Document - HIPAA 834 Benefit Enrollment to Excel


For Desktop Application

HIPAA 834 to Excel Desktop Program User Manual


834 Data Mapping


Exported Name, Description 834 Loop Segment Data Element-Sub DE
Member Name, Loop 2100A and Detail Loop 2000
Last Name2100ANM103
First Name2100ANM104
SSN (or ID)2100ANM108, 09
Subscriber No, Qaualifer=0F 2000 REF 02
Sex 2100A DMG 03
DOB, Date of Birth 2100A DMG 02
Address 2100A N3, N4 vary
Subscriber Indicator 2000 INS 01
Relationship 2000 INS 02
Maintenance Type 2000 INS 03
Maintenance Reason 2000 INS 04
Benefit Status 2000 INS 05
Medicare Plan 2000 INS 06-01
MC eligibility 2000 INS 06-02
COBRA Event 2000 INS 07
Employment 2000 INS 08
Student 2000 INS 09
Handicap 2000 INS 10
Disability Information, Loop 2200
Disability Type 2200 DSB 1
Medical Code Qualifier 2200 DSB 7
Medical Code 2200 DSB 8
Start Date, Qualifier=360 2200 DTP 3
End Date, Qualifier=361 2200 DTP 3
Health Coverage, Loop 2300
Maintenance Code 2300 HD 1
Insurance Line Code 2300 HD 3
Coverage Level 2300 HD 5
Late Enrollment 2300 HD 9
Benefit Begin, Qualifier=348 2300 DTP 3
End Date, Qualifier=349 2300 DTP 3
Co-Insurace, Qualifier=B9 2300 AMT 2
Co-Payment, Qualifier=C1 2300 AMT 2
Deductible, Qualifier=D2 2300 AMT 2
Premium, Qualifier=P3 2300 AMT 2
Spend Down, Qualifier=R 2300 AMT 2
Provider Information, Loop 2310
Line No 2310 LX 1
Last Name 2310 NM1 3
First Name 2310 NM1 4
Coordination of Benefit Loop 2320
Payer Resp code 2320 COB 1
Policy No 2320 COB 2
COB code 2320 COB 3
COB Service Type 2320 COB 4
Benefit Begin, Qualifier=344 2320 DTP 3
End Date, Qualifier=345 2320 DTP 3