Section title: X12 EDI Examples
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ASC X12 Version: 005010 | Transaction Set: 834 | TR3 ID: 005010X220

Example 5: Change subscriber information

John Doe is correcting his date of birth.

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*GENERIC INC*FI*000111000~

Specifies the sponsor/sender's tax ID number.

N1*IN*ABC INSURANCE*FI*654456654~

Specifies the insurance company/receiver's tax ID number.

Table 2

INS*Y*18*001*25*A***FT~

Beginning of Table 2. Indicates that the subscriber (John Doe) is updating coverage as an active employee.

REF*0F*123456789~

John's subscriber ID number.

REF*1L*123456001~

This is the group number assigned by the carrier.

NM1*IL*1*DOE*JAMES*E***34*103229876~

Members name and ssn.

DMG*D8*19500415*M~

This is John's date of birth and gender.

NM1*70*1*DOE*JAMES*E~

Subscriber's name. The NM101 = 70 indicates that this is a change to information previously sent.

DMG*D8*19500416*M~

This is John's incorrect date of birth.

SE*12*12345~

End of transaction set. 12 segments were sent and the control number in the ST segment is 12345.