Appendix E - Data Element Glossary

Data Element Name Index

This section contains an alphabetic listing of data elements used in this implementation guide. Consult the X12N Data Element Dictionary for a complete list of all X12N Data Elements. Data element names in normal type are generic ASC X12 names. Italic type indicates a health care industry defined name.

Legend

Industry Name
Industry name definition.
800 - Transaction Set ID and Name
H=Header, D=Detail, S=Summary | Loop ID | Reference Designator | Composite ID-Position in Composite | X12 Data Element Number
 
Account Number
Account number assigned.
834 - Benefit and Enrollment Maintenance
D | 2500 | FSA04 | C062-02 | 508
 
Account Relationship Code
Code indicating relationship or type of account an entity maintains with a vendor or financial institution.
834 - Benefit and Enrollment Maintenance
D | 2500 | FSA04 | C062-01 | 1636
 
Action Code
Code indicating type of action
834 - Benefit and Enrollment Maintenance
H | | BGN08 | - | 306
D | 2300 | IDC04 | - | 306
D | 2310 | PLA01 | - | 306
 
Address Information
Address information.
834 - Benefit and Enrollment Maintenance
D | 2330 | N301 | - | 166
D | 2330 | N302 | - | 166
 
Amount Qualifier Code
Code to qualify amount.
834 - Benefit and Enrollment Maintenance
D | 2100A | AMT01 | - | 522
D | 2300 | AMT01 | - | 522
D | 2500 | AMT01 | - | 522
 
Assigned Number
Number assigned for differentiation within a transaction set.
834 - Benefit and Enrollment Maintenance
D | 2310 | LX01 | - | 554
D | 2700 | LX01 | - | 554
 
Benefit Status Code
The type of coverage under which benefits are paid.
834 - Benefit and Enrollment Maintenance
D | 2000 | INS05 | - | 1216
 
Birth Sequence Number
A number indicating the order of birth for the identified person in relationship to family members with the same date of birth.
834 - Benefit and Enrollment Maintenance
D | 2000 | INS17 | - | 1470
 
Citizenship Status Code
Code indicating citizenship status
834 - Benefit and Enrollment Maintenance
D | 2100A | DMG06 | - | 1066
D | 2100B | DMG06 | - | 1066
 
Code List Qualifier Code
Code identifying a specific industry code list.
834 - Benefit and Enrollment Maintenance
D | 2100A | DMG05 | C056-02 | 1270
D | 2100A | DMG10 | - | 1270
D | 2100B | DMG05 | C056-02 | 1270
D | 2100B | DMG10 | - | 1270
 
Communication Number
Complete communications number including country or area code when applicable
834 - Benefit and Enrollment Maintenance
D | 2100A | PER04 | - | 364
D | 2100A | PER06 | - | 364
D | 2100A | PER08 | - | 364
D | 2100D | PER04 | - | 364
D | 2100D | PER06 | - | 364
D | 2100D | PER08 | - | 364
D | 2100E | PER04 | - | 364
D | 2100E | PER06 | - | 364
D | 2100E | PER08 | - | 364
D | 2100F | PER04 | - | 364
D | 2100F | PER06 | - | 364
D | 2100F | PER08 | - | 364
D | 2100G | PER04 | - | 364
D | 2100G | PER06 | - | 364
D | 2100G | PER08 | - | 364
D | 2310 | PER04 | - | 364
D | 2310 | PER06 | - | 364
D | 2310 | PER08 | - | 364
D | 2330 | PER04 | - | 364
 
Communication Number Qualifier
Code identifying the type of communication number.
834 - Benefit and Enrollment Maintenance
D | 2100A | PER03 | - | 365
D | 2100A | PER05 | - | 365
D | 2100A | PER07 | - | 365
D | 2100D | PER03 | - | 365
D | 2100D | PER05 | - | 365
D | 2100D | PER07 | - | 365
D | 2100E | PER03 | - | 365
D | 2100E | PER05 | - | 365
D | 2100E | PER07 | - | 365
D | 2100F | PER03 | - | 365
D | 2100F | PER05 | - | 365
D | 2100F | PER07 | - | 365
D | 2100G | PER03 | - | 365
D | 2100G | PER05 | - | 365
D | 2100G | PER07 | - | 365
D | 2310 | PER03 | - | 365
D | 2310 | PER05 | - | 365
D | 2310 | PER07 | - | 365
D | 2330 | PER03 | - | 365
 
Confidentiality Code
Code indicating the access to insured information.
834 - Benefit and Enrollment Maintenance
D | 2000 | INS13 | - | 1165
 
Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event Code
A Qualifying Event is an event under the law which results in loss of coverage for a Qualified Beneficiary.
834 - Benefit and Enrollment Maintenance
D | 2000 | INS07 | - | 1219
 
