Sample EDI 835 Data for the Health Care Claim Payment/Advice Transaction Set


AgencySet IDFGTransaction DescriptionSubcommitteeStandard
ANSI835HPHealth Care Claim Payment/Advice InsuranceDownload


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Research and Development:
Below is a sample EDI 835 transaction set. The Jobisez.com site has an online translation tool that converts the EDI 835 (Health Care Claim Payment/Advice) document into a CSV file. If you are researching the 835s, you can view other trading partner's mapping specifications. You can also gain knowledge by researching all EDI document types. Jobisez LLC can also provide assistance if you need additional help.

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Are you looking to trade the EDI 835 transaction with one of your trading partners? Do you need an EDI VAN Savings solution to exchange the 835? Or perhaps you would like to use a Cloud-Based application, so you can plug your 835 transaction directly into your ERP and TMS systems. Even small companies have the ability to trade the EDI 835 by using the EDI Mobile Device solution.

Sample of an EDI 835 Transaction Set

ST*835*0001
BPR*I*39.62*C*ACH*CTX*01*071000013*DA*00000000000000000*1376002057**01*071000013*DA*652218405*20180622
TRN*1*4782018169A229*1376002057
DTM*405*20180618
N1*PR*ILLINOIS COMPTROLLER
N3*325 W. ADAMS
N4*SPRINGFIELD*IL*627041871
PER*CX*HFS billing helpdesk*TE*1-877-782-5565
PER*BL*HFS technical helpdesk*TE*1-800-366-8768
N1*PE*U S SERVICES INC*FI*200811719
N3*6259 W HIGGINS AVE
N4*CHICAGO*IL*60630
REF*PQ*2008117196064601
LX*1
TS3*1467611764*K*20181231*3*234
CLP*KINJO00000*1*42*16.55**MC*20181652227810201*K*1
NM1*QC*1*KING*JOYCE****MR*034746578
NM1*82*2*US DIAGNOSTICS*****XX*1467611764
DTM*232*20180524
SVC*HC:73120:LT*42*16.55
DTM*472*20180524
CAS*CO*45*25.45
CLP*KINJO00000*1*150*3.99**MC*20181652227810301*K*1
NM1*QC*1*KING*JOYCE****MR*034746578
NM1*82*2*US DIAGNOSTICS*****XX*1467611764
DTM*232*20180524
SVC*HC:R0075:UN*150*3.99
DTM*472*20180524
CAS*CO*45*146.01
CLP*KINJO00000*1*42*19.08**MC*20181652227810401*K*1
NM1*QC*1*KING*JOYCE****MR*034746578
NM1*82*2*US DIAGNOSTICS*****XX*1467611764
DTM*232*20180524
SVC*HC:73560:RT*42*19.08
DTM*472*20180524
CAS*CO*45*22.92
SE*37*0001


Official Definition:
Data contents of the Health Care Claim Payment/Advice Transaction Set (835) for use within the context of the Electronic Data Interchange environment. This transaction set can be used to make a payment, send an Explanation of Benefits (EOB) remittance advice, or make a payment and send an EOB remittance advice only from a health insurer to a health care provider either directly or via a financial institution.



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