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
 
APTC Contributor/Tax Payer Address Line
Address line of the APTC Contributor/Tax Payer.
834 - Health Insurance Exchange Enrollment
D | 2100I | N301 | - | 166
D | 2100I | N302 | - | 166
 
APTC Contributor/Tax Payer City Name
City name of the APTC Contributor/Tax Payer.
834 - Health Insurance Exchange Enrollment
D | 2100I | N401 | - | 19
 
APTC Contributor/Tax Payer First Name
First name of the APTC Contributor/Tax Payer.
834 - Health Insurance Exchange Enrollment
D | 2100I | NM104 | - | 1036
 
APTC Contributor/Tax Payer Identifier
Identification number of the APTC Contributor/Tax Payer.
834 - Health Insurance Exchange Enrollment
D | 2100I | NM109 | - | 67
 
APTC Contributor/Tax Payer Last Name
Last name of the APTC Contributor/Tax Payer.
834 - Health Insurance Exchange Enrollment
D | 2100I | NM103 | - | 1035
 
APTC Contributor/Tax Payer Middle Name
Middle name of the APTC Contributor/Tax Payer.
834 - Health Insurance Exchange Enrollment
D | 2100I | NM105 | - | 1037
 
APTC Contributor/Tax Payer Name Prefix
Prefix for the name of the APTC Contributor/Tax Payer.
834 - Health Insurance Exchange Enrollment
D | 2100I | NM106 | - | 1038
 
APTC Contributor/Tax Payer Name Suffix
Suffix for the name of the APTC Contributor/Tax Payer.
834 - Health Insurance Exchange Enrollment
D | 2100I | NM107 | - | 1039
 
APTC Contributor/Tax Payer Postal Zone or ZIP Code
Address line of the APTC Contributor/Tax Payer.
834 - Health Insurance Exchange Enrollment
D | 2100I | N403 | - | 116
 
APTC Contributor/Tax Payer State or Province Code
State of the APTC Contributor/Tax Payer.
834 - Health Insurance Exchange Enrollment
D | 2100I | N402 | - | 156
 
Account Holder Name
Name of bank account owner.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF03 | - | 352
 
Account Number
Account number assigned.
834 - Health Insurance Exchange Enrollment
H | 1100EA | ACT01 | - | 508
H | 1100EB | ACT01 | - | 508
 
Action Code
Code indicating type of action
834 - Health Insurance Exchange Enrollment
H | | BGN08 | - | 306
D | 2310 | PLA01 | - | 306
 
Agent/Broker Identification Code
Identification number of the Agent/Broker.
834 - Health Insurance Exchange Enrollment
D | 2750A | N104 | - | 67
 
Agent/Broker License Number
License number assigned to the Agent/Broker as issued by a state licensing entity.
834 - Health Insurance Exchange Enrollment
D | 2750A | REF02 | - | 127
 
Agent/Broker Name
Name of the Agent/Broker.
834 - Health Insurance Exchange Enrollment
D | 2750A | N102 | - | 93
 
Agent/Broker Relationship Date(s)
Date the relationship with the Agent/Broker is effective or terminated.
834 - Health Insurance Exchange Enrollment
D | 2750A | DTP03 | - | 1251
 
Alternate Billing Address Line
Address line of the alternate billing address.
834 - Health Insurance Exchange Enrollment
H | 1100EA | N301 | - | 166
H | 1100EA | N302 | - | 166
 
Alternate Billing City Name
City Name of the alternate billing address.
834 - Health Insurance Exchange Enrollment
H | 1100EA | N401 | - | 19
 
Alternate Billing Postal Zone or ZIP Code
Zip Code of the alternate billing address.
834 - Health Insurance Exchange Enrollment
H | 1100EA | N403 | - | 116
 
Alternate Billing State or Province Code
State of the alternate billing address.
834 - Health Insurance Exchange Enrollment
H | 1100EA | N402 | - | 156
 
Amount Qualifier Code
Code to qualify amount.
834 - Health Insurance Exchange Enrollment
H | 1100EA | AMT01 | - | 522
 
Assigned Number
Number assigned for differentiation within a transaction set.
834 - Health Insurance Exchange Enrollment
D | 2310 | LX01 | - | 554
D | 2700A | LX01 | - | 554
D | 2700B | LX01 | - | 554
D | 2700C | LX01 | - | 554
 
Bank Account Number
The Enrollee's bank account number at the Receiving Depository Financial Institution.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF04 | C040-02 | 127
 
Benefit Status Code
The type of coverage under which benefits are paid.
834 - Health Insurance Exchange Enrollment
D | 2000 | INS05 | - | 1216
 
Billing Address Line
Address line of the Sponsor/Employer Group.
834 - Health Insurance Exchange Enrollment
H | 1000E | N301 | - | 166
H | 1000E | N302 | - | 166
 
Billing City Name
City Name of the Sponsor/Employer Group.
834 - Health Insurance Exchange Enrollment
H | 1000E | N401 | - | 19
 
Billing Postal Zone or ZIP Code
Zip Code of the Sponsor/Employer Group.
834 - Health Insurance Exchange Enrollment
H | 1000E | N403 | - | 116
 
Billing State or Province Code
State of the Sponsor/Employer Group.
834 - Health Insurance Exchange Enrollment
H | 1000E | N402 | - | 156
 
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 - Health Insurance Exchange Enrollment
D | 2000 | INS17 | - | 1470
 
Card Holder Name
Name of credit/debit card owner.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF03 | - | 352
 
Card Security Code
Security identifier on the credit/debit card.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF04 | C040-02 | 127
 
Citizenship Status Code
Code indicating citizenship status
834 - Health Insurance Exchange Enrollment
D | 2100A | DMG06 | - | 1066
D | 2100B | DMG06 | - | 1066
 
