ASC X12 Version: 005010 | Transaction Set: 834 | TR3 ID: 005010X220
Example 07: Terminate Eligibility for a Subscriber
The eligibility for John Doe is being canceled because he terminated employment on 10/1/1996.
Transmission Explanation
Table 1
ST*834*12345*005010X220A1~
Used to indicate the start of a transaction set and to specify a transaction set control number.
BGN*00*12456*19980520*1200****2~
This is an original transaction uniquely identified by the sender with reference #12456. The transaction was created on 5/20/1998 at 12:00 Noon.
N1*P5**FI*999888777~
Specifies the sponsor/sender's tax ID number.
N1*IN**FI*654456654~
Specifies the insurance company/receiver's tax ID number.
Table 2
INS*Y*18*024*08*A***TE~
Beginning of Table 2. Indicates that the subscriber (John Doe) is terminating all coverage.
REF*0F*123456789~
John's subscriber ID number.
REF*1L*123456001~
This is the group number assigned by the carrier.
DTP*357*D8*19961001~
The benefits under this plan are terminating 10/01/1996.
NM1*IL*1*DOE*JOHN*E***34*103229876~
Subscriber's name.
SE*10*12345~
End of transaction set. 10 segments were sent and the control number in the ST segment is 12345.