Contact Function Code
Code identifying the major duty or responsibility of the person or group named.
834 - Benefit and Enrollment Maintenance
D | 2100A | PER01 | - | 366
D | 2100D | PER01 | - | 366
D | 2100E | PER01 | - | 366
D | 2100F | PER01 | - | 366
D | 2100G | PER01 | - | 366
D | 2310 | PER01 | - | 366
D | 2330 | PER01 | - | 366
 
Contract Amount
Fixed monetary amount pertaining to the contract
834 - Benefit and Enrollment Maintenance
D | 2100A | AMT02 | - | 782
D | 2300 | AMT02 | - | 782
 
Coordination of Benefits Code
Code identifying whether there is a coordination of benefits
834 - Benefit and Enrollment Maintenance
D | 2320 | COB03 | - | 1143
 
Coordination of Benefits Date
The dates of eligibility for coordination of benefits
834 - Benefit and Enrollment Maintenance
D | 2320 | DTP03 | - | 1251
 
Coordination of Benefits Insurer Identification Code
Code identifying the insurer for coordination of benefits.
834 - Benefit and Enrollment Maintenance
D | 2330 | NM109 | - | 67
 
Coordination of Benefits Insurer Name
Name of the insurer for coordination of benefits.
834 - Benefit and Enrollment Maintenance
D | 2330 | NM103 | - | 1035
 
Coordination of Benefits Other Insurance Company City Name
Name of the city in which the Other Insurance Company exists.
834 - Benefit and Enrollment Maintenance
D | 2330 | N401 | - | 19
 
Coordination of Benefits Other Insurance Company Country Code
The country code of the Other Insurance Company.
834 - Benefit and Enrollment Maintenance
D | 2330 | N404 | - | 26
 
Coordination of Benefits Other Insurance Company Country Subdivision Code
The country subdivision code of the Other Insurance Company.
834 - Benefit and Enrollment Maintenance
D | 2330 | N407 | - | 1715
 
Coordination of Benefits Other Insurance Company Postal Zone or ZIP Code
Zip code in which the Other Insurance Company exists.
834 - Benefit and Enrollment Maintenance
D | 2330 | N403 | - | 116
 
Coordination of Benefits Other Insurance Company State Code
State in which the Other Insurance Company exists.
834 - Benefit and Enrollment Maintenance
D | 2330 | N402 | - | 156
 
Country of Birth Code
Code identifying the country of birth.
834 - Benefit and Enrollment Maintenance
D | 2100A | DMG12 | - | 26
D | 2100B | DMG12 | - | 26
 
Coverage Level Code
Code indicating the level of coverage being provided for this insured
834 - Benefit and Enrollment Maintenance
D | 2300 | HD05 | - | 1207
 
Coverage Period
The coverage period associated with this premium payment.
834 - Benefit and Enrollment Maintenance
D | 2300 | DTP03 | - | 1251
 
Custodial Parent Address Line
The first line of the address of the individual's parent who has legal custody of the individual.
834 - Benefit and Enrollment Maintenance
D | 2100F | N301 | - | 166
D | 2100F | N302 | - | 166
 
Custodial Parent City Name
The city of the individual's parent who has legal custody of the individual.
834 - Benefit and Enrollment Maintenance
D | 2100F | N401 | - | 19
 
Custodial Parent Country Code
The country code of the individual's parent who has legal custody of the individual.
834 - Benefit and Enrollment Maintenance
D | 2100F | N404 | - | 26
 
Custodial Parent Country Subdivision Code
The country subdivision code of the individual's parent who has legal custory of the individual.
834 - Benefit and Enrollment Maintenance
D | 2100F | N407 | - | 1715
 
Custodial Parent First Name
The first name of the individual's parent who has legal custody of the individual.
834 - Benefit and Enrollment Maintenance
D | 2100F | NM104 | - | 1036
 
Custodial Parent Identifier
The identification number of the individual's parent who has legal custody of the individual.
834 - Benefit and Enrollment Maintenance
D | 2100F | NM109 | - | 67
 
Custodial Parent Last Name
The last name of the individual's parent who has legal custody of the individual.
834 - Benefit and Enrollment Maintenance
D | 2100F | NM103 | - | 1035
 
Custodial Parent Middle Name
The middle name of the individual's parent who has legal custody of the individual.
834 - Benefit and Enrollment Maintenance
D | 2100F | NM105 | - | 1037
 
Custodial Parent Name Prefix
The prefix to the name of the individual's parent who has legal custody of the individual.
834 - Benefit and Enrollment Maintenance
D | 2100F | NM106 | - | 1038
 
Custodial Parent Name Suffix
The suffix to the name of the individual's parent who has legal custody of the individual.
834 - Benefit and Enrollment Maintenance
D | 2100F | NM107 | - | 1039
 
Custodial Parent Postal Zone or ZIP Code
The postal ZIP code of the individual's parent who has legal custody of the individual.
834 - Benefit and Enrollment Maintenance
D | 2100F | N403 | - | 116
 
Custodial Parent State Code
The code for the state of the individual's parent who has legal custody of the individual.
834 - Benefit and Enrollment Maintenance
D | 2100F | N402 | - | 156
 
