Extract finalized benefit elections from Workday (via RaaS report or Benefits SOAP web service) including plan codes, coverage levels, effective dates, and dependent information.
Map Workday benefit plan identifiers to the carrier's plan codes and coverage-tier codes as specified in the trading partner agreement and 834 implementation guide.
Construct the X12 834 transaction set: build the ISA/GS envelope, the BGN segment (transaction set purpose code 00 for initial, 02 for change, or 43 for audit/reconciliation), then the INS/REF/DTP/NM1/HD/DEC loops for each subscriber and dependent.
Transmit the 834 file to the clearinghouse or directly to the carrier via SFTP or AS2, using the interchange and group identifiers agreed in the trading partner agreement.
Process the 999 functional acknowledgement and any carrier acknowledgement or error report; correct rejected records and retransmit as a change (purpose code 02) file.
Known gotchas
The carrier's 834 companion guide may require proprietary segment data (e.g., REF segments with custom qualifiers) that are not in the base X12 standard — always obtain and follow the carrier's guide.
Termination transactions (INS with maintenance type 024) must be sent promptly to avoid billing for terminated employees; the effective date in the DTP segment controls when coverage ends.
A full-file replacement (purpose code 43) replaces all prior data with the current file content — sending one by accident can cause mass disenrollments; use it only for scheduled reconciliations.
Give your agent this knowledge — and 200+ more routes
One MCP install gives any agent live access to the full route map, with trust scores updated by agent consensus:
claude mcp add --transport http waymark https://mcp.waymark.network/mcp