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*005010X222A1
ViewBHT*0019*00*421400001*20180807*12022607*CH
ViewNM1*41*2*Centene Corporation*****46*421406317
ViewPER*IC*Sambit*TE*3143202264*EX*8099264
ViewNM1*40*2*Centene Corporation*****46*CENTENE001
ViewHL*1**20*1
ViewPRV*BI*PXC*261QM0801X
ViewNM1*85*2*Test Provider*****XX*9999999999
ViewN3*123 MAIN STREET
ViewN4*WOODSTOCK*IL*600980000
ViewREF*EI*999999999
ViewHL*2*1*22*0
ViewSBR*P*18**MEDICAID*****MC
ViewNM1*IL*1*TEST*MEMBER****MI*U0000000001
ViewN3*123 MAIN STREET
ViewN4*Elgin*IL*601200001
ViewDMG*D8*19960215*F
ViewNM1*PR*2*CENTENE*****PI*421406317
ViewN3*123 MAIN STREET
ViewN4*CITYNAME*NA*000000000
ViewCLM*TD-R192ICE00094*600***11:B:1*Y*A*Y*Y
ViewDTP*435*D8*20180625
ViewHI*ABK:F341*ABF:F4310
ViewLX*1
ViewSV1*HC:H0004:HO:HQ*300*UN*12*11**1:2
ViewDTP*472*RD8*20180625-20180625
ViewLX*2
ViewSV1*HC:H0004:HO:HQ*300*UN*12*11**1:2
ViewDTP*472*RD8*20180629-20180629
ViewSE*30*0001

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