Date Time Period
Expression of a date, a time, or a range of dates, times, or dates and times.
834 - Benefit and Enrollment Maintenance
H | | DTP03 | - | 1251
D | 2000 | DTP03 | - | 1251
D | 2300 | DTP03 | - | 1251
 
Date Time Period Format Qualifier
Code indicating the date format, time format, or date and time format.
834 - Benefit and Enrollment Maintenance
H | | DTP02 | - | 1250
D | 2000 | INS11 | - | 1250
D | 2000 | DTP02 | - | 1250
D | 2000 | DTP02 | - | 1250
D | 2100A | DMG01 | - | 1250
D | 2100B | DMG01 | - | 1250
D | 2200 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2320 | DTP02 | - | 1250
D | 2500 | DTP02 | - | 1250
D | 2750 | DTP02 | - | 1250
 
Date Time Qualifier
Code specifying the type of date or time or both date and time.
834 - Benefit and Enrollment Maintenance
H | | DTP01 | - | 374
D | 2000 | DTP01 | - | 374
D | 2000 | DTP01 | - | 374
D | 2100A | HLH01 | C061-03 | 374
D | 2200 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2320 | DTP01 | - | 374
D | 2500 | DTP01 | - | 374
D | 2750 | DTP01 | - | 374
 
Diagnosis Code
An ICD-9-CM Diagnosis Code identifying a diagnosed medical condition.
834 - Benefit and Enrollment Maintenance
D | 2200 | DSB08 | - | 1137
 
Disability Eligibility Date
Date when individual became eligible for disability benefits.
834 - Benefit and Enrollment Maintenance
D | 2200 | DTP03 | - | 1251
 
Disability Type Code
An indicator to describe type of disability.
834 - Benefit and Enrollment Maintenance
D | 2200 | DSB01 | - | 1146
 
Drop Off Location Address Line
The address line of the drop off location.
834 - Benefit and Enrollment Maintenance
D | 2100H | N301 | - | 166
D | 2100H | N302 | - | 166
 
Drop Off Location City Name
The city name of the drop off location address.
834 - Benefit and Enrollment Maintenance
D | 2100H | N401 | - | 19
 
Drop Off Location Country Code
The country code of the drop off location address.
834 - Benefit and Enrollment Maintenance
D | 2100H | N404 | - | 26
 
Drop Off Location Country Subdivision Code
The country subdivision code of the drop off location address.
834 - Benefit and Enrollment Maintenance
D | 2100H | N407 | - | 1715
 
Drop Off Location Postal Zone or ZIP Code
The postal ZIP code of the drop off location address.
834 - Benefit and Enrollment Maintenance
D | 2100H | N403 | - | 116
 
Drop Off Location State Code
The state code of the drop off location address.
834 - Benefit and Enrollment Maintenance
D | 2100H | N402 | - | 156
 
Employment Class Code
Code indicating category of employee.
834 - Benefit and Enrollment Maintenance
D | 2100A | EC01 | - | 1176
D | 2100A | EC02 | - | 1176
D | 2100A | EC03 | - | 1176
 
Employment Status Code
A code used to define the employment status of the individual covered by this insurance payer.
834 - Benefit and Enrollment Maintenance
D | 2000 | INS08 | - | 584
 
Entity Identifier Code
Code identifying an organizational entity, a physical location, property or an individual.
834 - Benefit and Enrollment Maintenance
H | 1000A | N101 | - | 98
H | 1000B | N101 | - | 98
H | 1000C | N101 | - | 98
D | 2100A | NM101 | - | 98
D | 2100B | NM101 | - | 98
D | 2100C | NM101 | - | 98
D | 2100D | NM101 | - | 98
D | 2100E | NM101 | - | 98
D | 2100F | NM101 | - | 98
D | 2100G | NM101 | - | 98
D | 2100H | NM101 | - | 98
D | 2310 | NM101 | - | 98
D | 2310 | PLA02 | - | 98
D | 2330 | NM101 | - | 98
D | 2750 | N101 | - | 98
 
Entity Relationship Code
Code describing the relationship of one identified person to another.
834 - Benefit and Enrollment Maintenance
D | 2310 | NM110 | - | 706
 
Entity Type Qualifier
Code qualifying the type of entity.
834 - Benefit and Enrollment Maintenance
D | 2100A | NM102 | - | 1065
D | 2100B | NM102 | - | 1065
D | 2100C | NM102 | - | 1065
D | 2100D | NM102 | - | 1065
D | 2100E | NM102 | - | 1065
D | 2100F | NM102 | - | 1065
D | 2100G | NM102 | - | 1065
D | 2100H | NM102 | - | 1065
D | 2310 | NM102 | - | 1065
D | 2330 | NM102 | - | 1065
 
Flexible Spending Account Selection Code
Code indicating selection of a type of Flexible Spending Account.
834 - Benefit and Enrollment Maintenance
D | 2500 | FSA02 | - | 1202
 
