Sana
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Sana Inbound - Standard
  • Specification
  • EDI Inspector
Sana

X12 834 Sana Inbound - Standard

X12 Release 5010Revised
Feb 18, 8:21 PM
Delimiters
  • ~ Segment
  • * Element
  • > Component
  • ^ Repetition
EDI samples
  • Sample 1
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Overview
ISA
-
Interchange Control Header
Max use 1
Required
GS
-
Functional Group Header
Max use 1
Required
heading
ST
0100
Transaction Set Header
Max use 1
Required
BGN
0200
Beginning Segment
Max use 1
Required
REF
0300
Reference Information
Max use 1
Optional
DTP
0400
Date or Time or Period
Max use 1
Optional
QTY
0600
Quantity Information
Max use 1
Optional
1000 Loop
GE
-
Functional Group Trailer
Max use 1
Required
IEA
-
Interchange Control Trailer
Max use 1
Required
ISA

Interchange Control Header

RequiredMax use 1
Example
ISA-01
I01
Authorization Information Qualifier
Required
Identifier (ID)
00
No Authorization Information Present (No Meaningful Information in I02)
ISA-02
I02
Authorization Information
Required
String (AN)
Min 10Max 10
ISA-03
I03
Security Information Qualifier
Required
Identifier (ID)
00
No Security Information Present (No Meaningful Information in I04)
ISA-04
I04
Security Information
Required
String (AN)
Min 10Max 10
ISA-05
I05
Interchange ID Qualifier
Required
Identifier (ID)
Min 2Max 2
Codes
ISA-06
I06
Interchange Sender ID
Required
String (AN)
Min 15Max 15
ISA-07
I05
Interchange ID Qualifier
Required
Identifier (ID)
Min 2Max 2
Codes
ISA-08
I07
Interchange Receiver ID
Required
String (AN)
Min 15Max 15
ISA-09
I08
Interchange Date
Required
Date (DT)
YYMMDD format
ISA-10
I09
Interchange Time
Required
Time (TM)
HHMM format
ISA-11
I65
Repetition Separator
Required
String (AN)
Min 1Max 1
^
Repetition Separator
ISA-12
I11
Interchange Control Version Number
Required
Identifier (ID)
00501
Standards Approved for Publication by ASC X12 Procedures Review Board through October 2003
ISA-13
I12
Interchange Control Number
Required
Numeric (N0)
Min 9Max 9
ISA-14
I13
Acknowledgment Requested
Required
Identifier (ID)
Min 1Max 1
0
No Interchange Acknowledgment Requested
1
Interchange Acknowledgment Requested (TA1)
ISA-15
I14
Interchange Usage Indicator
Required
Identifier (ID)
Min 1Max 1
I
Information
P
Production Data
T
Test Data
ISA-16
I15
Component Element Separator
Required
String (AN)
Min 1Max 1
>
Component Element Separator

Functional Group Header

RequiredMax use 1
Example
GS-01
479
Functional Identifier Code
Required
Identifier (ID)
BE
Benefit Enrollment and Maintenance (834)
GS-02
142
Application Sender's Code
Required
String (AN)
Min 2Max 15
GS-03
124
Application Receiver's Code
Required
String (AN)
Min 2Max 15
Required
Date (DT)
CCYYMMDD format
Required
Time (TM)
HHMM, HHMMSS, HHMMSSD, or HHMMSSDD format
GS-06
28
Group Control Number
Required
Numeric (N0)
Min 1Max 9
GS-07
455
Responsible Agency Code
Required
Identifier (ID)
Min 1Max 2
T
Transportation Data Coordinating Committee (TDCC)
X
Accredited Standards Committee X12
GS-08
480
Version / Release / Industry Identifier Code
Required
String (AN)
005010
Standards Approved for Publication by ASC X12 Procedures Review Board through October 2003

Heading

ST
0100
Heading > ST

Transaction Set Header

RequiredMax use 1
Example
ST-01
143
Transaction Set Identifier Code
Required
Identifier (ID)
834
Benefit Enrollment and Maintenance
ST-02
329
Transaction Set Control Number
Required
String (AN)
Min 4Max 9
ST-03
1705
Implementation Convention Reference
Optional
String (AN)
Min 1Max 35
BGN
0200
Heading > BGN