Code List Qualifier Code
Code identifying a specific industry code list.
834 - Health Insurance Exchange Enrollment
D | 2100A | DMG05 | C056-02 | 1270
D | 2100A | DMG10 | - | 1270
D | 2100A | HI01 | C022-01 | 1270
D | 2100A | HI02 | C022-01 | 1270
D | 2100A | HI03 | C022-01 | 1270
D | 2100A | HI04 | C022-01 | 1270
D | 2100A | HI05 | C022-01 | 1270
D | 2100A | HI06 | C022-01 | 1270
D | 2100A | HI07 | C022-01 | 1270
D | 2100A | HI08 | C022-01 | 1270
D | 2100A | HI09 | C022-01 | 1270
D | 2100A | HI10 | C022-01 | 1270
D | 2100A | HI11 | C022-01 | 1270
D | 2100A | HI12 | C022-01 | 1270
D | 2100B | DMG05 | C056-02 | 1270
D | 2100B | DMG10 | - | 1270
 
Communication Number
Complete communications number including country or area code when applicable
834 - Health Insurance Exchange Enrollment
H | 1000E | PER04 | - | 364
H | 1000E | PER06 | - | 364
H | 1000E | PER08 | - | 364
H | 1000E | PER04 | - | 364
H | 1000E | PER06 | - | 364
H | 1000E | PER08 | - | 364
H | 1100EA | PER04 | - | 364
H | 1100EA | PER06 | - | 364
H | 1100EA | PER08 | - | 364
H | 1100EB | PER04 | - | 364
H | 1100EB | PER06 | - | 364
H | 1100EB | PER08 | - | 364
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 | 2100I | PER04 | - | 364
D | 2100I | PER06 | - | 364
D | 2100I | 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 - Health Insurance Exchange Enrollment
H | 1000E | PER03 | - | 365
H | 1000E | PER05 | - | 365
H | 1000E | PER07 | - | 365
H | 1000E | PER03 | - | 365
H | 1000E | PER05 | - | 365
H | 1000E | PER07 | - | 365
H | 1100EA | PER03 | - | 365
H | 1100EA | PER05 | - | 365
H | 1100EA | PER07 | - | 365
H | 1100EB | PER03 | - | 365
H | 1100EB | PER05 | - | 365
H | 1100EB | PER07 | - | 365
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 | 2100I | PER03 | - | 365
D | 2100I | PER05 | - | 365
D | 2100I | 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 - Health Insurance Exchange Enrollment
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 - Health Insurance Exchange Enrollment
D | 2000 | INS07 | - | 1219
 
Contact Function Code
Code identifying the major duty or responsibility of the person or group named.
834 - Health Insurance Exchange Enrollment
H | 1000E | PER01 | - | 366
H | 1000E | PER01 | - | 366
H | 1100EA | PER01 | - | 366
H | 1100EB | PER01 | - | 366
D | 2100A | PER01 | - | 366
D | 2100D | PER01 | - | 366
D | 2100E | PER01 | - | 366
D | 2100F | PER01 | - | 366
D | 2100I | PER01 | - | 366
D | 2310 | PER01 | - | 366
D | 2330 | PER01 | - | 366
 
Coordination of Benefits Begin Date
The beginning date of the coverage provided by the other insurance company.
834 - Health Insurance Exchange Enrollment
D | 2320 | DTP03 | - | 1251
 
Coordination of Benefits Code
Code identifying whether there is a coordination of benefits
834 - Health Insurance Exchange Enrollment
D | 2320 | COB03 | - | 1143
 
Coordination of Benefits End Date
The ending date of the coverage provided by the other insurance company.
834 - Health Insurance Exchange Enrollment
D | 2320 | DTP03 | - | 1251
 
Coordination of Benefits Insurer Identification Code
Code identifying the insurer for coordination of benefits.
834 - Health Insurance Exchange Enrollment
D | 2330 | NM109 | - | 67
 
Coordination of Benefits Insurer Name
Name of the insurer for coordination of benefits.
834 - Health Insurance Exchange Enrollment
D | 2330 | NM103 | - | 1035
 
Country Code
Code indicating the geographic location.
834 - Health Insurance Exchange Enrollment
H | 1000E | N404 | - | 26
H | 1100EA | N404 | - | 26
H | 1100EB | N404 | - | 26
D | 2100A | N404 | - | 26
D | 2100C | N404 | - | 26
D | 2100D | N404 | - | 26
D | 2100E | N404 | - | 26
D | 2100F | N404 | - | 26
D | 2100G | N404 | - | 26
D | 2100I | N404 | - | 26
D | 2310 | N404 | - | 26
 
Country Subdivision Code
Code identifying the country subdivision.
834 - Health Insurance Exchange Enrollment
H | 1000E | N407 | - | 1715
H | 1100EA | N407 | - | 1715
H | 1100EB | N407 | - | 1715
D | 2100A | N407 | - | 1715
D | 2100C | N407 | - | 1715
D | 2100D | N407 | - | 1715
D | 2100E | N407 | - | 1715
D | 2100F | N407 | - | 1715
D | 2100G | N407 | - | 1715
D | 2100I | N407 | - | 1715
D | 2310 | N407 | - | 1715
 
Coverage Level Code
Code indicating the level of coverage being provided for this insured
834 - Health Insurance Exchange Enrollment
D | 2300 | HD05 | - | 1207
 
Coverage Period
The coverage period associated with this premium payment.
834 - Health Insurance Exchange Enrollment
D | 2300 | DTP03 | - | 1251
 
Coverage Specific Exchange Assigned Employer Group Identifier
Identification number assigned to an Employer Group by an Exchange.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Coverage Specific Exchange Assigned Qualified Health Plan Identifier
Identification number assigned to Qualified Health Plan by an Exchange.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Coverage Specific Issuer Assigned Employer Group Identifier
Identification number assigned to an Employer Group by an Issuer.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Coverage Specific Issuer Assigned Qualified Health Plan Identifier
Identification number assigned to Qualified Health Plan by an Issuer.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Credit Card Expiration Date
Expiration date of the credit/debit card.
834 - Health Insurance Exchange Enrollment
D | 2000 | DTP03 | - | 1251
 
Credit/Debit Card Number
Account number of the credit/debit card.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Custodial Parent Address Line
The first line of the address of the individual's parent who has legal custody of the individual.
834 - Health Insurance Exchange Enrollment
D | 2100E | N301 | - | 166
D | 2100E | N302 | - | 166
 
Custodial Parent City Name
The city of the individual's parent who has legal custody of the individual.
834 - Health Insurance Exchange Enrollment
D | 2100E | N401 | - | 19
 
