Build and submit an X12 834 benefit enrollment transaction

Verified steps

1. Assemble the ISA/GS envelope for transaction set 834 (Benefit Enrollment and Maintenance) with your sender ID (the employer or benefits administrator) and the receiver ID (the health plan or TPA)
2. Construct the BGN segment to indicate whether this is an initial enrollment file, a change file, or a full replacement file; replacement files replace all existing enrollment data for the group, so use them only when intended
3. For each member, build an INS segment specifying the member's relationship to the subscriber (self, spouse, child) and the maintenance type code indicating whether this is an addition, change, or termination of coverage
4. Add REF segments for member IDs (SSN, member ID), DTP segments for coverage effective and termination dates, and NM1/PER segments for member demographics and contact information
5. Include HD segments to specify the health coverage plan code, coverage type, and insurance line for each plan the member is enrolling in; attach COB segments if the member has other insurance
6. Close with SE, GE, and IEA trailers and transmit to the health plan via the agreed channel (SFTP or API with YOUR_TOKEN); confirm receipt of a 999 functional acknowledgment before considering the enrollment submitted