Beginning Segment

RequiredMax use 1
Example
If Time Code (BGN-05) is present, then Time (BGN-04) is required
BGN-01
353
Transaction Set Purpose Code
Required
Identifier (ID)
Min 2Max 2
BGN-02
127
Reference Identification
Required
String (AN)
Min 1Max 50
Required
Date (DT)
CCYYMMDD format
Optional
Time (TM)
HHMM, HHMMSS, HHMMSSD, or HHMMSSDD format
BGN-05
623
Time Code
Optional
Identifier (ID)
Min 2Max 2
BGN-08
306
Action Code
Optional
Identifier (ID)
Min 1Max 2
REF
0300
Heading > REF

Reference Information

OptionalMax use >1
Example
REF-01
128
Reference Identification Qualifier
Optional
Identifier (ID)
Min 2Max 3
REF-02
127
Reference Identification
Optional
String (AN)
Min 1Max 50
DTP
0400
Heading > DTP

Date or Time or Period

OptionalMax use >1
Example
DTP-01
374
Date/Time Qualifier
Required
Identifier (ID)
007
Effective
303
Maintenance Effective
382
Enrollment
DTP-02
1250
Date Time Period Format Qualifier
Required
Identifier (ID)
Min 2Max 3
DTP-03
1251
Date Time Period
Required
String (AN)
Min 1Max 35
QTY
0600
Heading > QTY

Quantity Information

OptionalMax use >1
Example
QTY-01
673
Quantity Qualifier
Required
Identifier (ID)
DT
Dependent Total
ET
Employee Total
TO
Total
QTY-02
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
1000 Loop
RequiredMax >1
N1
0700
Heading > 1000 Loop > N1

Party Identification

RequiredMax use 1
Example
N1-01
98
Entity Identifier Code
Required
Identifier (ID)
IN
Insurer
P5
Plan Sponsor
TV
Third Party Administrator (TPA)
Required
String (AN)
Min 1Max 60
N1-03
66
Identification Code Qualifier
Optional
Identifier (ID)
24
Employer's Identification Number
FI
Federal Taxpayer's Identification Number
N1-04
67
Identification Code
Optional
String (AN)
Min 2Max 80
1000 Loop end
Heading end

Detail

2000 Loop
RequiredMax >1
INS
0100
Detail > 2000 Loop > INS

Insured Benefit

RequiredMax use 1
Example
INS-01
1073
Yes/No Condition or Response Code
Required
Identifier (ID)
N
No
Y
Yes
INS-02
1069
Individual Relationship Code
Required
Identifier (ID)
01
Spouse
17
Stepson or Stepdaughter
18
Self
19
Child
26
Guardian
53
Life Partner
INS-03
875
Maintenance Type Code
Required
Identifier (ID)
Min 3Max 3
INS-04
1203
Maintenance Reason Code
Optional
Identifier (ID)
Min 2Max 3
INS-05
1216
Benefit Status Code
Optional
Identifier (ID)
A
Active
C
Consolidated Omnibus Budget Reconciliation Act (COBRA)
INS-06
C052
Medicare Status Code
OptionalMax use 1
To provide Medicare coverage and associated reason for Medicare eligibility
C052-01
1218
Medicare Plan Code
Required
Identifier (ID)
Min 1Max 1
INS-07
1219
Consolidated Omnibus Budget Reconciliation Act (COBRA) Qualifying Event Code
Optional
Identifier (ID)
Min 1Max 2
INS-08
584
Employment Status Code
Optional
Identifier (ID)
AC
Active
FT
Full-time
PT
Part-time
RT
Retired
TE
Terminated
INS-09
1220
Student Status Code
Optional
Identifier (ID)
Min 1Max 1
INS-10
1073
Yes/No Condition or Response Code
Optional
Identifier (ID)
Min 1Max 1
REF
0200
Detail > 2000 Loop > REF

