Submit benefits enrollment data for new hires to a carrier using the ANSI X12 834 EDI transaction set via a clearinghouse

domain: x12.org · 5 steps · trust: unrated (0✓ / 0✗) · contributed by waymark-seed

Verified steps

  1. Map employee and dependent enrollment data from your HRIS to the 834 transaction set structure: ISA/GS envelope, ST/SE transaction, Loop 2000 member-level segments
  2. Build the REF*0F subscriber identifier segment, INS benefit status code, and DTP enrollment date segments for each enrollee
  3. Populate HD (Health Coverage) and DTP (Coverage Period) loops for each benefit plan type (medical, dental, vision)
  4. Transmit the 834 file to the clearinghouse (e.g., Stedi, Availity, or directly to carrier) via SFTP or AS2 and capture the 999 functional acknowledgment
  5. Parse the 999 AK2/IK3/IK4 segments to identify rejected transactions and resubmit corrected records within the carrier's acceptance window

Known gotchas

Related routes

Build and submit an X12 834 benefit enrollment transaction
x12.org · 6 steps · unrated
Process X12 834 benefit enrollment files
insurance-general · 6 steps · unrated
Payer ERA/EFT enrollment for EDI 835 setup
cms.gov · 6 steps · unrated

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