834 Transaction - Benefit Enrollment

Overview

The 834 Transaction is the HIPAA-compliant Benefit Enrollment and Maintenance Transaction. Its purpose is to electronically transmit enrollment and dis-enrollment information.

In 2004, DHCS implemented a 4010 834 solution, however, this was implemented along with a supplemental transaction that held eligibility history.

The HIPAA 5010 version of all transactions is scheduled to be implemented on January 1st, 2012. DHCS will implement a compliant 5010 834 on this date. The current FAME file will continue to be made available for a short period of time after this date to allow plans time to transition. Once this transition period has been completed the FAME file will no longer be made available to managed care plans.

Impacted Covered Entities

Internal DHCS program areas and DHCS Health Plan trading partners.

Links

4010 834 Documents

Non-COHS Documents

COHS Documents

5010 834 DOCUMENTS

5010 834 Companion Guide (pdf)

5010 834 Mapping - X12 (pdf)

5010 834 Mapping - FAME  (pdf)

5010 834 Generic Test Data Overview (pdf)

DHCS 834-DA20110712 - Medical-123-HCP-001.txt

DHCS 834-DA20110712 - Dental - 495-HCP-001.txt

DHCS 834-DA20110712 - Dental - 4912-Vendor-001.txt

4010 834 Documents

FAQ's on 834+Supplemental File Production Release

834 + Supplemental File Data Scenarios (pdf) 

FINAL 834 Companion Guide v8 (pdf) 

834 Standard Companion Guide Change Report v7 to v8 (pdf)

Sample 834 Transaction (txt) or Sample 834 Dental Transaction (txt) - Note: These sample files have been modified for viewing on the website. The real file will be transmitted in 80 character fixed blocks. There is no PHI on this file and the data provided shows maximum field lengths and is not intended to be an accurate reflection of actual data that a health plan may see on their own file.

General FAME Documents

FAME Data Element Dictionary (pdf)

MEDS Renewal and Recon Schedule 2008 (pdf)

Non-COHS Documents

FAME File Names effective 03/21/2005 (pdf)

Medicare Part D PDP Non-COHS FAME layout (pdf)

Non-COHS FAME to 834 Mapping document (pdf)

COHS Documents

COHS FAME to 834 Mapping document w/Medicare Part D (pdf)

Medicare Part D COHS FAME layout (pdf)

mEDICARE pART d iNFORMATION

Project Information 

DHCS Medicare Part D information web page

MMA Part D Quick Reference Guide (pdf)

MEDS Quick Reference Guide (pdf)

MMA Part D Carrier Cross Reference Table (pdf)

File Layouts

MMEF 2100 Medicare Part D layout (pdf)

MMEF REC Medicare Part D layout (pdf)