Product: X12 EDI
Transaction: 835
Article Link: http://help.truecommerce.com/en/articles/10258368-x12-835-health-care-claim-payment-advice
835 - Health Care Claim Payment/Advice
FUNCTIONAL GROUP=HP
This X12 Transaction Set contains the format and establishes the data contents of the Health Care Claim Payment/Advice Transaction Set (835) for use within the context of the Electronic Data Interchange (EDI) 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.
SCHEMA
ST
Segment | Name | Position |
ST | Transaction Set Header | 0100 |
BPR | Beginning Segment for Payment Order/Remittance Advice | 0200 |
NTE | Note/Special Instruction | 0300 |
TRN | Trace | 0400 |
CUR | Currency | 0500 |
REF | Reference Information | 0600 |
DTM | Date/Time Reference | 0700 |
1000
Segment | Name | Position |
N1 | Party Identification | 0800 |
N2 | Additional Name Information | 0900 |
N3 | Party Location | 1000 |
N4 | Geographic Location | 1100 |
REF | Reference Information | 1200 |
PER | Administrative Communications Contact | 1300 |
RDM | Remittance Delivery Method | 1400 |
DTM | Date/Time Reference | 1500 |
2000
Segment | Name | Position |
LX | Transaction Set Line Number | 0030 |
TS3 | Transaction Statistics | 0050 |
TS2 | Transaction Supplemental Statistics | 0070 |
2100
Segment | Name | Position |
CLP | Claim Level Data | 0100 |
CAS | Claims Adjustment | 0200 |
RAS | Reason Adjustment | 0250 |
NM1 | Individual or Organizational Name | 0300 |
MIA | Inpatient Adjudication | 0330 |
MOA | Outpatient Adjudication | 0350 |
REF | Reference Information | 0400 |
DTM | Date/Time Reference | 0500 |
PER | Administrative Communications Contact | 0600 |
AMT | Monetary Amount Information | 0620 |
QTY | Quantity Information | 0640 |
2110
Segment | Name | Position |
SVC | Service Information | 0700 |
DTM | Date/Time Reference | 0800 |
CAS | Claims Adjustment | 0900 |
RAS | Reason Adjustment | 0950 |
REF | Reference Information | 1000 |
AMT | Monetary Amount Information | 1100 |
QTY | Quantity Information | 1200 |
LQ | Industry Code Identification | 1300 |
SE
Segment | Name | Position |
PLB | Provider Level Adjustment | 0100 |
SE | Transaction Set Trailer | 0200 |
COMMENTS
Notes |
|
2/0030 | The LX segment is used to provide a looping structure and logical grouping of claim payment information. |
2/0200 | The CAS segment is used to reflect changes to amounts within Table 2. |
2/0800 | The DTM segment in the SVC loop is to be used to express dates and date ranges specifically related to the service identified in the SVC segment. |
2/0900 | The CAS segment is used to reflect changes to amounts within Table 2. |
Comments |
|
1/0400 | The TRN segment is used to uniquely identify a claim payment and advice. |
1/0500 | The CUR segment does not initiate a foreign exchange transaction. |
1/0800 | The N1 loop allows for name/address information for the payer and payee which would be utilized to address remittance(s) for delivery. |
rev 12/09/2024