1 of 9

https://support.oracle.com/CSP/main/article?cmd=show&type=NOT&id=246149.1

Functional Setup & Frequently Asked Questions (FAQ) for Setting Up the ANSI 834 System Extract [ID 246149.1]
Modified 29-MAR-2011

Type BULLETIN

Status PUBLISHED

Applies to:
Oracle Advanced Benefits
Information in this document applies to any platform.

Purpose
-----------------------------------------------------------------------Functional Setup & FAQ for Setting Up the ANSI 834 System Extract
----------------------------------------------------------------------------------------------------------------------------------------------Introduction
-----------------------------------------------------------------------Seeded system extracts are available as of the July 2002 Family Pack which provide standardized data requirements and content to users of version ANSI ASC X12.84, Benefit Enrollment and Maintenance (834).
The ANSI 834 is used to transfer enrollment and maintenance information, specifically for healthcare products from the sponsor of the insurance coverage, benefit or policy to a payee.
These new standards and code sets are part of the 1996 Health Insurance Portability and Accountability Act (HIPAA) administrative simplification procedures.
Although HIPAA does not mandate the electronic transmission of healthcare data, it does establish uniform national standards for all organizations electronically transferring healthcare enrollment and
maintenance information from the sponsor to a payee (carrier).
These standards comply with the National Electronic Data Interchange guidelines and define commonly used business transactions in a formal structure called 'transaction sets'.
The technical requirements were drawn from the National Electronic Data Interchange Transaction Set Implementation Guide for Benefit Enrollment and Maintenance - 834 (ASC X12N 834 004010 X095), published by
the Washington
Publishing Company.
Rate
this document
The system extract capabilities in Oracle HRMS 11i have been enhanced to accommodate any data element and sets that are needed to support ANSI 834.
Seeded extracts are delivered with the professional user interface and can be copied into and used by a specific business group.
The system provides the default setups of the ANSI 834 for a Full Profile Extract and a Change Event Extract. These setups can be modified based on your individual requirements after copying the seeded extract into
your business group.

Scope and Application

For more information regarding ANSI 834 standards, you may go to the Washington Publishing Companys website at http://www.wpc-edi.com to obtain a copy of the National Electronic Data Interchange Transaction
Set Implementation Guide for Benefit Enrollment and Maintenance 834
(ASC X12N 834 004010 X095).

Functional Setup & Frequently Asked Questions (FAQ) for Setting Up the ANSI 834 System Extract
Setting Up The ANSI 834 System Extract
-----------------------------------------------------------------------The follow steps must be taken before attempting to use the ANSI 834 system extract.
(1) Enable Change Event Codes in your Business Group
1. Navigate to Other Definitions > Lookup Tables.

13-May-11 8:36 PM

2 of 9

https://support.oracle.com/CSP/main/article?cmd=show&type=NOT&id=246149.1

2. In the Type field, query BEN_EXT_CHG_EVT.

3. Click the Enabled boxes for the appropriate Event Codes.
A full list of required Event Codes is listed below.
4. Save your work.
Event Codes
----------Add Actual Termination Date
Add Benefit
Add Dependent
Add Mailing Address
Add Period of Service
Add Primary Address
Add Primary Care Provider
Change Actual Termination Date
Change of Approved Base Salary
Change of Hire Date
Delete Actual Termination Date
Delete Mailing Address
Delete Primary Address
Delete Primary Care Provider
Reinstate Benefit
Terminate Benefit after Coverage
Terminate Benefit before Coverage
Update Assignment Location
Update Benefit Option
Update Coverage End Date
Update Coverage Start Date
Update Date Of Birth
Update Date of Death
Update Disability Status
Update Email Address
Update Ethnic Origin
Update Full Name
Update Gender
Update Mailing City
Update Mailing County
Update Mailing Postal Code
Update Mailing State
Update Mailing Street
Update Marital Status
Update Opted for Medicare
Update Person Grade
Update Person Language
Update Person Tobacco Uses
Update Persons Payroll
Update Previous Last Name
Update Primary Address
Update Primary Care Provider ID
Update Primary Care Provider Name
Update Primary Care Provider Type
Update Primary City
Update Primary Country
Update Primary Postal Code
Update Primary State
Update Primary Street
Update Social Security/National Identifier
Update Student Status
Update Termination Reason
Update Home Phone
Update Work Phone
Update Participant Monthly Premium
Update School or College