Frequency Code
Code indicating frequency or type of payment.
834 - Benefit and Enrollment Maintenance
D | 2100A | ICM01 | - | 594
D | 2500 | FSA05 | - | 594
 
Gender Code
A code indicating the gender of the patient or insured.
834 - Benefit and Enrollment Maintenance
D | 2100A | DMG03 | - | 1068
 
Handicap Indicator
Code indicating if individual is handicapped or not.
834 - Benefit and Enrollment Maintenance
D | 2000 | INS10 | - | 1073
 
Health Related Code
Code indicating a specific health situation.
834 - Benefit and Enrollment Maintenance
D | 2100A | HLH01 | C061-01 | 1212
 
Health Related Code Status Date
Code indicating the status effective date of a specific health situation.
834 - Benefit and Enrollment Maintenance
D | 2100A | HLH01 | C061-04 | 373
 
Identification Card Count
The number of cards being requested.
834 - Benefit and Enrollment Maintenance
D | 2300 | IDC03 | - | 380
 
Identification Card Type Code
Code identifying the type of identification card
834 - Benefit and Enrollment Maintenance
D | 2300 | IDC02 | - | 1215
 
Identification Code Qualifier
Code designating the system/method of code structure used for Identification Code (67).
834 - Benefit and Enrollment Maintenance
H | 1000A | N103 | - | 66
H | 1000B | N103 | - | 66
H | 1000C | N103 | - | 66
D | 2100A | NM108 | - | 66
D | 2100A | LUI01 | - | 66
D | 2100B | NM108 | - | 66
D | 2100D | NM108 | - | 66
D | 2100F | NM108 | - | 66
D | 2100G | NM108 | - | 66
D | 2310 | NM108 | - | 66
D | 2330 | NM108 | - | 66
 
Implementation Convention Reference
Reference assigned to identify Implementation Convention.
834 - Benefit and Enrollment Maintenance
H | | ST03 | - | 1705
 
Individual Relationship Code
Code indicating the relationship between two individuals or entities.
834 - Benefit and Enrollment Maintenance
D | 2000 | INS02 | - | 1069
 
Insurance Line Code
Code identifying a group of insurance products
834 - Benefit and Enrollment Maintenance
D | 2300 | HD03 | - | 1205
 
Insurer Identification Code
Code identifying the insurer providing coverage.
834 - Benefit and Enrollment Maintenance
H | 1000B | N104 | - | 67
 
Insurer Name
Name of the insurer providing coverage.
834 - Benefit and Enrollment Maintenance
H | 1000B | N102 | - | 93
 
Language Code
Code indicating the language spoken by an individual.
834 - Benefit and Enrollment Maintenance
D | 2100A | LUI02 | - | 67
 
Language Description
Narrative text indicating the language spoken by an individual.
834 - Benefit and Enrollment Maintenance
D | 2100A | LUI03 | - | 352
 
Language Use Indicator
Code indicating the way a language is used by an individual, such as speaking or reading.
834 - Benefit and Enrollment Maintenance
D | 2100A | LUI04 | - | 1303
 
Late Enrollment Indicator
Code identifying if the insured is a late enrollee.
834 - Benefit and Enrollment Maintenance
D | 2300 | HD09 | - | 1073
 
Location Identification Code
Code which identifies a specific location.
834 - Benefit and Enrollment Maintenance
D | 2100A | ICM04 | - | 310
 
Location Identifier
Code which identifies a specific location.
834 - Benefit and Enrollment Maintenance
D | 2100A | N406 | - | 310
 
Location Qualifier
Code identifying type of location.
834 - Benefit and Enrollment Maintenance
D | 2100A | N405 | - | 309
 
Loop Identifier Code
The loop ID number given on the transaction set diagram is the value for this data element in segments LS and LE.
834 - Benefit and Enrollment Maintenance
D | 2000 | LS01 | - | 447
D | 2000 | LE01 | - | 447
 
Maintenance Reason Code
Code identifying reason for the maintenance change
834 - Benefit and Enrollment Maintenance
D | 2000 | INS04 | - | 1203
D | 2300 | HD02 | - | 1203
D | 2310 | PLA05 | - | 1203
D | 2500 | FSA03 | - | 1203
 
Maintenance Type Code
Code identifying a specific type of item maintenance
834 - Benefit and Enrollment Maintenance
D | 2000 | INS03 | - | 875
D | 2300 | HD01 | - | 875
D | 2500 | FSA01 | - | 875
 
Marital Status Code
Code defining the marital status of a person.
834 - Benefit and Enrollment Maintenance
D | 2100A | DMG04 | - | 1067
D | 2100B | DMG04 | - | 1067
 
Master Policy Number
The identification of the master policy providing coverage for the entities identified in the transaction.
834 - Benefit and Enrollment Maintenance
H | | REF02 | - | 127
 
Medicare Eligibility Reason Code
Code specifying reason for Medicare eligibility.
834 - Benefit and Enrollment Maintenance
D | 2000 | INS06 | C052-02 | 1701
 
