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.

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