EDI 835 Segments and Elements for the Health Care Claim Payment/Advice Standard


AgencySet IDFGTransaction DescriptionSubcommitteeStandard
ANSI835HPHealth Care Claim Payment/Advice InsuranceDownload


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Research and Development:
See the list of EDI 835 segments and elements in below data grid. The Jobisez.com site has an online translation tool that converts the EDI 835 (Health Care Claim Payment/Advice) document into a CSV file. For more detailed information, you can view a sample EDI 835 document by analyzing a transaction set example. 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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The EDI 835 Segments and Elements

SegmentDescriptionSectReqMax LoopMax UsagePos
BPRBeginning Segment For Payment Order/Remittance AdviceHM011
NTENote/Special InstructionHO09999992
TRNTraceHO013
CURCurrencyHO014
REFReference InformationHO09999995
DTMDate/Time ReferenceHO09999996
N1Party IdentificationHO20017
N2Additional Name InformationHO09999998
N3Party LocationHO09999999
N4Geographic LocationHO0110
REFReference InformationHO099999911
PERAdministrative Communications ContactHO099999912
RDMRemittance Delivery MethodHO0113
DTMDate/Time ReferenceHO0114
LXTransaction Set Line NumberDO999999115
TS3Transaction StatisticsDO0116
TS2Transaction Supplemental StatisticsDO0117
CLPClaim Level DataDM999999118
CASClaims AdjustmentDO09919
NM1Individual Or Organizational NameDM0920
MIAMedicare Inpatient AdjudicationDO0121
MOAMedicare Outpatient AdjudicationDO0122
REFReference InformationDO09923
DTMDate/Time ReferenceDO0924
PERAdministrative Communications ContactDO0325
AMTMonetary Amount InformationDO02026
QTYQuantity InformationDO02027
SVCService InformationDO999128
DTMDate/Time ReferenceDO0929
CASClaims AdjustmentDO09930
REFReference InformationDO09931
AMTMonetary Amount InformationDO02032
QTYQuantity InformationDO02033
LQIndustry Code IdentificationDO09934
PLBProvider Level AdjustmentSO099999935