Reference Information

RequiredMax use 2
Usage notes
Example
REF-01
128
Reference Identification Qualifier
Required
Identifier (ID)
0F
Subscriber SSN
1L
Group Number
REF-02
127
Reference Identification
Required
String (AN)
Min 1Max 50
REF-03
352
Sub-group
Optional
String (AN)
Min 1Max 80
DTP
0250
Detail > 2000 Loop > DTP

Date or Time or Period

OptionalMax use 2
Example
DTP-01
374
Date/Time Qualifier
Required
Identifier (ID)
336
Employment Begin
337
Employment End
DTP-02
1250
Date Time Period Format Qualifier
Required
Identifier (ID)
D8
Date Expressed in Format CCYYMMDD
DTP-03
1251
Date Time Period
Required
String (AN)
Min 8Max 35
2100 Loop
RequiredMax >1
NM1
0300
Detail > 2000 Loop > 2100 Loop > NM1

Individual or Organizational Name

RequiredMax use 1
Example
If either Identification Code Qualifier (NM1-08) or Identification Code (NM1-09) is present, then the other is required
NM1-01
98
Entity Identifier Code
Required
Identifier (ID)
IL
Insured or Subscriber
NM1-02
1065
Entity Type Qualifier
Required
Identifier (ID)
1
Person
NM1-03
1035
Name Last or Organization Name
Required
String (AN)
Min 1Max 60
NM1-04
1036
Name First
Required
String (AN)
Min 1Max 35
NM1-05
1037
Name Middle
Optional
String (AN)
Min 1Max 25
NM1-06
1038
Name Prefix
Optional
String (AN)
Min 1Max 10
NM1-07
1039
Name Suffix
Optional
String (AN)
Min 1Max 10
NM1-08
66
Identification Code Qualifier
Optional
Identifier (ID)
34
Social Security Number
NM1-09
67
Identification Code
Optional
String (AN)
Min 9Max 9
PER
0400
Detail > 2000 Loop > 2100 Loop > PER

Administrative Communications Contact

OptionalMax use 1
Example
PER-01
366
Contact Function Code
Required
Identifier (ID)
IP
Insured Party
PER-03
365
Communication Number Qualifier
Required
Identifier (ID)
CP
Cellular Phone
EM
Electronic Mail
HP
Home Phone Number
TE
Telephone
WP
Work Phone Number
PER-04
364
Communication Number
Optional
String (AN)
Min 1Max 256
PER-05
365
Communication Number Qualifier
Optional
Identifier (ID)
CP
Cellular Phone
EM
Electronic Mail
HP
Home Phone Number
TE
Telephone
WP
Work Phone Number
PER-06
364
Communication Number
Optional
String (AN)
Min 1Max 256
PER-07
365
Communication Number Qualifier
Optional
Identifier (ID)
CP
Cellular Phone
EM
Electronic Mail
TE
Telephone
WP
Work Phone Number
PER-08
364
Communication Number
Optional
String (AN)
Min 1Max 256
N3
0500
Detail > 2000 Loop > 2100 Loop > N3

Party Location

RequiredMax use 1
Example
N3-01
166
Address Information
Required
String (AN)
Min 1Max 55
N3-02
166
Address Information
Optional
String (AN)
Min 1Max 55
N4
0600
Detail > 2000 Loop > 2100 Loop > N4

Geographic Location

RequiredMax use 1
Example
N4-01
19
City Name
Required
String (AN)
Min 2Max 30
N4-02
156
State or Province Code
Required
Identifier (ID)
Min 2Max 2
N4-03
116
Postal Code
Required
Identifier (ID)
Min 5Max 9
DMG
0800
Detail > 2000 Loop > 2100 Loop > DMG

Demographic Information

OptionalMax use 1
Example
DMG-01
1250
Date Time Period Format Qualifier
Required
Identifier (ID)
D8
Date Expressed in Format CCYYMMDD
DMG-02
1251
Date Time Period
Required
String (AN)
Min 8Max 8
DMG-03
1068
Gender Code
Required
Identifier (ID)
F
Female
M
Male
U
Unknown
DMG-04
1067
Marital Status Code
Optional
Identifier (ID)
Min 1Max 1
DMG-06
1066
Citizenship Status Code
Optional
Identifier (ID)
Min 1Max 2
ICM
1100
Detail > 2000 Loop > 2100 Loop > ICM