13-May-11 8:36 PM

3 of 9

https://support.oracle.com/CSP/main/article?cmd=show&type=NOT&id=246149.1

(2) Copy the Extracts to your Business Group

1. Navigate to Mass Information eXchange: MIX > System Extract > Extract Definition.
2. In the Extract Name field, query ANSI% in the Name field to find the ANSI-834 Full Profile and ANSI-834 Change Event.
case sensitive.
3. For the first extract, in the New Extract Prefix field, designate a prefix to precede your extract name.
4. Click Copy Extract.
5. Answer Yes when asked whether to continue copying the extract definition.
6. Verification that your extract was successfully copied with the designated prefix will appear.
7. Repeat the above steps for the second extract.

Note: This field is

You can also verify that your extracts were saved by querying the Extract Name field youre your designated prefix.
After Copying the Extracts to your Business Group, complete the below steps only for healthcare plans for which you will be using the ANSI
extracts.
(3) Define Criteria to Extract Data for Specific Plans
1.
2.
3.
4.
5.
6.

Navigate to Mass Information eXchange: MIX > System Extract > Criteria Definition.
Query your ANSI extracts full and change only.
Go to the Benefits tab for the full extract.
For Criteria Type, select Enrollment Plan Name.
Save your work.
Repeat steps 3-5 for the other change extract.

(4) Change the Time Zone Element

The Time Zone element (BGN05) really only needs to be changed if the sender and the recipient of the extract are in different time zones.
The PS (Pacific Standard) Time Zone has been set as the default Time Zone.
1.
2.
3.
4.
5.

Navigate to Mass Information eXchange: MIX > System Extract > Layout Definition.
Go to the Data Elements tab.
Query your prefix BGN05_00 in the Name field.
Change the Value to your 2-character Time Zone.
Save your work.

(5) Define Policy Number, Broker Information & Sponsor Information

1.
2.
3.
4.
5.
6.
7.
8.

Navigate to Total Compensation > Programs and Plans > Plans > Details > Organizations.
Select your first Organization from the list of values in the Organization field.
Enter the Customer Identifier number.
Enter the Policy or Group Number.
Type in the Organization Role.
Select the Organization Role Type.
Repeat the above steps for each Organization for which you will use the ANSI extracts.
Save your work.

(6) Decode Plan Name and Plan Option Name

Because ANSI standards have defined codes for the Plan Type and Option differ from Oracle Benefits standards, the Plan Name (HD03) and Plan
Option Name (HD05) elements must be decoded.
Decode the Plan Name
1. Navigate to Mass Information eXchange: MIX > System Extract > Layout Definition.
2. Go to the Data Elements Tab
3. Query the Plan Name that you copied, HD03.
4. In the If Value Is field, select each healthcare Plan Name defined in your Business Group and enter the appropriate Code (as defined
below) in the Replace With field.
5. Save your work.
Code
---AG
AH

Plan Type Description

--------------------Preventative Care/Wellness
24 Hour Care

13-May-11 8:36 PM

4 of 9

https://support.oracle.com/CSP/main/article?cmd=show&type=NOT&id=246149.1

AJ
AK
DCP
DEN
EPO
FAC
HE
HLT
HMO
LTC
LTD
MM
MOD
PDG
POS
PPO
PRA
STD
UR
VIS

Medicare Risk
Mental Health
Dental Capitation (DMO)
Dental
Exclusive provider organization
Facility
Hearing
Health
Health Maintenance Organization
Long Term Care
Long Term Disability
Major Medical
Mail Order Drug
Prescription Drug
Point of Service
Preferred Provider Organization
Practitioners
Short Term Disability
Utilization review
Vision

Decode the Option

1.
2.
3.
4.