Custodial Parent First Name
The first name of the individual's parent who has legal custody of the individual.
834 - Health Insurance Exchange Enrollment
D | 2100E | NM104 | - | 1036
 
Custodial Parent Identifier
The identification number of the individual's parent who has legal custody of the individual.
834 - Health Insurance Exchange Enrollment
D | 2100E | NM109 | - | 67
 
Custodial Parent Last Name
The last name of the individual's parent who has legal custody of the individual.
834 - Health Insurance Exchange Enrollment
D | 2100E | NM103 | - | 1035
 
Custodial Parent Middle Name
The middle name of the individual's parent who has legal custody of the individual.
834 - Health Insurance Exchange Enrollment
D | 2100E | NM105 | - | 1037
 
Custodial Parent Name Prefix
The prefix to the name of the individual's parent who has legal custody of the individual.
834 - Health Insurance Exchange Enrollment
D | 2100E | NM106 | - | 1038
 
Custodial Parent Name Suffix
The suffix to the name of the individual's parent who has legal custody of the individual.
834 - Health Insurance Exchange Enrollment
D | 2100E | 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 - Health Insurance Exchange Enrollment
D | 2100E | N403 | - | 116
 
Custodial Parent State Code
The code for the state of the individual's parent who has legal custody of the individual.
834 - Health Insurance Exchange Enrollment
D | 2100E | N402 | - | 156
 
Date Time Period
Expression of a date, a time, or a range of dates, times, or dates and times.
834 - Health Insurance Exchange Enrollment
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 - Health Insurance Exchange Enrollment
H | | DTP02 | - | 1250
H | 1100EA | DTP02 | - | 1250
D | 2000 | INS11 | - | 1250
D | 2000 | DTP02 | - | 1250
D | 2000 | DTP02 | - | 1250
D | 2000 | DTP02 | - | 1250
D | 2000 | DTP02 | - | 1250
D | 2000 | DTP02 | - | 1250
D | 2100A | DMG01 | - | 1250
D | 2100A | HI01 | C022-03 | 1250
D | 2100A | HI02 | C022-03 | 1250
D | 2100A | HI03 | C022-03 | 1250
D | 2100A | HI04 | C022-03 | 1250
D | 2100A | HI05 | C022-03 | 1250
D | 2100A | HI06 | C022-03 | 1250
D | 2100A | HI07 | C022-03 | 1250
D | 2100A | HI08 | C022-03 | 1250
D | 2100A | HI09 | C022-03 | 1250
D | 2100A | HI10 | C022-03 | 1250
D | 2100A | HI11 | C022-03 | 1250
D | 2100A | HI12 | C022-03 | 1250
D | 2100B | DMG01 | - | 1250
D | 2200 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2320 | DTP02 | - | 1250
D | 2320 | DTP02 | - | 1250
D | 2750A | DTP02 | - | 1250
D | 2750B | DTP02 | - | 1250
D | 2750C | DTP02 | - | 1250
 
Date Time Qualifier
Code specifying the type of date or time or both date and time.
834 - Health Insurance Exchange Enrollment
H | | DTP01 | - | 374
H | 1100EA | DTP01 | - | 374
D | 2000 | DTP01 | - | 374
D | 2000 | DTP01 | - | 374
D | 2000 | 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 | 2320 | DTP01 | - | 374
D | 2750A | DTP01 | - | 374
D | 2750B | DTP01 | - | 374
D | 2750C | DTP01 | - | 374
 
Dependent Record Count
Total number of dependent records in this transaction.
834 - Health Insurance Exchange Enrollment
H | | QTY02 | - | 380
 
Description
A free-form description to clarify the related data elements and their content.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF03 | - | 352
D | 2000 | REF03 | - | 352
D | 2000 | REF03 | - | 352
D | 2000 | REF03 | - | 352
D | 2750A | REF03 | - | 352
D | 2750B | REF03 | - | 352
D | 2750C | REF03 | - | 352
 
Diagnosis Code
An ICD-9-CM Diagnosis Code identifying a diagnosed medical condition.
834 - Health Insurance Exchange Enrollment
D | 2200 | DSB08 | - | 1137
 
Disability Eligibility Date
Date when individual became eligible for disability benefits.
834 - Health Insurance Exchange Enrollment
D | 2200 | DTP03 | - | 1251
 
Disability Type Code
An indicator to describe type of disability.
834 - Health Insurance Exchange Enrollment
D | 2200 | DSB01 | - | 1146
 
Drop Off Location Address Line
The address line of the drop off location.
834 - Health Insurance Exchange Enrollment
D | 2100G | N301 | - | 166
D | 2100G | N302 | - | 166
 
Drop Off Location City Name
The city name of the drop off location address.
834 - Health Insurance Exchange Enrollment
D | 2100G | N401 | - | 19
 
Drop Off Location Postal Zone or ZIP Code
The postal ZIP code of the drop off location address.
834 - Health Insurance Exchange Enrollment
D | 2100G | N403 | - | 116
 
Drop Off Location State Code
The state code of the drop off location address.
834 - Health Insurance Exchange Enrollment
D | 2100G | N402 | - | 156
 
Effective Date
Date the provider information as submitted via the transaction is effective.
834 - Health Insurance Exchange Enrollment
H | | DTP03 | - | 1251
 
Employee Count
Total number of employee records in this transaction.
834 - Health Insurance Exchange Enrollment
H | 1100EA | REF02 | - | 127
 
Employer Classification Code
Code identifying the classification of the Employer Group.
834 - Health Insurance Exchange Enrollment
H | 1100EA | REF02 | - | 127
 
Employer Contribution
Amount of Employer Group contribution towards the premium.
834 - Health Insurance Exchange Enrollment
H | 1100EA | AMT02 | - | 782
 
Employer Dependent Coverage Indication
Code identifying whether the Employer Group provides dependent coverage.
834 - Health Insurance Exchange Enrollment
H | 1100EA | REF02 | - | 127
 
Employment Class Code
Code indicating category of employee.
834 - Health Insurance Exchange Enrollment
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 - Health Insurance Exchange Enrollment
D | 2000 | INS08 | - | 584
 