Individual Income

OptionalMax use 1
Example
ICM-01
594
Frequency Code
Required
Identifier (ID)
7
Annual
H
Hourly
ICM-02
782
Monetary Amount
Required
Decimal number (R)
Min 1Max 15
ICM-03
380
Quantity
Optional
Decimal number (R)
Min 1Max 15
ICM-04
310
Location Identifier
Optional
String (AN)
Min 1Max 30
HLH
1300
Detail > 2000 Loop > 2100 Loop > HLH

Health Information

OptionalMax use 1
Example
HLH-01
1212
Health-Related Code
Optional
Identifier (ID)
Min 1Max 1
2100 Loop end
2300 Loop
RequiredMax >1
HD
2600
Detail > 2000 Loop > 2300 Loop > HD

Health Coverage

RequiredMax use 1
Example
HD-01
875
Maintenance Type Code
Required
Identifier (ID)
Min 3Max 3
HD-02
1203
Maintenance Reason Code
Optional
Identifier (ID)
Min 2Max 3
HD-03
1205
Insurance Line Code
Required
Identifier (ID)
DEN
Dental
HLT
Health
VIS
Vision
HD-04
1204
Plan Coverage Description
Optional
String (AN)
Min 1Max 50
HD-05
1207
Coverage Level Code
Optional
Identifier (ID)
Min 3Max 3
DTP
2700
Detail > 2000 Loop > 2300 Loop > DTP

Date or Time or Period

RequiredMax use 10
Example
DTP-01
374
Date/Time Qualifier
Required
Identifier (ID)
Max use 2
348
Benefit Begin
349
Benefit End
DTP-02
1250
Date Time Period Format Qualifier
Required
Identifier (ID)
D8
Date Expressed in Format CCYYMMDD
DTP-03
1251
Date Time Period
Required
String (AN)
Min 8Max 8
REF
2900
Detail > 2000 Loop > 2300 Loop > REF

Reference Information

RequiredMax use 1
Example
REF-01
128
Reference Identification Qualifier
Required
Identifier (ID)
1L
Policy Number
REF-02
127
Reference Identification
Required
String (AN)
Min 1Max 50
([0-9a-f]{8}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{4}-[0-9a-f]{12}|[A-Z][0-9]{2}(.*)) RegEx pattern
Usage notes
2300 Loop end
2000 Loop end
SE
6900
Detail > SE

Transaction Set Trailer

RequiredMax use 1
Example
SE-01
96
Number of Included Segments
Required
Numeric (N0)
Min 1Max 10
SE-02
329
Transaction Set Control Number
Required
String (AN)
Min 4Max 9
Detail end

Functional Group Trailer

RequiredMax use 1
Example
GE-01
97
Number of Transaction Sets Included
Required
Numeric (N0)
Min 1Max 6
GE-02
28
Group Control Number
Required
Numeric (N0)
Min 1Max 9

Interchange Control Trailer

RequiredMax use 1
Example
IEA-01
I16
Number of Included Functional Groups
Required
Numeric (N0)
Min 1Max 5
IEA-02
I12
Interchange Control Number
Required
Numeric (N0)
Min 9Max 9
EDI Samples

Sample 1

ISA*00* *00* *30*260302465 *30*82-1990296 *230119*0814*^*00501*004443162*0*P*>~
GS*BE*260302465*82-1990296*20230119*0814*230108191*X*005010X220A1~
ST*834*FPH6IXWEM*005010X220A1~
BGN*00*FPH6IXWEM*20230119*081419*CS***4~
N1*IN*SANA BENEFITS, INC.*FI*82-1990296~
N1*P5*SANA BENEFITS, INC.*FI*82-1990296~
N1*TV*SANA BENEFITS, INC.*FI*82-1990296~