Navigate to Mass Information eXchange: MIX > System Extract > Layout Definition.
Go to the Data Elements Tab
Query the Element Name that you copied, _HD05.
In the If Value Is field, select each healthcare Option defined in your Business Group and enter the appropriate Code (as defined below)
in the Replace With field.
5. Save your work.
Code
---IND
EMP
ESP
CHD
DEP
ECH
FAM
SPC
SPO
TWO
E1D
E2D
E3D
E5D
E6D
E7D
E8D
E9D

Option Description
-----------------Individual
Employee Only
Employee and Spouse
Children Only
Dependents Only
Employee and Children
Family
Spouse and Children
Spouse Only
Two Party
Employee and One Dependent
Employee and Two Dependents
Employee and Three Dependents
Employee and One or More Dependents
Employee and Two or More Dependents
Employee and Three or More Dependents
Employee and Four or More Dependents
Employee and Five or more Dependents

(7) Decode Enrolled Life Event Name

Life event names are defined by Advanced Benefits Users and may vary between customers.
Thus, they need to be decoded to meet ANSI standards for the Enrolled Life Event Name (INS04) element.
1.
2.
3.
4.
5.
6.

Navigate to Mass Information eXchange: MIX > System Extract > Layout Definition.
Go to the Data Elements Tab
Query the Enrollment Life Event Name that you copied, _INS04.
Change the Type to Decoded Field.
Search for Enrollment Life Event Name in the Field.
In the If Value Is field, select each Life Event Name defined in your Business Group and enter the appropriate Code (as defined below) in
the Replace With field.
7. Save your work.

13-May-11 8:36 PM

5 of 9

https://support.oracle.com/CSP/main/article?cmd=show&type=NOT&id=246149.1

Code
---01
02
03
04
05
06
07
08
09
10
11
14
15
16
17
18
20
21
22
25
26
27
28
29
31
32
33
37
38
39
40
41
43
AI
XN
XT

Life Event Description

---------------------Divorce
Birth
Death
Retirement
Adoption
Strike
Termination of Benefits
Termination of Employment
COBRA
COBRA Premium Paid
Surviving Spouse
Voluntary Withdrawal
Primary Care Provider Change
Quit
Fired
Suspended
Active
Disability
Plan Change
Change in Identifying Data Elements (Use this code when a change has been made to the primary elements that identify an
individual such as first name, last name, SSN, DOB, employee ID number.)
Declined Coverage
Pre-Enrollment
Initial Enrollment
Benefit Selection
Legal Separation
Marriage
Personnel Data (Use this code for any data change that is not included into any other allowed codes. I.e. Change in
Coordination of Benefits information).
Leave of Absence with Benefits
Leave of Absence without Benefits
Lay Off with Benefits
Lay Off without Benefits
Re-enrollment
Change of Location (Use this for change of address.)
No reason given
Notification Only
Transfer

(8) Set up the Interchange Header & Trailer

The Interchange Header and Trailer are used to identify the start and end of a transmission of zero or more Functional Groups of information.
All data must be enveloped within the Interchange Header and Footer before electronic transmission can occur.
Interchange Control Header (ISA)
The ISA record must be of a fixed length.
Therefore, all elements within the ISA record must also be of a fixed length as indicated below
in the Required Length column.
Where no default data exists, the element value is seeded with spaces, illustrated by . below.
1. Element Field Name: Authorization Information Qualifier
Element Name: ISA01
Required Length: 2
Default Value: 00
Optional Setup Instructions: 00 represents that no authorization information is present in ISA02.
is present in ISA02, ISA01 should be changed to 03 which means Additional Data Identification.

If an additional data identifier

2. Element Field Name: Authorization Information

Element Name: ISA02
Required Length: 10
Default Value: ..........