Enrollee Address Line
Address line of the current mailing address of the insured enrollee.
834 - Health Insurance Exchange Enrollment
D | 2100A | N301 | - | 166
D | 2100A | N302 | - | 166
D | 2100C | N301 | - | 166
D | 2100C | N302 | - | 166
 
Enrollee Birth Date
The date of birth of the enrollee to the indicated coverage or policy.
834 - Health Insurance Exchange Enrollment
D | 2100A | DMG02 | - | 1251
 
Enrollee City Name
City name of the enrollee's mailing address.
834 - Health Insurance Exchange Enrollment
D | 2100A | N401 | - | 19
 
Enrollee Employer Address Line
First line of the current mailing address of the enrollee's employer.
834 - Health Insurance Exchange Enrollment
D | 2100D | N301 | - | 166
D | 2100D | N302 | - | 166
 
Enrollee Employer City Name
The city name of the enrollee's employer.
834 - Health Insurance Exchange Enrollment
D | 2100D | N401 | - | 19
 
Enrollee Employer Communications Contact
The name of the enrollee's employer.
834 - Health Insurance Exchange Enrollment
H | 1000E | PER02 | - | 93
H | 1000E | PER02 | - | 93
H | 1100EA | PER02 | - | 93
H | 1100EB | PER02 | - | 93
D | 2100D | PER02 | - | 93
 
Enrollee Employer First Name
First name of the enrollee's employer.
834 - Health Insurance Exchange Enrollment
D | 2100D | NM104 | - | 1036
 
Enrollee Employer Identifier
Identification number or reference for the enrollee's employer.
834 - Health Insurance Exchange Enrollment
D | 2100D | NM109 | - | 67
 
Enrollee Employer Middle Name
Middle name of the enrollee's employer.
834 - Health Insurance Exchange Enrollment
D | 2100D | NM105 | - | 1037
 
Enrollee Employer Name
The name of the enrollee's individual's employer.
834 - Health Insurance Exchange Enrollment
D | 2100D | NM103 | - | 1035
 
Enrollee Employer Name Prefix
Prefix to the name of the enrollee's employer.
834 - Health Insurance Exchange Enrollment
D | 2100D | NM106 | - | 1038
 
Enrollee Employer Name Suffix
Name suffix, including generation, of the enrollee's employer.
834 - Health Insurance Exchange Enrollment
D | 2100D | NM107 | - | 1039
 
Enrollee Employer Postal Zone or ZIP Code
The zip code of the enrollee's employer.
834 - Health Insurance Exchange Enrollment
D | 2100D | N403 | - | 116
 
Enrollee Employer State Code
The state postal code of the enrollee's employer.
834 - Health Insurance Exchange Enrollment
D | 2100D | N402 | - | 156
 
Enrollee First Name
The first name of the insured individual to the coverage.
834 - Health Insurance Exchange Enrollment
D | 2100A | NM104 | - | 1036
 
Enrollee 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 - Health Insurance Exchange Enrollment
D | 2300 | REF02 | - | 127
D | 2320 | COB02 | - | 127
 
Enrollee Height
Height of enrollee.
834 - Health Insurance Exchange Enrollment
D | 2100A | HLH02 | - | 65
 
Enrollee Identifier
Enrollee's unique identification number assigned by a payer.
834 - Health Insurance Exchange Enrollment
D | 2100A | NM109 | - | 67
 
Enrollee Indicator
Indicates whether the enrollee is the subscriber or a dependent.
834 - Health Insurance Exchange Enrollment
D | 2000 | INS01 | - | 1073
 
Enrollee Individual Death Date
Date of death for subscriber or dependent.
834 - Health Insurance Exchange Enrollment
D | 2000 | INS12 | - | 1251
 
Enrollee Last Name
The last name of the insured individual to the coverage.
834 - Health Insurance Exchange Enrollment
D | 2100A | NM103 | - | 1035
 
Enrollee Mail City Name
Name of the city of the enrollees mailing address.
834 - Health Insurance Exchange Enrollment
D | 2100C | N401 | - | 19
 
Enrollee Mail State Code
State of the enrollees mailing address.
834 - Health Insurance Exchange Enrollment
D | 2100C | N402 | - | 156
 
Enrollee Middle Name
The middle name of the insured individual to the coverage.
834 - Health Insurance Exchange Enrollment
D | 2100A | NM105 | - | 1037
 
Enrollee Name Prefix
The name prefix of the insured individual to the coverage.
834 - Health Insurance Exchange Enrollment
D | 2100A | NM106 | - | 1038
 
Enrollee Name Suffix
The name suffix of the insured individual to the coverage.
834 - Health Insurance Exchange Enrollment
D | 2100A | NM107 | - | 1039
 
Enrollee Postal Zone or Zip Code
The postal zip code of the enrollee's mailing address.
834 - Health Insurance Exchange Enrollment
D | 2100A | N403 | - | 116
D | 2100C | N403 | - | 116
 
Enrollee Reporting Category Effective Date(s)
The date the reporting category is effective or terminated.
834 - Health Insurance Exchange Enrollment
D | 2750C | DTP03 | - | 1251
 
Enrollee Reporting Category Name
The name of the reporting category.
834 - Health Insurance Exchange Enrollment
D | 2750C | N102 | - | 93
 
Enrollee Reporting Category Reference ID
Identifier associated with the reporting category.
834 - Health Insurance Exchange Enrollment
D | 2750C | REF02 | - | 127
 
Enrollee State or Province Code
State or Province of the Enrollee.
834 - Health Insurance Exchange Enrollment
D | 2100A | N402 | - | 156
 
Enrollee Supplemental Identifier
Identifies another or additional distinguishing code number associated with the enrollee.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Enrollee Weight
Weight of enrollee.
834 - Health Insurance Exchange Enrollment
D | 2100A | HLH03 | - | 81
 
Enrollment Amount
Amount pertaining to the enrollment.
834 - Health Insurance Exchange Enrollment
D | 2100A | HI01 | C022-05 | 782
D | 2100A | HI02 | C022-05 | 782
D | 2100A | HI03 | C022-05 | 782
D | 2100A | HI04 | C022-05 | 782
D | 2100A | HI05 | C022-05 | 782
D | 2100A | HI06 | C022-05 | 782
D | 2100A | HI07 | C022-05 | 782
D | 2100A | HI08 | C022-05 | 782
D | 2100A | HI09 | C022-05 | 782
D | 2100A | HI10 | C022-05 | 782
D | 2100A | HI11 | C022-05 | 782
D | 2100A | HI12 | C022-05 | 782
 
