[Oscar+Thatch subscriber enrollment] (CMS) 834 (FFE to FFE Issuer) Benefit Enrollment and Maintenance (X220A1) v7.0

ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *240105*1802*^*00501*000001566*1*P*>~
GS*BE*SENDER*RECEIVER*20240105*1802*000005757*X*005010X220A1~
ST*834*74592441*005010X220A1~
BGN*00*74592441*20240105*202953*ET***2~
DTP*007*D8*20240101~
N1*P5*John Doe*FI*000000001~
N1*IN*Insure Co*FI*111111111~
N1*BO*Thatch*94*111111111~
INS*Y*18*021*EC*A***AC~
REF*0F*0000068929~
REF*17*0000068929~
DTP*356*D8*20240101~
NM1*IL*1*Doe*John****34*000000000~
PER*IP**TE*5017622641***EM*john.doe@gmail.com~
N3*106 Test Trail~
N4*Hot Springs*AR*71913~
DMG*D8*19930101*F~
HLH*N~
HD*021**HLT~
DTP*348*D8*20240101~
REF*1L*68929001~
REF*CE*99999AR020001001~
LS*2700~
LX*1~
N1*75*REQUEST SUBMIT TIMESTAMP~
REF*17*2023121413374163~
LX*2~
N1*75*SEP REASON~
REF*17*HR~
DTP*007*D8*20240101~
LX*3~
N1*75*PRE AMT TOT~
REF*9X*941.20~
DTP*007*D8*20240101~
LE*2700~
SE*34*74592441~
GE*1*000005757~
IEA*1*000001566~

X12 834 [Oscar+Thatch subscriber enrollment] (CMS) 834 (FFE to FFE Issuer) Benefit Enrollment and Maintenance (X220A1) v7.0