835 Health Care Claim Payment/Advice (005040)
This is the standard X12 005040 spec, with 4 loops and 37 segment positions, as OpenEDI JSON, an ediFabric C# template and an ediFabric Native model. To change it for a trading partner, customize it in the EDI Spec Builder.
Use the 835 spec in your code
ediFabric .NET
Add the C# template and its common files to your project, or reference the template NuGet package, and read 835 files into TS835 objects. See ediFabric .NET.
ediFabric Native
Map version 005040 to the Native model with set_map, then parse 835 files to JSON from Python, Java, C or C#. See Convert between EDI and JSON.
OpenEDI
Select Customize in Spec Builder to copy the spec under your own name, change it for your partner, and parse files against it in EdiNation, ediFabric Native or ediFabric Cloud. Read about OpenEDI.
Generate 835 classes in Python, Java, Node.js, Go, Rust or C
ediFabric Native returns each 835 as JSON, with the property names of the OpenEDI schema. To work with that JSON as typed objects, generate classes from the OpenEDI file in your language and deserialize the JSON into TS835. Serialize the objects back to JSON to build EDI with ediFabric Native. The classes keep the loops, segments, lengths and code lists, but not the EDI data formats, so validate files with ediFabric Native. Read more in Generate a class from OpenEDI.
Python: datamodel-code-generator. Node.js: openapi-typescript. Java, Go, Rust and C: OpenAPI Generator.
835 structure
Loops and segments of the standard 835, with their usage and maximum repeats.
| ID | Name | Usage | Max use |
|---|---|---|---|
| ST | Transaction Set Header | Optional | 1 |
| BPR | Beginning Segment for Payment Order/Remittance Advice | Mandatory | 1 |
| NTE | Note/Special Instruction | Optional | >1 |
| TRN | Trace | Optional | 1 |
| CUR | Currency | Optional | 1 |
| REF | Reference Information | Optional | >1 |
| DTM | Date/Time Reference | Optional | >1 |
| Loop N1 | Party Identification | Optional | 200 |
| N1 | Party Identification | Mandatory | 1 |
| N2 | Additional Name Information | Optional | >1 |
| N3 | Party Location | Optional | >1 |
| N4 | Geographic Location | Optional | 1 |
| REF | Reference Information | Optional | >1 |
| PER | Administrative Communications Contact | Optional | >1 |
| RDM | Remittance Delivery Method | Optional | 1 |
| DTM | Date/Time Reference | Optional | 1 |
| Loop LX | Transaction Set Line Number | Optional | >1 |
| LX | Transaction Set Line Number | Mandatory | 1 |
| TS3 | Transaction Statistics | Optional | 1 |
| TS2 | Transaction Supplemental Statistics | Optional | 1 |
| Loop CLP | Claim Level Data | Mandatory | >1 |
| CLP | Claim Level Data | Mandatory | 1 |
| CAS | Claims Adjustment | Optional | 99 |
| NM1 | Individual or Organizational Name | Mandatory | 9 |
| MIA | Medicare Inpatient Adjudication | Optional | 1 |
| MOA | Medicare Outpatient Adjudication | Optional | 1 |
| REF | Reference Information | Optional | 99 |
| DTM | Date/Time Reference | Optional | 9 |
| PER | Administrative Communications Contact | Optional | 3 |
| AMT | Monetary Amount Information | Optional | 20 |
| QTY | Quantity Information | Optional | 20 |
| Loop SVC | Service Information | Optional | 999 |
| SVC | Service Information | Mandatory | 1 |
| DTM | Date/Time Reference | Optional | 9 |
| CAS | Claims Adjustment | Optional | 99 |
| REF | Reference Information | Optional | 99 |
| AMT | Monetary Amount Information | Optional | 20 |
| QTY | Quantity Information | Optional | 20 |
| LQ | Industry Code Identification | Optional | 99 |
| PLB | Provider Level Adjustment | Optional | >1 |
| SE | Transaction Set Trailer | Optional | 1 |