The basics of an EDI 834 file for third-party administrators.
As a third-party administrator, you’ve likely worked with an EDI 834 file in the past. If the process is not currently automated in your organization, you are typically manually sending enrollment data to the carrier, which can result in costly errors if the information is inputted incorrectly. Let’s break down what an 834 file is, how it’s used and why it’s important to automate.
Simply, an EDI 834 file is a benefit enrollment and maintenance document that must abide by HIPAA 5010 standards. This file is used by a multitude of organizations, such as employers, TPAs and insurance agencies, for enrolling their members directly into a benefit plan.
The 834 file includes demographic information on the employee, including the plan subscriber’s name, plan network information, eligibility and benefit information.
For third-party administrators, an EDI 843 file is commonly used to add, remove or update member’s enrollment information. The information submitted can be new member or dependent enrollments, adjustments to their current enrollment, reinstatement or disenrollment after the plan is terminated.
Once an 834 transaction is received, the recipient must respond back with a 999 Implementation Acknowledgement. This acknowledgment must also be HIPAA 5010 compliant and will provide information back on the acceptance of the document. The 999 will commonly include whether it was accepted, rejected, or accepted with errors.
With TPA Stream’s robust EDI 834 tool, importing enrollment data into a carrier system from a benefit administration system transforms the integration process, ensuring accurate data is transferred and errors are managed efficiently. This eliminates the manual work by TPAs to input member changes directly to the carriers and reduces errors.
Are you interested in learning more about how TPA Stream can help with EDI 824 integrations?