EDI Transaction Set
EDI 834: Benefit Enrollment And Maintenance
EDI 834 is the X12 Benefit Enrollment And Maintenance transaction set, used within Electronic Data Interchange (EDI). This transaction set can be used to establish communication between the sponsor of the insurance product and the payer. Such transaction(s) may or may not take place through a third party administrator (TPA).
What the 834 transaction set covers
Benefit Enrollment and Maintenance This X12 Transaction Set contains the format and establishes the data contents of the Benefit Enrollment and Maintenance Transaction Set (834) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to establish communication between the sponsor of the insurance product and the payer. Such transaction(s) may or may not take place through a third party administrator (TPA). For the purpose of this standard, the sponsor is the party or entity that ultimately pays for the coverage, benefit or product. A sponsor can be an employer, union, government agency, association, or insurance agency. The payer refers to an entity that pays claims, administers the insurance product or benefit, or both. A payer can be an insurance company, health maintenance organization (HMO), preferred provider organization (PPO), government agency (Medicare, Medicaid, Champus, etc.), or an entity that may be contracted by one of these former groups. For the purpose of the 834 transaction set, a third party administrator (TPA) can be contracted by a sponsor to handle data gathering from those covered by the sponsor if the sponsor does not elect to perform this function itself.
How Interlink handles the 834
Interlink Commerce maps, transmits, and monitors the 834 for you as part of fully managed EDI — connected straight to your ERP or systems, certified against your retailer’s requirements, and billed only when you trade. Most suppliers go live within 30 days.