13-May-11 8:36 PM

6 of 9

https://support.oracle.com/CSP/main/article?cmd=show&type=NOT&id=246149.1

Optional Setup Instructions: Used for additional identification or authorization of the interchange sender or data in the interchange.
If using an additional identifier, enter it here.
3. Element Field Name: Security Information Qualifier
Element Name: ISA03
Required Length: 2
Default Value: 00
Optional Setup Instructions: 00 represents that no security password is defined in ISA04.
4. Element Field Name: Security Information
Element Name: ISA04
Required Length: 10
Default Value: ..........
Optional Setup Instructions: A password may be defined to identify security information about the interchange sender or data in the
interchange.
If a password is being used, enter it here.
5. Element Field Name: Interchange ID Qualifier
Element Name: ISA05
Required Length: 2
Default Value: 30
Optional Setup Instructions: Qualifies the sender in ISA06.
If you wish to use some other qualifying data than your TIN, change the element value to your choice below.
01 Dun (D&B)
14 Duns plus suffix20 Health industry number (HIN)
27 Carrier ID Number as assigned by HCFA
28 Fiscal Intermediary ID number as assigned by HCFA
29 Medicare provider and supplier ID number as assigned by CFA
30 US Federal TIN
33 National Assn of Insurance Commissioners Company Code (NAIC)
ZZ - Mutually defined
6. Element Field Name: Interchange Sender ID
Element Name: ISA06
Required Length: 15
Default Value: ...............
Optional Setup Instructions: If your organization Tax ID number has been defined in Total Compensation > Plan > Details > Organization, this
number will be defaulted into ISA06.
If no TIN has been defined, enter it here and pad it with spaces to ensure that the element is 15
characters; otherwise, select which type of qualifying data you wish to use.
7. Element Field Name: Interchange ID Qualifier
Element Name: ISA07
Required Length: 2
Default Value: ..
Optional Setup Instructions: Qualifies the receiver in ISA08. The list of values is the same as in ISA05.
Select the appropriate qualifier code or leave the element as 2 spaces.
8. Element Field Name: Interchange Sender ID
Element Name: ISA08
Required Length: 15
Default Value: ...............
Optional Setup Instructions: ID code published by the data receiver.
When sending data, this ID is used as the sender ID.
If a receiver ID is known, enter it here and pad it with spaces to ensure that it is 15 characters.
9. Element Field Name: Interchange Control Number
Element Name: ISA13
Required Length: 9
Default Value: .........
Optional Setup Instructions: Control number assigned by the sender.
ISA13 must be identical to IEA02.
10. Element Field Name: Acknowledgment Requested

13-May-11 8:36 PM

7 of 9

https://support.oracle.com/CSP/main/article?cmd=show&type=NOT&id=246149.1

Element Name: ISA14

Required Length: 1
Default Value: .
Optional Setup Instructions: Enter a 0 if no interchange acknowledgment is requested, or a 1 if an interchange acknowledgment is desired.
11. Element Field Name: Acknowledgment Requested
Element Name: ISA15
Required Length: 1
Default Value: P
Optional Setup Instructions: P represents production data that is to be processed.
If sending test data only, change this value to T.
Interchange Group Trailer (IEA)
Element Field Name: Number of Included Functional Groups
Element Name: IEA01
Default Value: 1
Optional Setup Instructions: If more than 1 Functional Group of data is in the same interchange, change the element value to indicate how
many Functional Groups are included.
(9) Set up the Functional Group Header & Trailer
The Ansi 834 is just one of several Functional Group of information that may be sent electronically.
Oracle only seeds the extracts to send 834 Benefits Enrollment & Maintenance information.
Functional Group Header (GS)
1. Element Field Name: Interchange Control Number
Element Name: GS01
Default Value: BE
Optional Setup Instructions: BE indicates that 834 Benefits Enrollment & Maintenance data is being sent.
If using this seeded extract to send other non-834 data, this code must be changed to the appropriate Functional Identifier Code.
2. Element Field Name: Application Senders Code
Element Name: GS02
Default Value: null
Optional Setup Instructions: This code identifies the sender and is agreed upon by trading partners.
If you have an agreed upon code, you may enter it in this field.
Maximum field length is 15 characters.
3. Element Field Name: Application Receivers Code
Element Name: GS03
Default Value: null
Optional Setup Instructions: This code identifies the receiver and is agreed upon by trading partners.
This is used as an additional identification or authentication.
If you have an agreed upon code, you may enter it in this field.
Maximum field length is 15 characters.
4. Element Field Name: Group Control Number
Element Name: GS06
Default Value: null
Optional Setup Instructions: This number is assigned by the sender.
GS06 must be identical to the Group Control Number (GE02) in the Functional Group Trailer.
any value entered in GS06 will be copied into GE02.

The extract has been designed so that

Functional Group Trailer (GE)

Element Field Name: Number of Transaction Sets Included
Element Name: GE01
Default Value: 1
Optional Setup Instructions: If sending more than 1 Transaction Set is included in the Functional Group or Interchange group terminated
by the trailer containing this data element, change the data element to the appropriate number.

