ASC X12 Version: 005010 | Transaction Set: 834 | TR3 ID: 005010X220
Example 4: Add Subscriber Coverage
William Smith is adding dental coverage as a benefit, which will be effective on 7/1/2002.
Used to indicate the start of a transaction set and to specify a transaction set control number.
This is an original transaction uniquely identified by the sender with reference #12456. The transaction was created on 6/1/2002 at 12:00 Noon.
Master policy number (group ID).
Specifies the sponsor/sender's tax ID number.
Specifies the insurance company/receiver's tax ID number.
Beginning of Table 2. Indicates that the subscriber (William Smith) is updating coverage as an active employee.
William's subscriber ID number.
This is the group number assigned by the carrier.
William is enrolling in the Dental benefit.
The benefits under this plan begin 7/1/2002.
End of transaction set. 12 segments were sent and the control number in the ST segment is 12345.
In the previous example, to remove coverage do the following: change the maintenance type code (HD01) from 021 (addition) to 024 (cancellation/termination), and change the date/time qualifier (DTP01) from 348 (benefit begin) to 349 (benefit end).