Skip to Main Content

HIPAA SIMPLIFIED

Your online resource for healthcare regulations

DC_test_header

Benefit Enrollment

The ASC X12N Benefit Enrollment and Maintenance (834) transaction allows an entity, such as an employer, union, or insurance agency, to enroll individuals in a health plan electronically.  The transaction also supports changes to an existing enrollment and termination of an individual’s enrollment.

  • Benefit Enrollment

    • Standards

      Current Standard

      The current mandated version of the ASC X12N Benefit Enrollment and Maintenance (834) transaction is 5010.

      The Technical Report Type 3 (TR3) ASC X12N/005010X220A1 Benefit Enrollment and Maintenance (834) can be purchased at the ASC X12 Store.

      Anticipated Standard

      The next anticipated version of the ASC X12N Benefit Enrollment and Maintenance (834) transaction is 7030. This TR3 will be available for public review and comment from September 1 through October 31, 2016.

      Online ASC X12 Public Review Forum

    • Operating Rules

      Regulation

      Although CAQH CORE has developed operating rules pertaining to the ASC X12N Benefit Enrollment and Maintenance (834) transaction for their voluntary Phase IV certification program, the National Committee on Vital and Health Statistics (NCVHS), advisory body to the Department of Health and Human Services, recommended that the Phase IV Operating Rules not be adopted under regulatory mandate. No federal regulation is anticipated.

      Voluntary Certification

      CAQH CORE offers a voluntary certification program for their Phase IV Operating Rules, which cover the ASC X12N Benefit Enrollment and Maintenance (834) transaction.

      Claims and Encounters / Benefit Enrollment / Premium Payment / Referral and Authorization Operating Rules