Medicare Plan Code
Code identifying the Medicare Plan.
834 - Benefit and Enrollment Maintenance
D | 2000 | INS06 | C052-01 | 1218
 
Member Address Line
Address line of the current mailing address of the insured member.
834 - Benefit and Enrollment Maintenance
D | 2100A | N301 | - | 166
D | 2100A | N302 | - | 166
D | 2100C | N301 | - | 166
D | 2100C | N302 | - | 166
 
Member Birth Date
The date of birth of the member to the indicated coverage or policy.
834 - Benefit and Enrollment Maintenance
D | 2100A | DMG02 | - | 1251
 
Member City Name
City name of the member's mailing address.
834 - Benefit and Enrollment Maintenance
D | 2100A | N401 | - | 19
 
Member Country Code
The country code of the member.
834 - Benefit and Enrollment Maintenance
D | 2100A | N404 | - | 26
 
Member Country Subdivision Code
The country subdivision code of the member.
834 - Benefit and Enrollment Maintenance
D | 2100A | N407 | - | 1715
 
Member Employer Address Line
First line of the current mailing address of the member's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | N301 | - | 166
D | 2100D | N302 | - | 166
 
Member Employer City Name
The city name of the member's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | N401 | - | 19
 
Member Employer Communications Contact Name
The name of the member's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | PER02 | - | 93
 
Member Employer Country Code
The country code of the member's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | N404 | - | 26
 
Member Employer Country Subdivision Code
The country subdivision code of the member's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | N407 | - | 1715
 
Member Employer First Name
First name of the member's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | NM104 | - | 1036
 
Member Employer Identifier
Identification number or reference for the member's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | NM109 | - | 67
 
Member Employer Middle Name
Middle name of the member's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | NM105 | - | 1037
 
Member Employer Name
The name of the member's individual's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | NM103 | - | 1035
 
Member Employer Name Prefix
Prefix to the name of the member's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | NM106 | - | 1038
 
Member Employer Name Suffix
Name suffix, including generation, of the member's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | NM107 | - | 1039
 
Member Employer Postal Zone or ZIP Code
The zip code of the member's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | N403 | - | 116
 
Member Employer State Code
The state postal code of the member's employer.
834 - Benefit and Enrollment Maintenance
D | 2100D | N402 | - | 156
 
Member First Name
The first name of the insured individual to the coverage.
834 - Benefit and Enrollment Maintenance
D | 2100A | NM104 | - | 1036
 
Member Group or Policy Number
The identification number, control number, or code assigned by the carrier or administrator to identify the group under which the individual is covered.
834 - Benefit and Enrollment Maintenance
D | 2000 | REF02 | - | 127
D | 2300 | REF02 | - | 127
D | 2320 | COB02 | - | 127
D | 2320 | REF02 | - | 127
 
Member Height
Height of member.
834 - Benefit and Enrollment Maintenance
D | 2100A | HLH02 | - | 65
 
Member Identifier
Member's unique identification number assigned by a payer.
834 - Benefit and Enrollment Maintenance
D | 2100A | NM109 | - | 67
 
Member Indicator
Indicates whether the member is the subscriber or a dependent.
834 - Benefit and Enrollment Maintenance
D | 2000 | INS01 | - | 1073
 
Member Individual Death Date
Date of death for subscriber or dependent.
834 - Benefit and Enrollment Maintenance
D | 2000 | INS12 | - | 1251
 
Member Last Name
The last name of the insured individual to the coverage.
834 - Benefit and Enrollment Maintenance
D | 2100A | NM103 | - | 1035
 
Member Mail City Name
Name of the city of the members mailing address.
834 - Benefit and Enrollment Maintenance
D | 2100C | N401 | - | 19
 
Member Mail Country Code
The country code of the member's mailing address.
834 - Benefit and Enrollment Maintenance
D | 2100C | N404 | - | 26
 
Member Mail Country Subdivision Code
The country subdivision code of the member's mailing address.
834 - Benefit and Enrollment Maintenance
D | 2100C | N407 | - | 1715
 
Member Mail Postal Zone or ZIP Code
Zip code of the members mailing address.
834 - Benefit and Enrollment Maintenance
D | 2100C | N403 | - | 116
 
Member Mail State Code
State of the members mailing address.
834 - Benefit and Enrollment Maintenance
D | 2100C | N402 | - | 156
 
Member Middle Name
The middle name of the insured individual to the coverage.
834 - Benefit and Enrollment Maintenance
D | 2100A | NM105 | - | 1037
 
Member Name Prefix
The name prefix of the insured individual to the coverage.
834 - Benefit and Enrollment Maintenance
D | 2100A | NM106 | - | 1038
 
Member Name Suffix
The name suffix of the insured individual to the coverage.
834 - Benefit and Enrollment Maintenance
D | 2100A | NM107 | - | 1039
 