Enrollment Amount Code
Code to qualify amount.
834 - Health Insurance Exchange Enrollment
D | 2100A | HI01 | C022-02 | 1271
D | 2100A | HI02 | C022-02 | 1271
D | 2100A | HI03 | C022-02 | 1271
D | 2100A | HI04 | C022-02 | 1271
D | 2100A | HI05 | C022-02 | 1271
D | 2100A | HI06 | C022-02 | 1271
D | 2100A | HI07 | C022-02 | 1271
D | 2100A | HI08 | C022-02 | 1271
D | 2100A | HI09 | C022-02 | 1271
D | 2100A | HI10 | C022-02 | 1271
D | 2100A | HI11 | C022-02 | 1271
D | 2100A | HI12 | C022-02 | 1271
 
Enrollment Amount Related Date or Date Range
Date or date range associated with the enrollment amount.
834 - Health Insurance Exchange Enrollment
D | 2100A | HI01 | C022-04 | 1251
D | 2100A | HI02 | C022-04 | 1251
D | 2100A | HI03 | C022-04 | 1251
D | 2100A | HI04 | C022-04 | 1251
D | 2100A | HI05 | C022-04 | 1251
D | 2100A | HI06 | C022-04 | 1251
D | 2100A | HI07 | C022-04 | 1251
D | 2100A | HI08 | C022-04 | 1251
D | 2100A | HI09 | C022-04 | 1251
D | 2100A | HI10 | C022-04 | 1251
D | 2100A | HI11 | C022-04 | 1251
D | 2100A | HI12 | C022-04 | 1251
 
Entity Identifier Code
Code identifying an organizational entity, a physical location, property or an individual.
834 - Health Insurance Exchange Enrollment
H | 1000A | N101 | - | 98
H | 1000B | N101 | - | 98
H | 1000C | N101 | - | 98
H | 1000D | N101 | - | 98
H | 1000E | 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 | 2100I | NM101 | - | 98
D | 2310 | NM101 | - | 98
D | 2310 | PLA02 | - | 98
D | 2330 | NM101 | - | 98
D | 2750A | N101 | - | 98
D | 2750B | N101 | - | 98
D | 2750C | N101 | - | 98
 
Entity Relationship Code
Code describing the relationship of one identified person to another.
834 - Health Insurance Exchange Enrollment
D | 2310 | NM110 | - | 706
 
Entity Type Qualifier
Code qualifying the type of entity.
834 - Health Insurance Exchange Enrollment
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 | 2100I | NM102 | - | 1065
D | 2310 | NM102 | - | 1065
D | 2330 | NM102 | - | 1065
 
Exchange Assigned APTC Contributor/Tax Payer Identifier
Identification number assigned to the APTC Contributor/Tax Payer by the Exchange.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Exchange Assigned Dependent Identifier
Identification number assigned to the Individual/Dependent by the Exchange.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Exchange Assigned Employer Group Identifier
Identification number assigned to the Employer Group by the Exchange.
834 - Health Insurance Exchange Enrollment
H | | REF02 | - | 127
H | 1100EA | REF02 | - | 127
D | 2000 | REF02 | - | 127
 
Exchange Assigned Policy Identifier
Identification number assigned to the Policy by the Exchange.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Exchange Assigned Qualified Health Plan Identifier
Identification number assigned to the Health Plan by the Exchange.
834 - Health Insurance Exchange Enrollment
H | | REF02 | - | 127
D | 2000 | REF02 | - | 127
 
Exchange Assigned Subscriber Identifier
Identification number assigned to the Subscriber by the Exchange.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Gender Code
A code indicating the gender of the patient or insured.
834 - Health Insurance Exchange Enrollment
D | 2100A | DMG03 | - | 1068
 
Handicap Indicator
Code indicating if individual is handicapped or not.
834 - Health Insurance Exchange Enrollment
D | 2000 | INS10 | - | 1073
 
Health Coverage Sequence Number
The Sequence number indicating the Health Coverage Number level.
834 - Health Insurance Exchange Enrollment
D | 2100A | HI01 | C022-06 | 380
D | 2100A | HI02 | C022-06 | 380
D | 2100A | HI03 | C022-06 | 380
D | 2100A | HI04 | C022-06 | 380
D | 2100A | HI05 | C022-06 | 380
D | 2100A | HI06 | C022-06 | 380
D | 2100A | HI07 | C022-06 | 380
D | 2100A | HI08 | C022-06 | 380
D | 2100A | HI09 | C022-06 | 380
D | 2100A | HI10 | C022-06 | 380
D | 2100A | HI11 | C022-06 | 380
D | 2100A | HI12 | C022-06 | 380
D | 2300 | HD06 | - | 609
 
Health Related Code
Code indicating a specific health situation.
834 - Health Insurance Exchange Enrollment
D | 2100A | HLH01 | C061-01 | 1212
 
Health Related Code Status Date
Code indicating the status effective date of a specific health situation.
834 - Health Insurance Exchange Enrollment
D | 2100A | HLH01 | C061-04 | 373
 
Identification Code Qualifier
Code designating the system/method of code structure used for Identification Code (67).
834 - Health Insurance Exchange Enrollment
H | 1000A | N103 | - | 66
H | 1000B | N103 | - | 66
H | 1000C | N103 | - | 66
H | 1000D | N103 | - | 66
H | 1000E | N103 | - | 66
D | 2100A | NM108 | - | 66
D | 2100A | LUI01 | - | 66
D | 2100B | NM108 | - | 66
D | 2100D | NM108 | - | 66
D | 2100E | NM108 | - | 66
D | 2100F | NM108 | - | 66
D | 2100H | NM108 | - | 66
D | 2100I | NM108 | - | 66
D | 2310 | NM108 | - | 66
D | 2330 | NM108 | - | 66
D | 2750A | N103 | - | 66
 
Implementation Convention Reference
Reference assigned to identify Implementation Convention.
834 - Health Insurance Exchange Enrollment
H | | ST03 | - | 1705
 
