1*Yuen*Kei****34*987654376~

N3*10 W 34th St*Apt 8~

N4*New York*NY*10118~

DMG*D8*19660519*F~

HD*030**DEN**ESP~
 

Dependent Benefits  

HD*030**DEN**ESP~

DTP*348*D8*20171001~

REF*1L*00123456~

HD*030**VIS**ESP~

DTP*348*D8*20171001~

REF*1L*00123456~
 

Footer

SE*34*0001~

GE*1*1~

IEA*1*000000001
 

This Is What It Means:

ISA*00*          *00* *ZZ*123456789  *ZZ*135123390  *190807*1440*^*00501*000000001*1*T~

GS*BE*123456789*135123390*20190807*1440*1*X*005010X220A1~

ST*834*0001*005010X220A1~

BGN*00*0001*20190807*1440****4~

REF*38*00123456~

DTP*007*D8*20190807~

N1*P5*The Tea Cup*FI*123456789~

N1*IN*GUARDIAN*FI*135123390~

This shows company information.

INS*Y*18*030*XN*A***FT*N*N*D8*20190807*U~ Member Level Detail (Y=Employee, 18=EE, Employee Status, Status Code, ex. FT = Full Time)

REF*0F*111111118~ Subscriber Number (SSN)

REF*1L*00123456~ Group Sub-location Division (GSD)

DTP*336*D8*20110712~ DTP 336 = Hire Date

NM1*1L*1*Green*Geoffrey****34*111111118~ Employee Name and SSN

PER*IP**EM*geoffreygreen@example.com*HP*9455550987~ Contact information

N3*10 W 34th St*Apt 8~ Employee Address 1 and 2

N4*New York*NY*10118~ Employee City, State, Zip, Country

DMG*D8*19880210*M*I~ Employee Demographics (Birth Date/Gender/Marital Status)

ICM*7*64999.92*40*20140712~ Employee Salary

This shows employee information such as SSN, division codes, names, contact information, address, hire date, birth date, and salaries, where needed. An employee will be included as long as they have active plan benefits in the carrier specified. This pulls directly from the Namely Payroll profile fields at the time the file sends.

 

HD*030**DEN**ESP~ Coverage Data (Plan Code, Coverage Level)

DTP*348*D8*20171001~ Coverage Start Date

REF*1L*00123456~ Coverage Code

HD*030**VIS**ESP~Coverage Data (Plan Code, Coverage Level)

DTP*348*D8*20171001~ Coverage Start Date

REF*1L*00123456~ Coverage Data (Plan Code, Coverage Level)

HD*030**ADD**EMP~Coverage Data (Plan Code, Coverage Level)

DTP*348*D8*20171001~ Coverage Start Date

REF*1L*00123456~ Coverage Data (Plan Code, Coverage Level)

This shows employee benefits enrollment information. This pulls from plan benefits as long as the plans are active.

 

INS*N*01*030*XN*A****N*N*D8*20190807*U~ Member Level Detail (Y=Employee, 18=EE, Employee Status)

REF*0F*111111118~ Subscriber Number

REF*1L*00123456~ Group Sub-location Division (GSD)

DTP*356*D8*20171001~ Eligibility Begin Date

NM1*1L*1*Yuen*Kei****34*987654376~ Dependent Name and SSN

N3*10 W 34th St*Apt 8~ Dependent Address 1 and 2

N4*New York*NY*10118~ Employee City, State, Zip, Country

DMG*D8*19660519*F~ Dependent Demographics (Birth Date/Gender)

This shows dependent information such as SSN, names, address, birth date, where needed. This pulls from the dependent tab, as long as the dependent is enrolled in the carrier. Each field is pulled directly from Namely Payroll at the time of when the file sends.

 

HD*030**DEN**ESP~ Coverage Data (Plan Code, Coverage Level)

DTP*348*D8*20171001~ Coverage Start Date

REF*1L*00123456~ Coverage Code

HD*030**VIS**ESP~ Coverage Data (Plan Code, Coverage Level)

DTP*348*D8*20171001~ Coverage Start Date

REF*1L*00123456~Coverage Code

This shows dependent benefit enrollment information. This pulls from plan benefits in the dependent tab in Namely Payroll as long as the plans are active.

SE*43*0001~

GE*1*1~

IEA*1*000000001

This is the footer. It counts how many lines of data are on the file.