Member Postal Zone or Zip Code
The postal zip code of the member's mailing address.
834 - Benefit and Enrollment Maintenance
D | 2100A | N403 | - | 116
 
Member Reporting Category Effective Date(s)
The date the reporting category is effective or terminated.
834 - Benefit and Enrollment Maintenance
D | 2750 | DTP03 | - | 1251
 
Member Reporting Category Name
The name of the reporting category.
834 - Benefit and Enrollment Maintenance
D | 2750 | N102 | - | 93
 
Member Reporting Category Reference ID
Identifier associated with the reporting category.
834 - Benefit and Enrollment Maintenance
D | 2750 | REF02 | - | 127
 
Member School City Name
Name of the city of the members school address.
834 - Benefit and Enrollment Maintenance
D | 2100E | N401 | - | 19
 
Member School Communications Contact Name
Name of school attended by referenced member.
834 - Benefit and Enrollment Maintenance
D | 2100E | PER02 | - | 93
 
Member School Country Code
The country code of the member's school address.
834 - Benefit and Enrollment Maintenance
D | 2100E | N404 | - | 26
 
Member School Country Subdivision Code
The country subdivision code of the member's school address.
834 - Benefit and Enrollment Maintenance
D | 2100E | N407 | - | 1715
 
Member School Postal Zone or ZIP Code
Zip code of the members school address.
834 - Benefit and Enrollment Maintenance
D | 2100E | N403 | - | 116
 
Member School State Code
State of the members school address.
834 - Benefit and Enrollment Maintenance
D | 2100E | N402 | - | 156
 
Member State Code
Member State Code.
834 - Benefit and Enrollment Maintenance
D | 2100A | N402 | - | 156
 
Member Supplemental Identifier
Identifies another or additional distinguishing code number associated with the member.
834 - Benefit and Enrollment Maintenance
D | 2000 | REF02 | - | 127
 
Member Weight
Weight of member.
834 - Benefit and Enrollment Maintenance
D | 2100A | HLH03 | - | 81
 
Monetary Amount
Monetary amount.
834 - Benefit and Enrollment Maintenance
D | 2500 | AMT02 | - | 782
 
Original Transaction Set Reference Number
Number that identified the original transaction set.
834 - Benefit and Enrollment Maintenance
H | | BGN06 | - | 127
 
Payer Responsibility Sequence Code
Code indicating the order in which benefits for this payer will be adjudicated when multiple payers are involved.
834 - Benefit and Enrollment Maintenance
D | 2320 | COB01 | - | 1138
 
Plan Coverage Description
A description or number that identifies the plan or coverage
834 - Benefit and Enrollment Maintenance
D | 2300 | HD04 | - | 1204
D | 2300 | IDC01 | - | 1204
D | 2500 | FSA06 | - | 1204
 
Plan Sponsor Name
The name of the entity providing coverage to the subscriber.
834 - Benefit and Enrollment Maintenance
H | 1000A | N102 | - | 93
 
Prior Coverage Month Count
Number of months of prior health insurance coverage.
834 - Benefit and Enrollment Maintenance
D | 2300 | REF02 | - | 127
 
Prior Incorrect Insured Birth Date
The birth date previously reported or used for an individual when corrected data is reported.
834 - Benefit and Enrollment Maintenance
D | 2100B | DMG02 | - | 1251
 
Prior Incorrect Insured Gender Code
The gender previously reported or used for an individual when corrected data is reported.
834 - Benefit and Enrollment Maintenance
D | 2100B | DMG03 | - | 1068
 
Prior Incorrect Member First Name
The first name previously reported or used for an individual when a corrected name is reported.
834 - Benefit and Enrollment Maintenance
D | 2100B | NM104 | - | 1036
 
Prior Incorrect Member Identifier
The identification number previously reported or used for an individual when a corrected name is reported.
834 - Benefit and Enrollment Maintenance
D | 2100B | NM109 | - | 67
 
Prior Incorrect Member Last Name
The last name previously reported or used for an individual when a corrected name is reported.
834 - Benefit and Enrollment Maintenance
D | 2100B | NM103 | - | 1035
 
Prior Incorrect Member Middle Name
The middle name previously reported or used for an individual when a corrected name is reported.
834 - Benefit and Enrollment Maintenance
D | 2100B | NM105 | - | 1037
 
Prior Incorrect Member Name Prefix
The prefix to the name previously reported or used for an individual when a corrected name is reported.
834 - Benefit and Enrollment Maintenance
D | 2100B | NM106 | - | 1038
 
Prior Incorrect Member Name Suffix
The suffix to the name previously reported or used for an individual when a corrected name is reported.
834 - Benefit and Enrollment Maintenance
D | 2100B | NM107 | - | 1039
 
Product Option Code
Code indicating an option chosen for the product.
834 - Benefit and Enrollment Maintenance
D | 2500 | FSA07 | - | 1161
 
Product or Service ID Qualifier
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
834 - Benefit and Enrollment Maintenance
D | 2200 | DSB07 | - | 235
 