Indian Tribal Status Effective Date
Effective date of the Indian Tribal Status.
834 - Health Insurance Exchange Enrollment
D | 2000 | DTP03 | - | 1251
 
Individual Relationship Code
Code indicating the relationship between two individuals or entities.
834 - Health Insurance Exchange Enrollment
D | 2000 | INS02 | - | 1069
 
Insurance Line Code
Code identifying a group of insurance products
834 - Health Insurance Exchange Enrollment
D | 2300 | HD03 | - | 1205
 
Insurer Identification Code
Code identifying the insurer providing coverage.
834 - Health Insurance Exchange Enrollment
H | 1000C | N104 | - | 67
 
Insurer Name
Name of the insurer providing coverage.
834 - Health Insurance Exchange Enrollment
H | 1000C | N102 | - | 93
 
Issuer Assigned APTC Contributor/Tax Payer Identifier
Identification number assigned to the APTC Contributor/Tax Payer by the Issuer.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Issuer Assigned Dependent Identifier
Identification number assigned to the Individual/Dependent by the issuer.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Issuer Assigned Employer Group Identifier
Identification number assigned to the Employer Group by the Issuer.
834 - Health Insurance Exchange Enrollment
H | | REF02 | - | 127
D | 2000 | REF02 | - | 127
 
Issuer Assigned Policy Identifier
Identification number assigned to the Policy by the Issuer.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Issuer Assigned Qualified Health Plan Identifier
Identification number assigned to the Qualified Health Plan by the Issuer.
834 - Health Insurance Exchange Enrollment
H | | REF02 | - | 127
D | 2000 | REF02 | - | 127
 
Issuer Assigned Subscriber Number
Identification number assigned to the Subscriber by the Issuer.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Language Code
Code indicating the language spoken by an individual.
834 - Health Insurance Exchange Enrollment
D | 2100A | LUI02 | - | 67
 
Language Description
Narrative text indicating the language spoken by an individual.
834 - Health Insurance Exchange Enrollment
D | 2100A | LUI03 | - | 352
 
Language Use Indicator
Code indicating the way a language is used by an individual, such as speaking or reading.
834 - Health Insurance Exchange Enrollment
D | 2100A | LUI04 | - | 1303
 
Late Enrollment Indicator
Code identifying if the insured is a late enrollee.
834 - Health Insurance Exchange Enrollment
D | 2300 | HD09 | - | 1073
 
Location Identifier
Code which identifies a specific location.
834 - Health Insurance Exchange Enrollment
D | 2100A | N406 | - | 310
 
Location Qualifier
Code identifying type of location.
834 - Health Insurance Exchange Enrollment
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 - Health Insurance Exchange Enrollment
D | 2000 | LS01 | - | 447
D | 2000 | LE01 | - | 447
 
Maintenance Reason Code
Code identifying reason for the maintenance change
834 - Health Insurance Exchange Enrollment
D | 2000 | INS04 | - | 1203
D | 2310 | PLA05 | - | 1203
 
Maintenance Type Code
Code identifying a specific type of item maintenance
834 - Health Insurance Exchange Enrollment
D | 2000 | INS03 | - | 875
D | 2300 | HD01 | - | 875
 
Marital Status Code
Code defining the marital status of a person.
834 - Health Insurance Exchange Enrollment
D | 2100A | DMG04 | - | 1067
D | 2100B | DMG04 | - | 1067
 
Medicare Eligibility Reason Code
Code specifying reason for Medicare eligibility.
834 - Health Insurance Exchange Enrollment
D | 2000 | INS06 | C052-02 | 1701
 
Medicare Plan Code
Code identifying the Medicare Plan.
834 - Health Insurance Exchange Enrollment
D | 2000 | INS06 | C052-01 | 1218
 
Name First
Individual first name.
834 - Health Insurance Exchange Enrollment
D | 2100G | NM104 | - | 1036
 
Name Last or Organization Name
Individual last name or organization name.
834 - Health Insurance Exchange Enrollment
D | 2100G | NM103 | - | 1035
 
Name Middle
Individual middle name or initial.
834 - Health Insurance Exchange Enrollment
D | 2100G | NM105 | - | 1037
 
Name Prefix
The prefix to an individual's name.
834 - Health Insurance Exchange Enrollment
D | 2100G | NM106 | - | 1038
 
Name Suffix
Ths suffix to an individual's name.
834 - Health Insurance Exchange Enrollment
D | 2100G | NM107 | - | 1039
 
Navigator Identifier
Identification number of the Navigator.
834 - Health Insurance Exchange Enrollment
D | 2750B | REF02 | - | 127
 
Navigator Name
Name of the Navigator.
834 - Health Insurance Exchange Enrollment
D | 2750B | N102 | - | 93
 
Navigator Relationship Date(s)
Date the relationship with the Navigator is effective or terminated.
834 - Health Insurance Exchange Enrollment
D | 2750B | DTP03 | - | 1251
 
Other Plan's Enrollee Coordination of Benefits Group Identifier
Identification number assigned to the Group by the Other Plan.
834 - Health Insurance Exchange Enrollment
D | 2320 | REF02 | - | 127
 
Other Plan's Enrollee Group or Policy Number
Policy number assigned to the Group by the Other Plan.
834 - Health Insurance Exchange Enrollment
D | 2320 | REF02 | - | 127
 
Payer Responsibility Sequence Number Code
Code identifying the insurance carrier's level of responsibility for a payment of a claim
834 - Health Insurance Exchange Enrollment
D | 2320 | COB01 | - | 1138
 
Plan Sponsor Name
The name of the entity providing coverage to the subscriber.
834 - Health Insurance Exchange Enrollment
H | 1000D | N102 | - | 93
 
Prior Coverage Month Count
Number of months of prior health insurance coverage.
834 - Health Insurance Exchange Enrollment
D | 2300 | REF02 | - | 127
 
Prior Incorrect Enrollee First Name
The first name previously reported or used for an individual when a corrected name is reported.
834 - Health Insurance Exchange Enrollment
D | 2100B | NM104 | - | 1036
 