INS*Y*18*030*XN*A***FT~
REF*0F*837498753~
REF*1L*10001*Sales~
DTP*336*D8*20180207~
NM1*IL*1*FAKERTON*CHAD****34*837498753~
PER*IP**HP*8767362273~
N3*1200 W STATE ST~
N4*COLUMBUS*OH*43205~
DMG*D8*19871018*M*R~
HD*030**HLT**EMP~
DTP*348*D8*20211201~
DTP*349*D8*20220131~
REF*1L*11111111-1111-4111-8111-111111111111~

INS*Y*18*030*XN*A***FT~
REF*0F*987378471~
REF*1L*10001~
DTP*336*D8*20120122~
NM1*IL*1*CUSTOMER*DAVID*O***34*987378471~
PER*IP**HP*8762763890~
N3*444 S High Street~
N4*COLUMBUS*OH*43205~
DMG*D8*19850807*M*R~
HD*030**HLT**EMP~
DTP*348*D8*20211201~
DTP*348*D8*20220131~
REF*1L*11111111-1111-4111-A111-333333333333~
HD*030**HLT**ESP~
DTP*348*D8*20220201~
REF*1L*11111111-1111-4111-B111-222222222222~

INS*N*01*030*XN*A~
REF*0F*987378471~
REF*1L*10001~
DTP*336*D8*20190528~
NM1*IL*1*CUSTOMER*JENNA****34*233672876~
PER*IP**HP*8762763890~
N3*444 S High Street~
N4*COLUMBUS*OH*43205~
DMG*D8*19890202*F~
HD*030**HLT**ESP~
DTP*348*D8*20220201~
REF*1L*11111111-1111-4111-a111-222222222222~

SE*47*FPH6IXWEM~
GE*1*230108191~
IEA*1*004443162~

Sample 2

ISA*00* *00* *30*260302465 *30*82-1990296 *230119*0814*^*00501*004443162*0*P*>~
GS*BE*260302465*82-1990296*20230119*0814*230108191*X*005010X220A1~
ST*834*FPH6IXWEM*005010X220A1~
BGN*00*FPH6IXWEM*20230119*081419*CS***4~
N1*IN*SANA BENEFITS, INC.*FI*82-1990296~
N1*P5*SANA BENEFITS, INC.*FI*82-1990296~
N1*TV*SANA BENEFITS, INC.*FI*82-1990296~

INS*Y*18*030*XN*A***FT~
REF*0F*837498753~
REF*1L*10001*Sales~
DTP*336*D8*20180207~
NM1*IL*1*FAKERTON*CHAD****34*837498753~
PER*IP**HP*8767362273~
N3*1200 W STATE ST~
N4*COLUMBUS*OH*43205~
DMG*D8*19871018*M*R~
HD*030**HLT**EMP~
DTP*348*D8*20211201~
DTP*349*D8*20220131~
REF*1L*11111111-aefb-4111-8111-111111111111~

INS*Y*18*030*XN*A***FT~
REF*0F*987378471~
REF*1L*10001~
DTP*336*D8*20120122~
NM1*IL*1*Customer*DAVID*O***34*987378471~
PER*IP**WP*8762763890~
N3*444 S High Street~
N4*COLUMBUS*OH*43205~
DMG*D8*19850807*M*R~
HD*030**HLT**EMP~
DTP*348*D8*20211201~
DTP*349*D8*20220131~
REF*1L*11111111-1111-4111-8111-333333333333~
HD*030**HLT**ESP~
DTP*348*D8*20220201~
REF*1L*11111111-abfe-4111-8111-222222222222~

INS*N*01*030*XN*A~
REF*0F*987378471~
REF*1L*10001~
DTP*336*D8*20190528~
NM1*IL*1*CUSTOMER*JENNA****34*233672876~
PER*IP**HP*8762763890~
N3*444 S High Street~
N4*COLUMBUS*OH*43205~
DMG*D8*19890202*F~
HD*030**HLT**ESP~
DTP*348*D8*20220201~
REF*1L*AB111111-A111-4111-a111-222222222222~

SE*47*FPH6IXWEM~
GE*1*230108191~
IEA*1*004443162~

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