Provider Address Line
The street address of the provider.
834 - Benefit and Enrollment Maintenance
D | 2310 | N301 | - | 166
D | 2310 | N302 | - | 166
 
Provider City Name
The city name of the provider.
834 - Benefit and Enrollment Maintenance
D | 2310 | N401 | - | 19
 
Provider Country Code
Code identifying the country of the provider.
834 - Benefit and Enrollment Maintenance
D | 2310 | N404 | - | 26
 
Provider Country Subdivision Code
The country subdivision code of the provider.
834 - Benefit and Enrollment Maintenance
D | 2310 | N407 | - | 1715
 
Provider Effective Date
The date the change of the primary care provider is effective.
834 - Benefit and Enrollment Maintenance
D | 2310 | PLA03 | - | 373
 
Provider First Name
The first name of the provider of care submitting a transaction or related to the information provided in or request by the transaction.
834 - Benefit and Enrollment Maintenance
D | 2310 | NM104 | - | 1036
 
Provider Identifier
Number assigned by the payer, regulatory authority, or other authorized body or agency to identify the provider.
834 - Benefit and Enrollment Maintenance
D | 2310 | NM109 | - | 67
 
Provider Last or Organization Name
The last name of the provider of care or name of the provider organization submitting a transaction or related to the information provided in or request by the transaction.
834 - Benefit and Enrollment Maintenance
D | 2310 | NM103 | - | 1035
 
Provider Middle Name
The middle name of the provider of care submitting a transaction or related to the information provided in or request by the transaction.
834 - Benefit and Enrollment Maintenance
D | 2310 | NM105 | - | 1037
 
Provider Name Prefix
The name prefix of the provider of care submitting a transaction or related to the information provided in or request by the transaction.
834 - Benefit and Enrollment Maintenance
D | 2310 | NM106 | - | 1038
 
Provider Name Suffix
The name suffix of the provider of care submitting a transaction or related to the information provided in or request by the transaction.
834 - Benefit and Enrollment Maintenance
D | 2310 | NM107 | - | 1039
 
Provider Postal Zone or ZIP Code
The zip code of the provider.
834 - Benefit and Enrollment Maintenance
D | 2310 | N403 | - | 116
 
Provider State Code
The State Postal Code of the provider
834 - Benefit and Enrollment Maintenance
D | 2310 | N402 | - | 156
 
Quantity Qualifier
Code specifying the type of quantity.
834 - Benefit and Enrollment Maintenance
H | | QTY01 | - | 673
 
Race or Ethnicity Code
Code indicating the racial or ethnic background of a person.
834 - Benefit and Enrollment Maintenance
D | 2100A | DMG05 | C056-03 | 1271
D | 2100B | DMG05 | C056-03 | 1271
 
Race or Ethnicity Collection Code
Code identifying how the Race or Ethnicity information was collected.
834 - Benefit and Enrollment Maintenance
D | 2100A | DMG11 | - | 1271
D | 2100B | DMG11 | - | 1271
 
Record Totals
Total number of records in this transaction.
834 - Benefit and Enrollment Maintenance
H | | QTY02 | - | 380
 
Reference Identification Qualifier
Code qualifying the reference identification.
834 - Benefit and Enrollment Maintenance
H | | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2320 | REF01 | - | 128
D | 2500 | REF01 | - | 128
D | 2750 | REF01 | - | 128
 
Responsible Party Address Line
Address line of the person or entity responsible for payment of balance of bill after applicable processing by other parties, insurers, or organizations.
834 - Benefit and Enrollment Maintenance
D | 2100G | N301 | - | 166
D | 2100G | N302 | - | 166
 
Responsible Party First Name
First name of the person or entity responsible for payment of balance of bill after applicable processing by other parties, insurers, or organizations.
834 - Benefit and Enrollment Maintenance
D | 2100G | NM104 | - | 1036
 
Responsible Party Identifier
The identification number of the individual responsible for payment of balance of bill after applicable processing by other parties, insurers, or organizations.
834 - Benefit and Enrollment Maintenance
D | 2100G | NM109 | - | 67
 
Responsible Party Last or Organization Name
Last name or organization name of the person or entity responsible for payment of balance of bill after applicable processing by other parties, insurers, or organizations.
834 - Benefit and Enrollment Maintenance
D | 2100G | NM103 | - | 1035
 
Responsible Party Middle Name
Middle name of the person or entity responsible for payment of balance of bill after applicable processing by other parties, insurers, or organizations.
834 - Benefit and Enrollment Maintenance
D | 2100G | NM105 | - | 1037
 
Responsible Party Name Prefix
The prefix to the name of the individual responsible for payment of balance of bill after applicable processing by other parties, insurers, or organizations.
834 - Benefit and Enrollment Maintenance
D | 2100G | NM106 | - | 1038
 
Responsible Party Suffix Name
Suffix for name of the person or entity responsible for payment of balance of bill after applicable processing by other parties, insurers, or organizations.
834 - Benefit and Enrollment Maintenance
D | 2100G | NM107 | - | 1039
 
