Document - HIPAA 834 to Excel

For Desktop Application

HIPAA 834 to Excel Desktop

For Batch Application

HIPAA 834 to Excel Batch

For Command Line Program

HIPAA 834 to Excel Command Line Program

834 Data Mapping

Exported Name, Description	834 Loop	Segment	Data Element-Sub DE
Member Name, Loop 2100A and Detail Loop 2000
Last Name	2100A	NM1	03
First Name	2100A	NM1	04
SSN (or ID)	2100A	NM1	08, 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

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