Prior Incorrect Enrollee Last Name
The last name previously reported or used for an individual when a corrected name is reported.
834 - Health Insurance Exchange Enrollment
D | 2100B | NM103 | - | 1035
 
Prior Incorrect Enrollee Middle Name
The middle name previously reported or used for an individual when a corrected name is reported.
834 - Health Insurance Exchange Enrollment
D | 2100B | NM105 | - | 1037
 
Prior Incorrect Enrollee Name Prefix
The prefix to the name previously reported or used for an individual when a corrected name is reported.
834 - Health Insurance Exchange Enrollment
D | 2100B | NM106 | - | 1038
 
Prior Incorrect Enrollee Name Suffix
The suffix to the name previously reported or used for an individual when a corrected name is reported.
834 - Health Insurance Exchange Enrollment
D | 2100B | NM107 | - | 1039
 
Prior Incorrect Insured Birth Date
The birth date previously reported or used for an individual when corrected data is reported.
834 - Health Insurance Exchange Enrollment
D | 2100B | DMG02 | - | 1251
 
Prior Incorrect Insured Gender Code
The gender previously reported or used for an individual when corrected data is reported.
834 - Health Insurance Exchange Enrollment
D | 2100B | DMG03 | - | 1068
 
Prior Incorrect Insured Identifier
The identification number previously reported or used for an individual when a corrected name is reported.
834 - Health Insurance Exchange Enrollment
D | 2100B | NM109 | - | 67
 
Prior Race or Ethnicity Code
Code qualifying the prior race or ethnicity.
834 - Health Insurance Exchange Enrollment
D | 2100B | DMG05 | C056-03 | 1271
 
Product or Service ID Qualifier
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
834 - Health Insurance Exchange Enrollment
D | 2200 | DSB07 | - | 235
 
Provider Address Line
The street address of the provider.
834 - Health Insurance Exchange Enrollment
D | 2310 | N301 | - | 166
D | 2310 | N302 | - | 166
 
Provider City Name
The city name of the provider.
834 - Health Insurance Exchange Enrollment
D | 2310 | N401 | - | 19
 
Provider Effective Date
The date the change of the primary care provider is effective.
834 - Health Insurance Exchange Enrollment
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 - Health Insurance Exchange Enrollment
D | 2310 | NM104 | - | 1036
 
Provider Identifier
Number assigned by the payer, regulatory authority, or other authorized body or agency to identify the provider.
834 - Health Insurance Exchange Enrollment
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 - Health Insurance Exchange Enrollment
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 - Health Insurance Exchange Enrollment
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 - Health Insurance Exchange Enrollment
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 - Health Insurance Exchange Enrollment
D | 2310 | NM107 | - | 1039
 
Provider Postal Zone or ZIP Code
The zip code of the provider.
834 - Health Insurance Exchange Enrollment
D | 2310 | N403 | - | 116
 
Provider State Code
The State Postal Code of the provider
834 - Health Insurance Exchange Enrollment
D | 2310 | N402 | - | 156
 
Quantity Qualifier
Code specifying the type of quantity.
834 - Health Insurance Exchange Enrollment
H | | QTY01 | - | 673
H | | QTY01 | - | 673
H | | QTY01 | - | 673
 
Race or Ethnicity Code
Code indicating the racial or ethnic background of a person.
834 - Health Insurance Exchange Enrollment
D | 2100A | DMG05 | C056-03 | 1271
 
Race or Ethnicity Collection Code
Code identifying how the Race or Ethnicity information was collected.
834 - Health Insurance Exchange Enrollment
D | 2100A | DMG11 | - | 1271
D | 2100B | DMG11 | - | 1271
 
Receiver Identifier
Number identifying the organization receiving the payment.
834 - Health Insurance Exchange Enrollment
H | 1000B | N104 | - | 67
 
Receiver Name
Name of organization receiving the transaction.
834 - Health Insurance Exchange Enrollment
H | 1000B | N102 | - | 93
 
Record Totals
Total number of records in this transaction.
834 - Health Insurance Exchange Enrollment
H | | QTY02 | - | 380
 
Reference Identification Qualifier
Code qualifying the reference identification.
834 - Health Insurance Exchange Enrollment
H | | REF01 | - | 128
H | | REF01 | - | 128
H | | REF01 | - | 128
H | | REF01 | - | 128
H | 1100EA | REF01 | - | 128
H | 1100EA | REF01 | - | 128
H | 1100EA | REF01 | - | 128
H | 1100EA | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF04 | C040-01 | 128
D | 2000 | REF01 | - | 128
D | 2000 | REF04 | C040-01 | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2320 | REF01 | - | 128
D | 2320 | REF01 | - | 128
D | 2750A | REF01 | - | 128
D | 2750B | REF01 | - | 128
D | 2750C | REF01 | - | 128
 
Responsible Person Address Line
Address line of the Responsibile Person.
834 - Health Insurance Exchange Enrollment
D | 2100F | N301 | - | 166
D | 2100F | N302 | - | 166
 
Responsible Person City Name
Name of the city of the Responsible Person.
834 - Health Insurance Exchange Enrollment
D | 2100F | N401 | - | 19
 
Responsible Person First Name
First name of the person responsible for the enrollee.
834 - Health Insurance Exchange Enrollment
D | 2100F | NM104 | - | 1036
 
Responsible Person Identifier
Identification number of the Responsible Person.
834 - Health Insurance Exchange Enrollment
D | 2100F | NM109 | - | 67
 
Responsible Person Last or Organization Name
Last name or organization name of the person responsible for the enrollee.
834 - Health Insurance Exchange Enrollment
D | 2100F | NM103 | - | 1035
 
Responsible Person Middle Name
Middle name of the person responsible for the enrollee.
834 - Health Insurance Exchange Enrollment
D | 2100F | NM105 | - | 1037
 
Responsible Person Name Prefix
Prefix for the name of the person responsible for the enrollee.
834 - Health Insurance Exchange Enrollment
D | 2100F | NM106 | - | 1038
 
Responsible Person Postal Zone or ZIP Code
Zip code of the Responsible Person.
834 - Health Insurance Exchange Enrollment
D | 2100F | N403 | - | 116
 
Responsible Person Relationship Code
Code qualifying the Responsible Person's relationship to the enrollee.
834 - Health Insurance Exchange Enrollment
D | 2100F | NM110 | - | 706
 
