Functional Setup & Frequently Asked Questions (FAQ) for Setting Up the ANSI 834 System Extract (Doc ID 246149.1)

Last updated on JUNE 21, 2023

Applies to:

Purpose

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Functional Setup & FAQ for Setting Up the ANSI 834 System Extract
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Introduction
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Seeded system extracts are available as of the July 2002 Family Pack which provide standardized data requirements and content to users of version ANSI ASC X12.84, Benefit Enrollment and Maintenance (834).

The ANSI 834 is used to transfer enrollment and maintenance information, specifically for healthcare products from the sponsor of the insurance coverage, benefit or policy to a payee.

These new standards and code sets are part of the 1996 Health Insurance Portability and Accountability Act (HIPAA) administrative simplification procedures.

Although HIPAA does not mandate the electronic transmission of healthcare data, it does establish uniform national standards for all organizations electronically transferring healthcare enrollment and
maintenance information from the sponsor to a payee (carrier).

These standards comply with the National Electronic Data Interchange guidelines and define commonly used business transactions in a formal structure called 'transaction sets'.

The technical requirements were drawn from the National Electronic Data Interchange Transaction Set Implementation Guide for Benefit Enrollment and Maintenance - 834 (ASC X12N 834 004010 X095), published by the Washington Publishing Company.

The system extract capabilities in Oracle HRMS 11i have been enhanced to accommodate any data element and sets that are needed to support ANSI 834.

Seeded extracts are delivered with the professional user interface and can be copied into and used by a specific business group.

The system provides the default setups of the ANSI 834 for a Full Profile Extract and a Change Event Extract. These setups can be modified based on your individual requirements after copying the seeded extract into your business group.

Scope

For more information regarding ANSI 834 standards, you may go to the Washington Publishing Company’s website at http://www.wpc-edi.com to obtain a copy of the National Electronic Data Interchange Transaction Set Implementation Guide for Benefit Enrollment and Maintenance – 834 (ASC X12N 834 004010 X095).

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