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Sample EDI 837 Data for the Health Care Claim Transaction Set
| Agency | Set ID | FG | Trans Desc | Committee |
| ANSI | 837 | HC | Health Care Claim | Insurance |
EDI 837 Main Page Online EDI 837 Translation Need Help?
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
| Entire Segment |
| ST*837*0021*005010X222A1 |
| BHT*0019*00*0123*20061015*1023*RP |
| NM1*41*2*PREMIER BILLING SERVICE*****46*TGJ23 |
| PER*IC*JERRY*TE*3055552222*EX*231 |
| NM1*40*2*AHLIC*****46*66783JJT |
| HL*1**20*1 |
| PRV*BI*PXC*203BF0100Y |
| NM1*85*2*BEN KILDARE SERVICE*****XX*9876543210 |
| N3*234 SEAWAY ST |
| N4*MIAMI*FL*33111 |
| REF*EI*587654321 |
| NM1*87*2 |
| N3*2345 OCEAN BLVD |
| N4*MIAMI*FL*33111 |
| HL*2*1*22*0 |
| SBR*P*18*12312-A******HM |
| NM1*IL*1*SMITH*TED****MI*00221111 |
| N3*236 N MAIN ST |
| N4*MIAMI*FL*33413 |
| DMG*D8*19430501*M |
| NM1*PR*2*ALLIANCE HEALTH AND LIFE INSURANCE*****PI*741234 |
| CLM*26462967*100***11:B:1*Y*A*Y*I |
| DTP*431*D8*19981003 |
| REF*D9*17312345600006351 |
| HI*BK:0340*BF:V7389 |
| NM1*77*2*KILDARE ASSOCIATES*****XX*5812345679 |
| N3*2345 OCEAN BLVD |
| N4*MIAMI*FL*33111 |
| LX*1 |
| SV1*HC:99213*40*UN*1***1 |
| DTP*472*D8*20061003 |
| LX*2 |
| SV1*HC:87072*15*UN*1***1 |
| DTP*472*D8*20061003 |
| LX*3 |
| SV1*HC:99214*35*UN*1***2 |
| DTP*472*D8*20061010 |
| LX*4 |
| SV1*HC:86663*10*UN*1***2 |
| DTP*472*D8*20061010 |
| SE*41*0021 |
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