SegmentElementDescriptionReqMin LengthMax LengthType
BPR1Transaction Handling CodeM12ID
BPR2Monetary AmountM118R
BPR3Credit/Debit Flag CodeM11ID
BPR4Payment Method CodeM33ID
BPR5Payment Format CodeO110ID
BPR6(Dfi) Id Number QualifierC22ID
BPR7(Dfi) Identification NumberC312AN
BPR8Account Number QualifierO13ID
BPR9Account NumberC135AN
BPR10Originating Company IdentifierO1010AN
BPR11Originating Company Supplemental CodeO99AN
BPR12(Dfi) Id Number QualifierC22ID
BPR13(Dfi) Identification NumberC312AN
BPR14Account Number QualifierO13ID
BPR15Account NumberC135AN
BPR16DateO88DT
BPR17Business Function CodeO13ID
BPR18(Dfi) Id Number QualifierC22ID
BPR19(Dfi) Identification NumberC312AN
BPR20Account Number QualifierO13ID
BPR21Account NumberC135AN
NTE1Note Reference CodeO33ID
NTE2DescriptionM180AN
TRN1Trace Type CodeM12ID
TRN2Reference IdentificationM150AN
TRN3Originating Company IdentifierO1010AN
TRN4Reference IdentificationO150AN
CUR1Entity Identifier CodeM23ID
CUR2Currency CodeM33ID
CUR3Exchange RateO410R
CUR4Entity Identifier CodeO23ID
CUR5Currency CodeO33ID
CUR6Currency Market/Exchange CodeO33ID
CUR7Date/Time QualifierC33ID
CUR8DateO88DT
CUR9TimeO48TM
CUR10Date/Time QualifierC33ID
CUR11DateC88DT
CUR12TimeC48TM
CUR13Date/Time QualifierC33ID
CUR14DateC88DT
CUR15TimeC48TM
CUR16Date/Time QualifierC33ID
CUR17DateC88DT
CUR18TimeC48TM
CUR19Date/Time QualifierC33ID
CUR20DateC88DT
CUR21TimeC48TM
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
DTM1Date/Time QualifierM33ID
DTM2DateC88DT
DTM3TimeC48TM
DTM4Time CodeO22ID
DTM5Date Time Period Format QualifierC23ID
DTM6Date Time PeriodC135AN
N11Entity Identifier CodeM23ID
N12NameC160AN
N13Identification Code QualifierC12ID
N14Identification CodeC280AN
N15Entity Relationship CodeO22ID
N16Entity Identifier CodeO23ID
N21NameM160AN
N22NameO160AN
N31Address InformationM155AN
N32Address InformationO155AN
N41City NameO230AN
N42State Or Province CodeC22ID
N43Postal CodeO315ID
N44Country CodeC23ID
N45Location QualifierC12ID
N46Location IdentifierO130AN
N47Country Subdivision CodeC13ID
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
RDM1Report Transmission CodeM12ID
RDM2NameO160AN
RDM3Communication NumberO1256AN
RDM4Reference Identification QualifierO23ID
RDM5Reference IdentificationO150AN
RDM6Reference Identification QualifierO23ID
RDM7Reference IdentificationO150AN
RDM8Reference Identification QualifierO23ID
RDM9Reference IdentificationO150AN
RDM10Reference Identification QualifierO23ID
RDM11Reference IdentificationO150AN
RDM12Reference Identification QualifierO23ID
RDM13Reference IdentificationO150AN
RDM14Reference Identification QualifierO23ID
RDM15Reference IdentificationO150AN
DTM1Date/Time QualifierM33ID
DTM2DateC88DT
DTM3TimeC48TM
DTM4Time CodeO22ID
DTM5Date Time Period Format QualifierC23ID
DTM6Date Time PeriodC135AN
LX1Assigned NumberM16N0
TS31Reference IdentificationM150AN
TS32Facility Code ValueM12AN
TS33DateM88DT
TS34QuantityM115R
TS35Monetary AmountM118R
TS36Monetary AmountO118R
TS37Monetary AmountO118R
TS38Monetary AmountO118R
TS39Monetary AmountO118R
TS310Monetary AmountO118R
TS311Monetary AmountO118R
TS312Monetary AmountO118R
TS313Monetary AmountO118R
TS314Monetary AmountO118R
TS315Monetary AmountO118R
TS316Monetary AmountO118R
TS317Monetary AmountO118R
TS318Monetary AmountO118R
TS319Monetary AmountO118R
TS320Monetary AmountO118R
TS321Monetary AmountO118R
TS322Monetary AmountO118R
TS323QuantityO115R
TS324Monetary AmountO118R
TS21Monetary AmountO118R
TS22Monetary AmountO118R
TS23Monetary AmountO118R
TS24Monetary AmountO118R
TS25Monetary AmountO118R
TS26Monetary AmountO118R
TS27QuantityO115R
TS28Monetary AmountO118R
TS29Monetary AmountO118R
TS210QuantityO115R
TS211QuantityO115R
TS212QuantityO115R
TS213QuantityO115R
TS214QuantityO115R
TS215Monetary AmountO118R
TS216QuantityO115R
TS217Monetary AmountO118R
TS218Monetary AmountO118R
TS219Monetary AmountO118R
CLP1Claim Submitter's IdentifierM138AN
CLP2Claim Status CodeM12ID
CLP3Monetary AmountM118R
CLP4Monetary AmountM118R
CLP5Monetary AmountO118R
CLP6Claim Filing Indicator CodeO12ID
CLP7Reference IdentificationO150AN
CLP8Facility Code ValueO12AN
CLP9Claim Frequency Type CodeO11ID
CLP10Patient Status CodeO12ID
CLP11Diagnosis Related Group (Drg) CodeO14ID
CLP12QuantityO115R
CLP13Percentage As DecimalO110R
CLP14Yes/No Condition Or Response CodeO11ID
CAS1Claim Adjustment Group CodeM12ID
CAS2Claim Adjustment Reason CodeM15ID
CAS3Monetary AmountM118R
CAS4QuantityO115R
CAS5Claim Adjustment Reason CodeC15ID
CAS6Monetary AmountC118R
CAS7QuantityC115R
CAS8Claim Adjustment Reason CodeC15ID
CAS9Monetary AmountC118R
CAS10QuantityC115R
CAS11Claim Adjustment Reason CodeC15ID
CAS12Monetary AmountC118R
CAS13QuantityC115R
CAS14Claim Adjustment Reason CodeC15ID
CAS15Monetary AmountC118R
CAS16QuantityC115R
CAS17Claim Adjustment Reason CodeC15ID
CAS18Monetary AmountC118R
