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


AgencySet IDFGTransaction DescriptionSubcommittee
ANSI835HPHealth Care Claim Payment/Advice Insurance


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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.

Sample of an EDI 835 Transaction Set

ST*835*0001
BPR*I*187.50*C*CHK************20050412
TRN*1*0012524879*1559123456
REF*EV*030240928
DTM*405*20050412
N1*PR*YOUR TAX DOLLARS AT WORK
N3*481A00 DEER RUN ROAD
N4*WEST PALM BCH*FL*11114
PER*BL*JOHN WAYNE*TE*8005551212*EX*123
N1*PE*ACME MEDICAL CENTER*FI*599944521
N3*PO BOX 863382
N4*ORLANDO*FL*55115
REF*PQ*10488
LX*1
CLP*0001000054*3*1766.5*187.50**12*50580155533
NM1*QC*1*ISLAND*ELLIS*E***MI*789123456
NM1*82*2*JONES JONES ASSOCIATES*****BS*AB34U
DTM*232*20050120
SVC*HC:24599*1766.5*187.50**1
DTM*472*20050120
CAS*OA*23*1579
REF*1B*44280
AMT*B6*1700
SE*24*0001

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.



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