Responsible Person City Name
Name of the city of the Responsible Person.
834 - Benefit and Enrollment Maintenance
D | 2100G | N401 | - | 19
 
Responsible Person Country Code
The country code of the responsible person.
834 - Benefit and Enrollment Maintenance
D | 2100G | N404 | - | 26
 
Responsible Person Country Subdivision Code
The country subdivision code of the responsible person.
834 - Benefit and Enrollment Maintenance
D | 2100G | N407 | - | 1715
 
Responsible Person Postal Zone or ZIP Code
Zip code of the Responsible Person.
834 - Benefit and Enrollment Maintenance
D | 2100G | N403 | - | 116
 
Responsible Person State Code
State of the Responsible Person.
834 - Benefit and Enrollment Maintenance
D | 2100G | N402 | - | 156
 
Salary Grade Code
A code that identifies the salary or wage level of an employee.
834 - Benefit and Enrollment Maintenance
D | 2100A | ICM05 | - | 1214
 
School Address Line
Address line of address for school of referenced individual
834 - Benefit and Enrollment Maintenance
D | 2100E | N301 | - | 166
D | 2100E | N302 | - | 166
 
School Name
Name of school attended by referenced person.
834 - Benefit and Enrollment Maintenance
D | 2100E | NM103 | - | 1035
 
Service Type Code
Code identifying the classification of service.
834 - Benefit and Enrollment Maintenance
D | 2320 | COB04 | - | 1365
 
Sponsor Identifier
Identification of the party paying for the coverage.
834 - Benefit and Enrollment Maintenance
H | 1000A | N104 | - | 67
 
Status Information Effective Date
The date that the status information provided is effective.
834 - Benefit and Enrollment Maintenance
D | 2000 | DTP03 | - | 1251
 
Student Status Code
Code indicating the student status of the patient if 19 years of age or older, not handicapped and not the insured
834 - Benefit and Enrollment Maintenance
D | 2000 | INS09 | - | 1220
 
Subscriber Identifier
Insured's or subscriber's unique identification number assigned by a payer.
834 - Benefit and Enrollment Maintenance
D | 2000 | REF02 | - | 127
 
TPA or Broker Account Number
Account number assigned to the Third Party Administrator or broker
834 - Benefit and Enrollment Maintenance
H | 1100C | ACT01 | - | 508
H | 1100C | ACT06 | - | 508
 
TPA or Broker Identification Code
Code identifying the Third Party Administrator or broker
834 - Benefit and Enrollment Maintenance
H | 1000C | N104 | - | 67
 
TPA or Broker Name
Name of the Third Party Administrator or Broker.
834 - Benefit and Enrollment Maintenance
H | 1000C | N102 | - | 93
 
Tax Advantage Account Date
Dates of coverage for the Tax Advantage Account.
834 - Benefit and Enrollment Maintenance
D | 2500 | DTP03 | - | 1251
 
Tax Advantage Account Health Insurance Policy Number
The policy number identifying the participant's health insurance tax advantage account.
834 - Benefit and Enrollment Maintenance
D | 2500 | REF02 | - | 127
 
Time Zone Code
Code identifying the time zone used in specifying a time.
834 - Benefit and Enrollment Maintenance
H | | BGN05 | - | 623
 
Transaction Segment Count
A tally of all segments between the ST and the SE segments including the ST and SE segments.
834 - Benefit and Enrollment Maintenance
D | | SE01 | - | 96
 
Transaction Set Control Number
The unique identification number within a transaction set.
834 - Benefit and Enrollment Maintenance
H | | ST02 | - | 329
D | | SE02 | - | 329
 
Transaction Set Creation Date
Identifies the date the submitter created the transaction.
834 - Benefit and Enrollment Maintenance
H | | BGN03 | - | 373
 
Transaction Set Creation Time
Time file is created for transmission.
834 - Benefit and Enrollment Maintenance
H | | BGN04 | - | 337
 
Transaction Set Identifier Code
Code uniquely identifying a Transaction Set.
834 - Benefit and Enrollment Maintenance
H | | ST01 | - | 143
 
Transaction Set Purpose Code
Code identifying purpose of transaction set.
834 - Benefit and Enrollment Maintenance
H | | BGN01 | - | 353
 
Transaction Set Reference Number
Number uniquely identifying a transaction set.
834 - Benefit and Enrollment Maintenance
H | | BGN02 | - | 127
 
Wage Amount
Amount of wages or income for the specified period.
834 - Benefit and Enrollment Maintenance
D | 2100A | ICM02 | - | 782
 
Work Hours Count
Number of hours of employment for a specified period.
834 - Benefit and Enrollment Maintenance
D | 2100A | ICM03 | - | 380
 
Yes No Condition or Response Code
Code indicating a Yes or No condition or response.
834 - Benefit and Enrollment Maintenance
D | 2100A | HLH01 | C061-02 | 1073