CAS19QuantityC115R
NM11Entity Identifier CodeM23ID
NM12Entity Type QualifierM11ID
NM13Name Last Or Organization NameC160AN
NM14Name FirstO135AN
NM15Name MiddleO125AN
NM16Name PrefixO110AN
NM17Name SuffixO110AN
NM18Identification Code QualifierC12ID
NM19Identification CodeC280AN
NM110Entity Relationship CodeC22ID
NM111Entity Identifier CodeO23ID
NM112Name Last Or Organization NameO160AN
MIA1QuantityM115R
MIA2Monetary AmountO118R
MIA3QuantityO115R
MIA4Monetary AmountO118R
MIA5Reference IdentificationO150AN
MIA6Monetary AmountO118R
MIA7Monetary AmountO118R
MIA8Monetary AmountO118R
MIA9Monetary AmountO118R
MIA10Monetary AmountO118R
MIA11Monetary AmountO118R
MIA12Monetary AmountO118R
MIA13Monetary AmountO118R
MIA14Monetary AmountO118R
MIA15QuantityO115R
MIA16Monetary AmountO118R
MIA17Monetary AmountO118R
MIA18Monetary AmountO118R
MIA19Monetary AmountO118R
MIA20Reference IdentificationO150AN
MIA21Reference IdentificationO150AN
MIA22Reference IdentificationO150AN
MIA23Reference IdentificationO150AN
MIA24Monetary AmountO118R
MOA1Percentage As DecimalO110R
MOA2Monetary AmountO118R
MOA3Reference IdentificationO150AN
MOA4Reference IdentificationO150AN
MOA5Reference IdentificationO150AN
MOA6Reference IdentificationO150AN
MOA7Reference IdentificationO150AN
MOA8Monetary AmountO118R
MOA9Monetary AmountO118R
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
DTM1Date/Time QualifierM33ID
DTM2DateC88DT
DTM3TimeC48TM
DTM4Time CodeO22ID
DTM5Date Time Period Format QualifierC23ID
DTM6Date Time PeriodC135AN
PER1Contact Function CodeM22ID
PER2NameO160AN
PER3Communication Number QualifierC22ID
PER4Communication NumberC1256AN
PER5Communication Number QualifierC22ID
PER6Communication NumberC1256AN
PER7Communication Number QualifierC22ID
PER8Communication NumberC1256AN
PER9Contact Inquiry ReferenceO120AN
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
SVC1Product/Service Id QualifierM22ID
SVC2Product/Service IdM148AN
SVC3Procedure ModifierM22AN
SVC4Procedure ModifierM22AN
SVC5Procedure ModifierM22AN
SVC6Procedure ModifierM22AN
SVC7DescriptionM180AN
SVC8Product/Service IdM148AN
SVC9Monetary AmountM118R
SVC10Monetary AmountO118R
SVC11Product/Service IdO148AN
SVC12QuantityO115R
SVC13Product/Service Id QualifierO22ID
SVC14Product/Service IdO148AN
SVC15Procedure ModifierO22AN
SVC16Procedure ModifierO22AN
SVC17Procedure ModifierO22AN
SVC18Procedure ModifierO22AN
SVC19DescriptionO180AN
SVC20Product/Service IdO148AN
SVC21QuantityO115R
DTM1Date/Time QualifierM33ID
DTM2DateC88DT
DTM3TimeC48TM
DTM4Time CodeO22ID
DTM5Date Time Period Format QualifierC23ID
DTM6Date Time PeriodC135AN
CAS1Claim Adjustment Group CodeM12ID
CAS2Claim Adjustment Reason CodeM15ID
CAS3Monetary AmountM118R
CAS4QuantityO115R
CAS5Claim Adjustment Reason CodeC15ID
CAS6Monetary AmountC118R
CAS7QuantityC115R
CAS8Claim Adjustment Reason CodeC15ID
CAS9Monetary AmountC118R
CAS10QuantityC115R
CAS11Claim Adjustment Reason CodeC15ID
CAS12Monetary AmountC118R
CAS13QuantityC115R
CAS14Claim Adjustment Reason CodeC15ID
CAS15Monetary AmountC118R
CAS16QuantityC115R
CAS17Claim Adjustment Reason CodeC15ID
CAS18Monetary AmountC118R
CAS19QuantityC115R
REF1Reference Identification QualifierM23ID
REF2Reference IdentificationC150AN
REF3DescriptionC180AN
REF4Reference Identification QualifierO23ID
REF5Reference IdentificationO150AN
REF6Reference Identification QualifierO23ID
REF7Reference IdentificationO150AN
REF8Reference Identification QualifierO23ID
REF9Reference IdentificationO150AN
AMT1Amount Qualifier CodeM13ID
AMT2Monetary AmountM118R
AMT3Credit/Debit Flag CodeO11ID
QTY1Quantity QualifierM22ID
QTY2QuantityC115R
QTY3Unit Or Basis For Measurement CodeO22ID
QTY4ExponentO115R
QTY5MultiplierO110R
QTY6Unit Or Basis For Measurement CodeO22ID
QTY7ExponentO115R
QTY8MultiplierO110R
QTY9Unit Or Basis For Measurement CodeO22ID
QTY10ExponentO115R
QTY11MultiplierO110R
QTY12Unit Or Basis For Measurement CodeO22ID
QTY13ExponentO115R
QTY14MultiplierO110R
QTY15Unit Or Basis For Measurement CodeO22ID
QTY16ExponentO115R
QTY17MultiplierO110R
QTY18Free-Form InformationC130AN
LQ1Code List Qualifier CodeO13ID
LQ2Industry CodeC130AN
PLB1Reference IdentificationM150AN
PLB2DateM88DT
PLB3Adjustment Reason CodeM22ID
PLB4Reference IdentificationM150AN
PLB5Monetary AmountM118R
PLB6Adjustment Reason CodeC22ID
PLB7Reference IdentificationC150AN
PLB8Monetary AmountC118R
PLB9Adjustment Reason CodeC22ID
PLB10Reference IdentificationC150AN
PLB11Monetary AmountC118R
PLB12Adjustment Reason CodeC22ID
PLB13Reference IdentificationC150AN
PLB14Monetary AmountC118R
PLB15Adjustment Reason CodeC22ID
PLB16Reference IdentificationC150AN
PLB17Monetary AmountC118R
PLB18Adjustment Reason CodeC22ID
PLB19Reference IdentificationC150AN
PLB20Monetary AmountC118R


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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