13-May-11 8:36 PM

8 of 9

https://support.oracle.com/CSP/main/article?cmd=show&type=NOT&id=246149.1

After completing steps 1 through 9, the ANSI system extract setup is complete.
Sample ANSI Extract Outputs
-----------------------------------------------------------------------Sample extracts are available from Chapter 4 of the National Electronic Data Interchange Transaction Set Implementation Guide for Benefit
Enrollment and Maintenance 834 (ASC X12N 834 004010 X095), pages 159-163.
Each line in
contained in
Please refer
decipher the

the extract is called a Segment and each Segment begins with a Record code (ie. ST) which identifies the type of information
the Segment.
to the above referenced document for a full list of Record definitions and seeded values in order to
below examples.

Based on the business scenario described in the above referenceddocument, the sample outputs are what you can expect to see when
running the ANSI Change Extract.

Frequently Asked Questions

-----------------------------------------------------------------------1. When do I use the Full Extract?
When you send an electronic transmission of complete enrollment information for a new participant or group of participants, the Full
Extract should be used.
2. When do I use the Change Extract?
When you send an electronic transmission of maintenance information that updates the data for an existing participant or group of
participants, the Change Extract should be used.
3. How do I test my extract to make sure that it works?
You can run the Full or Change extracts for a sample set of data and send it to your healthcare provider as a test run.
Just define ISA15 to T in the Interchange Header record to indicate that the transmission is a test.
The recipient of the data can then inform you of any errors in the data or format of the transmission.
4. Can I send my premium payment and enrollment information in one transmission?
Maybe. General Ansi standards allow you to send more than one Functional Group of information in one transmission.
However, the Oracle Benefits only provides the Ansi 834 extracts to extract enrollment and maintenance information.
5. What is the data hierarchy and structure of the interchange?
The communications envelope is illustrated below.
There can be multiple transaction sets within one functional group and multiple functional groups within the interchange.
ISA Interchange Control Header
GS Functional Group Header
ST Transaction Set Header
Detail Segments
SE Transaction Set Trailer
GE Functional Group Trailer
ISE Interchange Control Trailer
6. Who should use these extracts to send enrollment and maintenance information to healthcare providers?
Customers sending enrollment and maintenance information via an electronic transmission or if mandated by the healthcare provider
are required to comply with Ansi 834 standards.
7. Can I send other healthcare information electronically?
Oracle Benefits only seeds the extracts for the electronic transmission of enrollment and maintenance data as this is the
information that Standard and Advanced Benefits supports.
Sending other healthcare information electronically may require a translation software or a similar extract creation by the software
applications provider who maintains that data for you.
8. Where can I get more information on the HIPAA requirements?
Go to the Washington Publishing Companys website at http://www.wpc-edi.com to obtain a copy of the National Electronic
Data Interchange Transaction Set Implementation Guide for Benefit Enrollment and Maintenance 834 (ASC X12N 834 004010 X095).

13-May-11 8:36 PM

9 of 9

https://support.oracle.com/CSP/main/article?cmd=show&type=NOT&id=246149.1

9. How do I know what type of data the different data segment IDs represent?
Page 21 of the National Electronic Data Interchange Transaction Set Implementation Guide for Benefit Enrollment and Maintenance 834
(ASC X12N 834 004010 X095) provides a list of segment IDs and names.
10. Where can I find definitions of the various EDI terms such as Transaction Set, Functional Group, Segment, etc.?
Section A of the National Electronic Data Interchange Transaction Set Implementation Guide for Benefit Enrollment and Maintenance 834
(ASC X12N 834 004010 X095) provides a list of ASC X12 nomenclature and definitions.
11. If I do not send any healthcare data electronically to the provider, do I need to be concerned with these extracts?
No

Related
Products
Oracle E-Business Suite > Human Capital Management > Benefits > Oracle Advanced Benefits
Keywords
BENEFITS; COBRA; CRITERIA; EXTRACT CRITERIA; EXTRACT DEFINITION; FREQUENTLY ASKED QUESTIONS; SYSTEM EXTRACT; TECHNICAL REQUIREMENTS
Errors
INS-04; INS-4

Back to top
Copyright (c) 2007, 2010, Oracle. All rights reserved. Legal Notices and Terms of Use | Privacy Statement

13-May-11 8:36 PM