EDI 834 Benefit Enrollment And Maintenance

This X12 Transaction Set contains the format and establishes the data contents of the Abandoned Property Filings Transaction Set 834 for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set is used to report abandoned property filings information, such as uncashed checks or abandoned bank account balances, to government agencies and may be used by the government agencies to distribute information on abandoned property for publication to the general public. It may also be used to initiate an Electronic Funds Transfer (EFT) payment to transfer the value of the abandoned property to the government agencies.

Segments

Position

Segment

Name

Max use

Transaction Set Header

Mandatory

AtMax 1

To indicate the start of a transaction set and to assign a control number

BGN

Beginning Segment

Mandatory

AtMax 1

To indicate the beginning of a transaction set

REF

Reference Identification

Opt

GT 1

To specify identifying information

DTP

Date or Time or Period

Opt

GT 1

To specify any or all of a date, a time, or a time period

AMT

Monetary Amount

Opt

GT 1

To indicate the total monetary amount

QTY

Quantity

Opt

GT 1

To specify quantity information

1000

LOOP

Mandatory

GT 1

Name

Mandatory

AtMax 1

To identify a party by type of organization, name, and code

Additional Name Information

Opt

AtMax 2

To specify additional names or those longer than 35 characters in length

Address Information

Opt

AtMax 2

To specify the location of the named party

100

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

110

PER

Administrative Communications Contact

Opt

AtMax 3

To identify a person or office to whom administrative communications should be directed

1100

LOOP

Mandatory

AtMax 10

120

ACT

Account Identification

Opt

AtMax 1

To specify account information

130

REF

Reference Identification

Opt

AtMax 5

To specify identifying information

140

Address Information

Opt

AtMax 1

To specify the location of the named party

150

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

160

PER

Administrative Communications Contact

Opt

AtMax 5

To identify a person or office to whom administrative communications should be directed

170

DTP

Date or Time or Period

Opt

AtMax 1

To specify any or all of a date, a time, or a time period

180

AMT

Monetary Amount

Opt

AtMax 1

To indicate the total monetary amount

2000

LOOP

Mandatory

GT 1

INS

Insured Benefit

Opt

AtMax 1

To provide benefit information on insured entities

REF

Reference Identification

Mandatory

GT 1

To specify identifying information

DTP

Date or Time or Period

Opt

GT 1

To specify any or all of a date, a time, or a time period

2100

LOOP

Mandatory

GT 1

NM1

Individual or Organizational Name

Opt

AtMax 1

To supply the full name of an individual or organizational entity

PER

Administrative Communications Contact

Opt

AtMax 1

To identify a person or office to whom administrative communications should be directed

Address Information

Opt

AtMax 1

To specify the location of the named party

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

DMG

Demographic Information

Opt

AtMax 1

To supply demographic information

Electronic Funds Transfer Information

Opt

AtMax 1

To supply information on the electronic funds transfer (EFT) method of payment

100

Employment Class

Opt

GT 1

To provide class of employment information

110

ICM

Individual Income

Opt

AtMax 1

To supply information to determine benefit eligibility, deductibles, and retirement and investment contributions

120

AMT

Monetary Amount

Opt

AtMax 10

To indicate the total monetary amount

130

HLH

Health Information

Opt

AtMax 1

To provide health information

140

Health Care Information Codes

Opt

AtMax 10

To supply information related to the delivery of health care

150

LUI

Language Use

Opt

GT 1

To specify language, type of usage, and proficiency or fluency

2200

LOOP

Mandatory

AtMax 4

200

DSB

Disability Information

Opt

AtMax 1

To supply disability information

210

DTP

Date or Time or Period

Opt

AtMax 10

To specify any or all of a date, a time, or a time period

220

AD1

Adjustment Amount

Opt

AtMax 10

To specify the characteristics of an adjustment

2300

LOOP

Mandatory

AtMax 99

260

Health Coverage

Opt

AtMax 1

To provide information on health coverage

270

DTP

Date or Time or Period

Opt

AtMax 10

To specify any or all of a date, a time, or a time period

280

AMT

Monetary Amount

Opt

AtMax 3

To indicate the total monetary amount

290

REF

Reference Identification

Opt

AtMax 5

To specify identifying information

300

IDC

Identification Card

Opt

GT 1

To provide notification to produce replacement identification card(s)

2310

LOOP

Mandatory

AtMax 30

310

Assigned Number

Opt

AtMax 1

To reference a line number in a transaction set

320

NM1

Individual or Organizational Name

Opt

AtMax 1

To supply the full name of an individual or organizational entity

330

Name

Opt

AtMax 3

To identify a party by type of organization, name, and code

340

Additional Name Information

Opt

AtMax 1

To specify additional names or those longer than 35 characters in length

350

Address Information

Opt

AtMax 2

To specify the location of the named party

360

Geographic Location

Opt

AtMax 2

To specify the geographic place of the named party

370

PER

Administrative Communications Contact

Opt

AtMax 2

To identify a person or office to whom administrative communications should be directed

380

PRV

Provider Information

Opt

AtMax 1

To specify the identifying characteristics of a provider

390

DTP

Date or Time or Period

Opt

AtMax 6

To specify any or all of a date, a time, or a time period

395

PLA

Place or Location

Opt

AtMax 1

To indicate action to be taken for the location specified and to qualify the location specified

