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.

Solutions:
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*000000001
BPR*DATA*NOT*VALID*RANDOM*TEXT
TRN*1*0000000000*1999999999
DTM*111*20090915
N1*PR*ALWAYS INSURANCE COMPANY
N7*AROUND THE CORNER
N4*SHINE CITY*GREEN STATE*ZIP
REF*DT*435864864
N1*PE*FI*888888888*P.O.BOX 456*SHINE CITY*GREEN STATE*ZIP*EARTH
LX*1
CLP*PCN123456789**5555.55**CCN987654321
CAS*PR*909099*100.00
NM1*QC*1*PATIENT*TREATED*ONE***34*333333333
DTM*273*20020824
AMT*A1*10.10
AMT*A2*20.20
LX*2
CLP*PCN123456789**4444.44**CCN987654321
CAS*PR*909099*200.00
NM1*QC*1*PATIENT*TREATED*TWO***34*444444444
DTM*273*20020824
AMT*A1*30.30
AMT*A2*40.40
SE*24*000000001


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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