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834 Transmission Page Map | |
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Fields that Display by Default | |
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Field on Transmission Page |
Location of Data in EDI |
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Amount |
n/a |
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Assigned |
From My Tasks page |
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Document Date |
BGN03 + BGN04 |
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Number of Errors |
Count of errors with a severity greater than 2 |
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Original File Date |
Date supplied by the -m Instream command line parameter |
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Original File Name |
Name supplied by the -m Instream command line parameter |
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Receiver |
Criteria set up by TI administrator |
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Sender |
Criteria set up by TI administrator |
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Status |
From My Tasks page See List of Statuses |
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Submitter Identifier |
2000 - Subscriber Number REF02 |
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Fields that you can add with Choose Fields Link | |
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Field on Transmission Page |
Location of Data in EDI |
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Beginning Segment Action Code |
BGN08 |
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Beginning Segment Cross Reference Identification |
BGN06 |
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Beginning Segment Date |
BGN03 |
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Beginning Segment Reference Identification |
BGN02 |
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Beginning Segment Time |
BGN04 |
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Beginning Segment Time Code |
BGN05 |
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Beginning Segment Transaction Set Purpose Code |
BGN01 |
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COB Effective Date Time Period |
File Effective Date DTP03 |
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COB Effective Date Time Period Format Qualifier |
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COB Effective Date Time Qualifier |
File Effective Date DTP01 |
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COB Eligibility Date Time Period |
2320 - DTP03 if available Otherwise 2300 - DTP03 |
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COB Eligibility Date Time Period Format Qualifier |
2320 - DTP02 if available Otherwise 2300 - DTP02 |
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COB Eligibility Date Time Qualifier |
2320 - DTP01 if available Otherwise 2300 - DTP01 |
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Disability Type Code |
2200 - DSB01 |
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Incorrect Member Demographics Date Time Period |
2100B - DMG02 |
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Incorrect Member Demographics Date Time Period Format Qualifier |
2100B - DMG01 |
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Incorrect Member Demographics Gender Code |
2100B - DMG03 |
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Incorrect Member Name Entity Identifier Code |
2100B - NM101 |
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Incorrect Member Name Entity Type Qualifier |
2100B - NM102 |
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Incorrect Member Name First |
2100B - NM104 |
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Incorrect Member Name Identification Code |
2100B - NM109 |
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Incorrect Member Name Identification Code Qualifier |
2100B - NM108 |
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Incorrect Member Name Last or Organization |
2100B - NM103 |
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Incorrect Member Name Middle |
2100B - NM105 |
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Incorrect Member Name Prefix |
2100B - NM106 |
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Incorrect Member Name Suffix |
2100B - NM107 |
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Medical Code Value |
2200 - DSB08 |
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Member Benefit Status Code |
2000 - INS05 |
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Member COBRA Qualifying Event Code |
2000 - INS07 |
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Member Communications Contact Function Code |
2100A - PER01 |
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Member Communications Number 1 |
2100A - PER04 |
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Member Communications Number 2 |
2100A - PER06 |
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Member Communications Number 3 |
2100A - PER08 |
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Member Communications Number Qualifier 1 |
2100A - PER03 |
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Member Communications Number Qualifier 2 |
2100A - PER05 |
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Member Communications Number Qualifier 3 |
2100A - PER07 |
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Member Date Time Period |
2000 - INS12 |
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Member Date Time Period Format Qualifier |
2000 - INS11 |
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Member Demographics Citizenship Status Code |
2100A - DMG06 |
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Member Demographics Date Time Period |
2100A - DMG02 |
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Member Demographics Date Time Period Format Qualifier |
2100A - DMG01 |
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Member Demographics Gender Code |
2100A - DMG03 |
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Member Demographics Marital Status Code |
2100A - DMG04 |
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Member Demographics Race or Ethnicity Code |
2100A - DMG05 |
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Member Employment Status Code |
2000 - INS08 |
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Member First Name |
2100A - NM104 |
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Member Handicapped (Y) Status |
2000 - INS10 |
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Member Individual Relationship Code |
2000 - INS02 |
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Member Last Name |
2100A - NM103 |
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Member Level Date Time Period |
2000 - DTP03 |
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Member Level Date Time Period Format Qualifier |
2000 - DTP02 |
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Member Level Date Time Qualifier |
2000 - DTP01 |
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Member Maintenance Reason Code |
2000 - INS04 |
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Member Maintenance Type Code |
2000 - INS03 |
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Member Medicare Plan Code |
2000 - INS06 |
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Member Number |
2000 - INS17 |
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Member Policy Number Reference Identification |
2000 - Member Policy Number REF02 |
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Member Policy Number Reference Identification Qualifier |
2000 – Member Policy Number REF01 |
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Member Residence City Name |
2100A - N401 |
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Member Residence Country Code |
2100A - N404 |
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Member Residence Location Identifier |
2100A - N406 |
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Member Residence Location Qualifier |
2100A - N405 |
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Member Residence Postal Code |
2100A - N403 |
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Member Residence State or Province Code |
2100A - N402 |
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Member Residence Street Address 1 |
2100A - N301 |
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Member Residence Street Address 2 |
2100A - N302 |
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Member Student Status Code |
2000 - INS09 |
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Member Subscriber (Y) or Dependent (N) Status |
2000 - INS01 |
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Payer Identification Code |
1000B - N104 |
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Payer Name |
1000B - N102 |
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Product/Service ID Qualifier |
2200 - DSB07 |
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Sponsor Identification Code |
1000A - N104 |
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Sponsor Name |
1000A - N102 |
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Subscriber Number |
2000 - Subscriber Number REF02 |
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TPA/Broker Identification Code |
1000C - N104 |
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TPA/Broker Name |
1000C - N102 |
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Transaction Set Policy Number Reference Identification |
Transaction Set Policy Number REF02 |
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Transaction Set Policy Number Reference Identification Qualifier |
Transaction Set Policy Number REF01 |