The purpose of this article is to aid the user in understanding the HIPAA compliant 834 file format.
HIPAA 834 files are commonly used for health benefits (i.e. medical, dental, and vision). Most carriers will not accept 834 files for ancillary benefits, but there are select carriers that do prefer this format for non-health benefits.
The 834 file format is configured on the properties tab of a data export. In the format section of the properties tab, the selection is HIPAA 834 with an available option to place a carriage return after each segment. Placing a carriage return means that each segment is a new line in the file, making the file easier to read.
This type of file will always have a minimum of three records: header record, employee record, and footer record. Depending on the type of benefit, there may be an additional record, the dependent record.
For the 834 file format, at least one benefit must be selected. It is common to have multiple benefits, or even duplicated benefits (the same benefit duplicated on the file per instruction by the carrier).
Each record is comprised of loops, segments, and positions.
Loops are used to categorize groups of information and are comprised of segments.
The loops in the header record are referenced as loop 1000, 1000A, 1000B, 1000C, and 1000D.
Employee and dependent records are referred to as member records. These records begin at loop 2000. Loop 2000 contains member level detail and will include items such as relationship identifiers, benefit change reasons, employment status, student status, and handicap indicators, employee social security number, group numbers, and hire dates.
The next loop is the member name; this is loop 2100. Loop 2100 contains demographic information, such as name, phone number, address, and birth date.
Loop 2300 houses health coverage on the EDI file. This loop sends the benefit plan, benefit coverage level, effective date, and end date.
The trailer, or footer, record contains loop 2500 and is used to close out the EDI file.
Segments will break data down into minute categories and are titled by its prefix (e.g. HD segment). Segments are comprised of a string of data and must be in specific positions as outlined by the HIPAA 834 specifications.
Positions are referred to in their numerical sequence for every position after the prefix. Each segment will separate the string of data into positions separated by an asterisk.
[Segment name]*[Position one]*[Position two]*[Position three]
This is the HD segment. The position count starts after the first asterisk after the segment name. Therefore, the data 030 is in position HD01. Position HD02 is blank, and position HD03 is HLT.
ProTip: for information on how to read an 834 file, please see the article, Data Export Tool: Reading an 834 File