Responsible Person State Code
State of the Responsible Person.
834 - Health Insurance Exchange Enrollment
D | 2100F | N402 | - | 156
 
Responsible Person Suffix Name
Suffix for the name of the person responsible for the enrollee.
834 - Health Insurance Exchange Enrollment
D | 2100F | NM107 | - | 1039
 
Routing Number
The routing number assigned to the bank.
834 - Health Insurance Exchange Enrollment
D | 2000 | REF02 | - | 127
 
Service Type Code
Code identifying the classification of service.
834 - Health Insurance Exchange Enrollment
D | 2320 | COB04 | - | 1365
 
Sponsor First Name
First name of the Sponsor who ultimately pays for the coverage, benefit, or product.
834 - Health Insurance Exchange Enrollment
D | 2100H | NM104 | - | 1036
 
Sponsor Identifier
Identification of the party paying for the coverage.
834 - Health Insurance Exchange Enrollment
H | 1000D | N104 | - | 67
H | 1000E | N104 | - | 67
D | 2100H | NM109 | - | 67
 
Sponsor Last or Organization Name
Last name or orgnaization name of the person or entity of the Sponsor who ultimately pays for the coverage, benefit, or product.
834 - Health Insurance Exchange Enrollment
D | 2100H | NM103 | - | 1035
 
Sponsor Middle Name
Middle name of the Sponsor who ultimately pays for the coverage, benefit, or product.
834 - Health Insurance Exchange Enrollment
D | 2100H | NM105 | - | 1037
 
Sponsor Name
Name of sponsor.
834 - Health Insurance Exchange Enrollment
H | 1000E | N102 | - | 93
 
Sponsor Name Prefix
Prefix for the name of the Sponsor who ultimately pays for the coverage, benefit, or product.
834 - Health Insurance Exchange Enrollment
D | 2100H | NM106 | - | 1038
 
Sponsor Name Suffix
Suffix for the name of the Sponsor who ultimately pays for the coverage, benefit, or product.
834 - Health Insurance Exchange Enrollment
D | 2100H | NM107 | - | 1039
 
Sponsor/Employer Group Other Location Address Line
Address line of additional locations for the Employer Group.
834 - Health Insurance Exchange Enrollment
H | 1100EB | N301 | - | 166
H | 1100EB | N302 | - | 166
 
Sponsor/Employer Group Other Location City Name
City Name of additional locations for the Employer Group.
834 - Health Insurance Exchange Enrollment
H | 1100EB | N401 | - | 19
 
Sponsor/Employer Group Other Location Postal Zone or ZIP Code
Zip Code of additional locations for the Employer Group.
834 - Health Insurance Exchange Enrollment
H | 1100EB | N403 | - | 116
 
Sponsor/Employer Group Other Location State or Province Code
State Code of additional locations for the Employer Group.
834 - Health Insurance Exchange Enrollment
H | 1100EB | N402 | - | 156
 
Status Information Effective Date
The date that the status information provided is effective.
834 - Health Insurance Exchange Enrollment
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 - Health Insurance Exchange Enrollment
D | 2000 | INS09 | - | 1220
 
Submitter Identifier
Code or number identifying the entity submitting the claim.
834 - Health Insurance Exchange Enrollment
H | 1000A | N104 | - | 67
 
Submitter Name
Name identifying the entity submitting the transaction.
834 - Health Insurance Exchange Enrollment
H | 1000A | N102 | - | 93
 
Subscriber Record Count
Total number of subscriber records in this transaction.
834 - Health Insurance Exchange Enrollment
H | | QTY02 | - | 380
 
Time Zone Code
Code identifying the time zone used in specifying a time.
834 - Health Insurance Exchange Enrollment
H | | BGN05 | - | 623
 
Tobacco Status Effective Date
The Effective date of the tobacco status.
834 - Health Insurance Exchange Enrollment
D | 2000 | DTP03 | - | 1251
 
Transaction Segment Count
A tally of all segments between the ST and the SE segments including the ST and SE segments.
834 - Health Insurance Exchange Enrollment
D | | SE01 | - | 96
 
Transaction Set Control Number
The unique identification number within a transaction set.
834 - Health Insurance Exchange Enrollment
H | | ST02 | - | 329
D | | SE02 | - | 329
 
Transaction Set Creation Date
Identifies the date the submitter created the transaction.
834 - Health Insurance Exchange Enrollment
H | | BGN03 | - | 373
 
Transaction Set Creation Time
Time file is created for transmission.
834 - Health Insurance Exchange Enrollment
H | | BGN04 | - | 337
 
Transaction Set Identifier Code
Code uniquely identifying a Transaction Set.
834 - Health Insurance Exchange Enrollment
H | | ST01 | - | 143
 
Transaction Set Purpose Code
Code identifying purpose of transaction set.
834 - Health Insurance Exchange Enrollment
H | | BGN01 | - | 353
 
Transaction Set Reference Number
Number uniquely identifying a transaction set.
834 - Health Insurance Exchange Enrollment
H | | BGN02 | - | 127
 
Version Identifier
Revision level of a particular format, program, technique or algorithm.
834 - Health Insurance Exchange Enrollment
D | 2100A | HI01 | C022-07 | 799
D | 2100A | HI02 | C022-07 | 799
D | 2100A | HI03 | C022-07 | 799
D | 2100A | HI04 | C022-07 | 799
D | 2100A | HI05 | C022-07 | 799
D | 2100A | HI06 | C022-07 | 799
D | 2100A | HI07 | C022-07 | 799
D | 2100A | HI08 | C022-07 | 799
D | 2100A | HI09 | C022-07 | 799
D | 2100A | HI10 | C022-07 | 799
D | 2100A | HI11 | C022-07 | 799
D | 2100A | HI12 | C022-07 | 799
 
Waiting Period Days
Number of days in the waiting period for new enrollees.
834 - Health Insurance Exchange Enrollment
H | 1100EA | DTP03 | - | 1251
 
Yes No Condition or Response Code
Code indicating a Yes or No condition or response.
834 - Health Insurance Exchange Enrollment
D | 2100A | HLH01 | C061-02 | 1073