X12 834 Benefit Enrollment

1. 834 structure

   BGN, sponsor and payer loops, member INS segments and 2300 health coverage loops.

2. Member level detail

   INS maintenance type codes (add, change, terminate), relationship, benefit status and employment status.

3. Coverage loops

   HD health coverage, DTP effective and termination dates, plan identifiers and COB.

4. Full file vs audit enrollment

   Reconciling full-file and change-only 834 files, and handling reinstatements.

5. FHIR Coverage mapping

   Mapping 834 member and coverage data to FHIR Coverage and Patient resources.

Each section links to the official page. Titles and summaries by Extra Credit; the docs belong to their authors.

• Price Transparency (Transparency in Coverage)
• SMART on FHIR (App Launch)
• TEFCA
• UB-04 (CMS-1450) Claim Form
• US Core Implementation Guide
• X12 270/271 Eligibility
• X12 276/277 Claim Status
• X12 278 Prior Authorization
• X12 820 Payment and Remittance
• X12 835 Remittance Advice
• X12 837I Institutional Claim
• X12 837P Professional Claim