2320

LOOP

Mandatory

AtMax 5

400

COB

Coordination of Benefits

Opt

AtMax 1

To supply information on coordination of benefits

405

REF

Reference Identification

Opt

GT 1

To specify identifying information

410

Name

Opt

AtMax 1

To identify a party by type of organization, name, and code

420

Additional Name Information

Opt

AtMax 1

To specify additional names or those longer than 35 characters in length

430

Address Information

Opt

AtMax 2

To specify the location of the named party

440

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

450

DTP

Date or Time or Period

Opt

AtMax 2

To specify any or all of a date, a time, or a time period

2400

LOOP

Mandatory

AtMax 10

460

Life Coverage

Opt

AtMax 1

To provide information on life coverage

470

AMT

Monetary Amount

Opt

AtMax 5

To indicate the total monetary amount

480

DTP

Date or Time or Period

Opt

AtMax 2

To specify any or all of a date, a time, or a time period

485

REF

Reference Identification

Opt

GT 1

To specify identifying information

2410

LOOP

Mandatory

AtMax 20

490

BEN

Beneficiary or Owner Information

Opt

AtMax 1

To supply beneficiary, co-participant, and owner information

500

NM1

Individual or Organizational Name

Opt

AtMax 1

To supply the full name of an individual or organizational entity

510

Name

Opt

AtMax 1

To identify a party by type of organization, name, and code

520

Additional Name Information

Opt

AtMax 1

To specify additional names or those longer than 35 characters in length

530

Address Information

Opt

AtMax 1

To specify the location of the named party

540

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

542

DMG

Demographic Information

Opt

AtMax 1

To supply demographic information

2500

LOOP

Mandatory

AtMax 5

550

FSA

Flexible Spending Account

Opt

AtMax 1

To supply flexible spending account information

560

AMT

Monetary Amount

Opt

AtMax 10

To indicate the total monetary amount

570

DTP

Date or Time or Period

Opt

AtMax 10

To specify any or all of a date, a time, or a time period

575

REF

Reference Identification

Opt

GT 1

To specify identifying information

2600

LOOP

Mandatory

GT 1

580

Retirement Product

Opt

AtMax 1

To specify the retirement product characteristics

590

DTP

Date or Time or Period

Opt

GT 1

To specify any or all of a date, a time, or a time period

592

REF

Reference Identification

Opt

GT 1

To specify identifying information

594

INV

Investment Vehicle Selection

Opt

GT 1

To specify type of investment vehicle or account and other basic data about the investment

596

AMT

Monetary Amount

Opt

AtMax 20

To indicate the total monetary amount

597

QTY

Quantity

Opt

AtMax 20

To specify quantity information

598

File Information

Opt

AtMax 3

To transmit a fixed-format record or matrix contents

600

REL

Relationship

Opt

AtMax 1

To specify relationship and birth order of entity

2610

LOOP

Mandatory

GT 1

610

NM1

Individual or Organizational Name

Opt

AtMax 1

To supply the full name of an individual or organizational entity

630

Additional Name Information

Opt

AtMax 1

To specify additional names or those longer than 35 characters in length

651

DMG

Demographic Information

Opt

AtMax 1

To supply demographic information

652

BEN

Beneficiary or Owner Information

Opt

AtMax 1

To supply beneficiary, co-participant, and owner information

653

REF

Reference Identification

Opt

GT 1

To specify identifying information

2620

LOOP

Mandatory

GT 1

654

NX1

Property or Entity Identification

Opt

AtMax 1

To define the attributes of a property or an entity

655

Address Information

Opt

AtMax 1

To specify the location of the named party

656

Geographic Location

Opt

AtMax 1

To specify the geographic place of the named party

657

DTP

Date or Time or Period

Opt

GT 1

To specify any or all of a date, a time, or a time period

2630

LOOP

Mandatory

GT 1

660

Financial Contribution

Opt

AtMax 1

To specify the financial contribution information

670

DTP

Date or Time or Period

Opt

GT 1

To specify any or all of a date, a time, or a time period

2640

LOOP

Mandatory

GT 1

678

INV

Investment Vehicle Selection

Opt

AtMax 1

To specify type of investment vehicle or account and other basic data about the investment

679

DTP

Date or Time or Period

Opt

GT 1

To specify any or all of a date, a time, or a time period

680

QTY

Quantity

Opt

GT 1

To specify quantity information

681

ENT

Entity

Opt

GT 1

To designate the entities which are parties to a transaction and specify a reference meaningful to those entities

682

REF

Reference Identification

Opt

GT 1

To specify identifying information

683

AMT

Monetary Amount

Opt

AtMax 20

To indicate the total monetary amount

684

File Information

Opt

AtMax 3

To transmit a fixed-format record or matrix contents

2650

LOOP

Mandatory

GT 1

685

AIN

Income

Opt

AtMax 1

To provide type and amount of income obtained

686

QTY

Quantity

Opt

GT 1

To specify quantity information

687

DTP

Date or Time or Period

Opt

GT 1

To specify any or all of a date, a time, or a time period

690

Transaction Set Trailer

Mandatory

AtMax 1

To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)

Elements

Position	Element	Name	Requirement	Type	Min/Max	Repeat

1	143	Transaction Set Identifier Code	Mandatory	ID	3/3	1

2	329	Transaction Set Control Number	Mandatory	Alphanumeric	4/9	1

EDI Dictionary

EDI 834 Benefit Enrollment And Maintenance

Segments

Elements