What is a 834 transaction?

The EDI 834 transaction set represents a Benefit Enrollment and Maintenance document. It is used by employers, as well as unions, government agencies or insurance agencies, to enroll members in a healthcare benefit plan. Reinstatement of a member’s benefit enrollment.

What are 834 files used for?

This file is used by a multitude of organizations, such as employers, TPAs and insurance agencies, for enrolling their members directly into a benefit plan. The 834 file includes demographic information on the employee, including the plan subscriber’s name, plan network information, eligibility and benefit information.

What is an 834 companion guide?

The VBA 834 Benefit Enrollment and Maintenance Companion Guide provides supplemental information to the Trading Partner Agreement (TPA) that exists between VBA and its electronic trading partners. The ASC X12 834 v005010X220A1 is the established standard for the benefit enrollment and maintenance transaction.

What is a HIPAA 834 transaction?

Under HIPAA, electronic transactions are communications between two parties that relate to the provision of healthcare. HIPAA 834 is the specific format that employers must use when they electronically communicate employee health insurance benefit enrollment and maintenance data to employee health plans.

What does health insurance eligibility mean?

Eligibility Date: The date on which a person becomes eligible for insurance benefits. An employee who is eligible for insurance coverage based upon the stipulations of the group health insurance plan. Eligible Expenses: Expenses defined by the health insurance plan as eligible for coverage.

What is a benefit inquiry?

The eligibility/benefit inquiry transaction is used to obtain information about a benefit plan for an enrollee, including information on eligibility and coverage under the health plan. This inquiry can be sent from a health care provider to a health plan, or from one health plan to another.

What does EDI stand for?

Electronic Data Interchange
Electronic Data Interchange (EDI) is the electronic interchange of business information using a standardized format; a process which allows one company to send information to another company electronically rather than with paper. Business entities conducting business electronically are called trading partners.

What does EC mean in health insurance?

EE = Single ES = Employee / Spouse EC = Employee / Child EMC = Employee / Multiple Children EF = Employee / Family SP = Spouse DP = Dependent.

Why is it called an 834 file?

This is an “834 EDI transmission.” Insurers sometimes call it, more simply, “an 834.” It is a technical, back-end reporting tool that consumers never see. It is meant to be read by computers, not human beings. It’s the form that tells the insurer’s system who you are and what you need.

What is an 834 report?

Put as simply as possible, an Electronic Data Interchange (EDI) 834 file is the standard format in which employers can communicate their employees’ health insurance enrollment and maintenance data to insurance carriers.

What are HIPAA standardized transactions?

The HIPAA transactions and code set standards are rules to standardize the electronic exchange of patient-identifiable, health-related information. They are based on electronic data interchange (EDI) standards, which allow the electronic exchange of information from computer to computer without human involvement.

What is EDI stand for?

Who qualifies Calpers?

To become eligible, you must receive credit for a minimum of 480 paid hours at the end of a control period. To continue your eligibility, you must either: Be credited with at least 480 paid hours at the end of each control period. Have at least 960 hours in two consecutive control periods (current and prior)

What is a 270 file?

The 270 Transaction Set is used to transmit Health Care Eligibility Benefit Inquiries from health care providers, insurers, clearinghouses and other health care adjudication processors. The 270 Transaction Set can be used to make an inquiry about the Medicare eligibility of an individual.

What is an eligibility check?

Eligibility checks must include criteria defined at network level as well as national/regional requirements and should be done before the proper evaluation phase. The eligibility check will take into account the eligibility of the applicants and the eligibility of the proposal.

What does 834 ID mean?

rollment and Maintenance (834). The 834 is used to transfer enrollment informa-tion from the sponsor of the insurance coverage, benefits, or policy to a payer. The intent of this implementation guide is to meet the health care industry’s spe-cific need for the initial enrollment and subsequent maintenance of individuals

What are the factors of 834?

Factors of 834 are 1, 2, 3, 6, 139, 278, 417, 834. So, 834 can be derived from smaller number in 4 possible ways using multiplication. Factors of 834 are 1, 2, 3, 6, 139, 278, 417, 834. So, 834 can be derived from smaller number in 4 possible ways using multiplication.

What is HIPAA 834?

Under HIPAA, electronic transactions are communications between two parties that relate to the provision of healthcare. HIPAA 834 is the specific format that employers must use when they electronically communicate employee health insurance benefit enrollment and maintenance data to employee health plans.

What is an EDI 834 file?

– Subscriber name and identification – Plan network identification – Subscriber eligibility and/or benefit information – Product/service identification