Sample EDI 837 Data for the Health Care Claim Transaction Set


AgencySet IDFGTransaction DescriptionSubcommittee
ANSI837HCHealth Care Claim Insurance


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Research and Development:
Below is a sample EDI 837 transaction set. The Jobisez.com site has an online translation tool that converts the EDI 837 (Health Care Claim) document into a CSV file. 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 837 Transaction Set

SegmentEntire Segment
ViewST*837*0001*005010X225A2
ViewBHT*0019*00*204*20200727*0857
ViewNM1*41*2*SUBMITTER*****46*SUBMITTER ID
ViewPER*IC*CONTACT NAME*ED*CONTACT*ED*CONTACT 2*ED*CONTACT 3
ViewNM1*40*2*WHAIC*****46*WHAIC 837
ViewHL*1**20*1
ViewNM1*SJ*2*GOOD SHEP 18.4*****XX*1232345672
ViewREF*1J*98765
ViewHL*2*1*22*0
ViewSBR*P*18*******09
ViewNM1*IL*1*MADHU*FU*U***MI*NO INSURANCE
ViewN3*AHGDH*ASDAHSGD
ViewN4*BARODA*MA*02124
ViewDMG*D8*19911010*M*2
ViewNM1*PR*2*SELF*****PI*UNKNOWN
ViewCLM*9505079*4725***13:A:1
ViewDTP*096*TM**
ViewDTP*434*RD8*20200604-20200604
ViewDTP*435*DT*202006040349
ViewCL1*1*1*01
ViewREF*EA*20024508
ViewHI*ABK:A050
ViewHI*APR:
ViewHI*APR:A050
ViewNM1*71*1*AAAAAAAAAAAAAAAAAAAAAAAAAA
ViewREF*1G*OTH000
ViewLX*1
ViewSV2*0370**4725*UN*2
ViewDTP*472*D8*20200604
ViewCLM*9505080*4725***13:A:1
ViewDTP*096*TM**
ViewDTP*434*RD8*20200604-20200604
ViewDTP*435*DT*202006040908
ViewCL1*1*1*01
ViewREF*EA*20024508
ViewHI*ABK:A040
ViewHI*APR:
ViewHI*APR:A040
ViewNM1*71*1*AAAAAAAAAAAAAAAAAAAAAAAAAA
ViewREF*1G*OTH000
ViewLX*1
ViewSV2*0370**4725*UN*2
ViewDTP*472*D8*20200604
ViewSE*44*0001

Solutions:
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