Electronic 834 Requests

NOTE: If a Third-Party Administrator will be used for 834 Electronic Enrollment,
an authorization form from the Group must be uploaded with this request.

SHP EDI 834 Companion Guide
EFiT Application Onboarding Guide

Qualifying Question

Will termination records be sent on EDI 834 file?

Sentara Health Plans EFiT will require receipt of a public key to set up the Managed File Transfer (MFT) account.

Action Requested (RequestType)

Contact Information

Employer Group Name

Employer Group Number

Employer Group Address

Employer Group City

Employer Group State

Employer Group Zip

Contact Name

Contact Email

Contact Name 2 (Not Required)

Contact Email 2 (Not Required)

Is your group self funded?

Does the Group have a Health Savings Account (HSA) Plan?

If yes, the TPA/Group will include the REF*ZZ Indicator on the 834 file.

Employer Group Information

Will you be using a Third-Party Administrator (TPA)?

TPA List

Other TPA not on this list

If your TPA is not listed, select YES and add their contact info below.

TPA Name

TPA Address

TPA City

TPA State

TPA Zip

TPA Contact Name

TPA Contact Email

TPA Contact Name 2 (Not Required)

TPA Contact Email 2 (Not Required)

834 File & Transaction Information

In this section, we will collect details regarding how often the 834-file will be sent and if the fille will contain changes-only or full membership. If sending a changes-only file, we will need to know how often a full-file will be sent as well.

File Type

If full file: When will full file be sent?

If changes only: When will full file be sent?

Will file be encrypted?

File Format

Excluded Members

Are any member to be excluded from the file (i.e., COBRA)?

Excluded Members List

Type of member data Employer Group/TPA will use for testing?

Files To Be Sent

Will test files be sent to SHP_EDI_ENROLLMENT@sentara.com?

Test File Names

Production Files

Attach a fileYou can upload a maximum of 15 files, each up to 90MB.

Qualifying Question

Contact Information

Employer Group Information

834 File & Transaction Information

Excluded Members

Files To Be Sent

You’re over the file size limit×Close

File upload limit reached×Close

Unsupported file formats×Close

You’re over the file size limit

File upload limit reached

Unsupported file formats