Sample EDI 864 Data for the Text Message Transaction Set


AgencySet IDFGTransaction DescriptionSubcommittee
ANSI864TXText MessageCommunications Controls


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Below is a sample EDI 864 transaction set. The Jobisez.com site has an online translation tool that converts the EDI 864 (Text Message) document into a CSV file. If you are researching the 864s, 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 864 Transaction Set

Element DetailsEntire Segment
ViewST*864*0001
ViewBMG*22*HEW Report
ViewMIT*0*SERVER REPORT*80*66
ViewMSG*September 14, 2015 02:02:55PM Production HeW Server Report *AA*1
ViewMSG**AA*1
ViewMSG* File Name: RLMP_20150914160222.RPT*AA*1
ViewMSG* Test/Production: Production*AA*1
ViewMSG*--------------------------------------------------------------------------------*AA*1
ViewMSG* ER=Server Error OK=Server Valid *AA*1
ViewMSG*--------------------------------------------------------------------------------*AA*1
ViewMSG*Patient Name: COVEY, EYTHANA S Claim Status: ER *AA*1
ViewMSG*Patient Number: 47678 Payer Code/Name: 77039 MEDICAID MONTAN*AA*1
ViewMSG*Insured's ID: 5047124 Validation Suite: MCAID *AA*1
ViewMSG*Type of Bill: N/A Date of Service: 08/28/2015 08/28/2015*AA*1
ViewMSG*NPI: 1225106842 FTN: 510137423 *AA*1
ViewMSG*Internal Claim No: 1465719649 Total Charge: 51.51 *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 39 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 35 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG*Patient Name: NELSON, BRANT R Claim Status: ER *AA*1
ViewMSG*Patient Number: 47627 Payer Code/Name: 77039 MEDICAID MONTAN*AA*1
ViewMSG*Insured's ID: 1104294 Validation Suite: MCAID *AA*1
ViewMSG*Type of Bill: N/A Date of Service: 08/11/2015 08/11/2015*AA*1
ViewMSG*NPI: 1225106842 FTN: 510137423 *AA*1
ViewMSG*Internal Claim No: 1465719664 Total Charge: 49.06 *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 80 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 76 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG*Patient Name: HAFLICH, LAURENCE A Claim Status: ER *AA*1
ViewMSG*Patient Number: 47653 Payer Code/Name: 77039 MEDICAID MONTAN*AA*1
ViewMSG*Insured's ID: 1278227 Validation Suite: MCAID *AA*1
ViewMSG*Type of Bill: N/A Date of Service: 08/31/2015 08/31/2015*AA*1
ViewMSG*NPI: 1225106842 FTN: 510137423 *AA*1
ViewMSG*Internal Claim No: 1465719677 Total Charge: 98.12 *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 121 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 117 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG*Patient Name: HAFLICH, LAURENCE A Claim Status: ER *AA*1
ViewMSG*Patient Number: 47646 Payer Code/Name: 77039 MEDICAID MONTAN*AA*1
ViewMSG*Insured's ID: 1278227 Validation Suite: MCAID *AA*1
ViewMSG*Type of Bill: N/A Date of Service: 08/10/2015 08/10/2015*AA*1
ViewMSG*NPI: 1225106842 FTN: 510137423 *AA*1
ViewMSG*Internal Claim No: 1465719693 Total Charge: 98.12 *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 162 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 158 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG*Patient Name: GINGER, DALE L Claim Status: ER *AA*1
ViewMSG*Patient Number: 47666 Payer Code/Name: 77039 MEDICAID MONTAN*AA*1
ViewMSG*Insured's ID: 1173177 Validation Suite: MCAID *AA*1
ViewMSG*Type of Bill: N/A Date of Service: 08/12/2015 08/12/2015*AA*1
ViewMSG*NPI: 1225106842 FTN: 510137423 *AA*1
ViewMSG*Internal Claim No: 1465719789 Total Charge: 68.68 *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 203 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 199 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG*Patient Name: HAFLICH, LAURENCE A Claim Status: ER *AA*1
ViewMSG*Patient Number: 47652 Payer Code/Name: 77039 MEDICAID MONTAN*AA*1
ViewMSG*Insured's ID: 1278227 Validation Suite: MCAID *AA*1
ViewMSG*Type of Bill: N/A Date of Service: 08/27/2015 08/27/2015*AA*1
ViewMSG*NPI: 1225106842 FTN: 510137423 *AA*1
ViewMSG*Internal Claim No: 1465719852 Total Charge: 98.12 *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 244 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 240 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG*Patient Name: OHNSTAD, RITA M Claim Status: ER *AA*1
ViewMSG*Patient Number: 47657 Payer Code/Name: 77039 MEDICAID MONTAN*AA*1
ViewMSG*Insured's ID: 1246589 Validation Suite: MCAID *AA*1
ViewMSG*Type of Bill: N/A Date of Service: 08/10/2015 08/10/2015*AA*1
ViewMSG*NPI: 1225106842 FTN: 510137423 *AA*1
ViewMSG*Internal Claim No: 1465719652 Total Charge: 98.12 *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 285 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 281 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG*Patient Name: BOWERS, JONATHAN Claim Status: ER *AA*1
ViewMSG*Patient Number: 47644 Payer Code/Name: 77039 MEDICAID MONTAN*AA*1
ViewMSG*Insured's ID: 1096492 Validation Suite: MCAID *AA*1
ViewMSG*Type of Bill: N/A Date of Service: 08/27/2015 08/27/2015*AA*1
ViewMSG*NPI: 1225106842 FTN: 510137423 *AA*1
ViewMSG*Internal Claim No: 1465719733 Total Charge: 98.12 *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 326 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 322 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG*Patient Name: BOWERS, JONATHAN Claim Status: ER *AA*1
ViewMSG*Patient Number: 47640 Payer Code/Name: 77039 MEDICAID MONTAN*AA*1
ViewMSG*Insured's ID: 1096492 Validation Suite: MCAID *AA*1
ViewMSG*Type of Bill: N/A Date of Service: 08/13/2015 08/13/2015*AA*1
ViewMSG*NPI: 1225106842 FTN: 510137423 *AA*1
ViewMSG*Internal Claim No: 1465719747 Total Charge: 98.12 *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 367 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 363 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG*Patient Name: NELSON, BRANT R Claim Status: ER *AA*1
ViewMSG*Patient Number: 47628 Payer Code/Name: 77039 MEDICAID MONTAN*AA*1
ViewMSG*Insured's ID: 1104294 Validation Suite: MCAID *AA*1
ViewMSG*Type of Bill: N/A Date of Service: 08/18/2015 08/18/2015*AA*1
ViewMSG*NPI: 1225106842 FTN: 510137423 *AA*1
ViewMSG*Internal Claim No: 1465719769 Total Charge: 49.06 *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 408 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1
ViewMSG**AA*1
ViewMSG* Loop/Segment: 2310B NM1 Sequence: Line Number: 404 *AA*1
ViewMSG* Field Name: Element ID: *AA*1
ViewMSG* Data in Field: N/A Error Number: 32195 *AA*1
ViewMSG* Error Message: (HEW) Rendering provider NPI or Provider ID is *AA*1
ViewMSG* missing. *AA*1

Solutions:
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