835 Health Care Claim Payment/Advice (004010X091A1)
Payers send the 835 electronic remittance advice (ERA) to explain claim payments, adjustments and denials. This is the standard X12 HIPAA 004010 spec, with 5 loops and 45 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 004010X091A1 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.
For a sample file, the same data as JSON, and code to parse, validate and generate the 835, see the 835 transaction guide.
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 | Financial Information | Mandatory | 1 |
| TRN | Reassociation Trace Number | Mandatory | 1 |
| CUR | Foreign Currency Information | Optional | 1 |
| REF | Receiver Identification | Optional | 1 |
| REF | Version Identification | Optional | 1 |
| DTM | Production Date | Optional | 1 |
| Loop N1 | Payer Identification | Mandatory | 1 |
| N1 | Payer Identification | Mandatory | 1 |
| N3 | Payer Address | Mandatory | 1 |
| N4 | Payer City State ZIP Code | Mandatory | 1 |
| REF | Additional Payer Identification | Optional | 4 |
| PER | Payer Contact Information | Optional | 1 |
| Loop N1 | Payee Identification | Mandatory | 1 |
| N1 | Payee Identification | Mandatory | 1 |
| N3 | Payee Address | Optional | 1 |
| N4 | Payee City State ZIP Code | Optional | 1 |
| REF | Payee Additional Identification | Optional | >1 |
| Loop LX | Header Number | Optional | >1 |
| LX | Header Number | Mandatory | 1 |
| TS3 | Provider Summary Information | Optional | 1 |
| TS2 | Provider Supplemental Summary Information | Optional | 1 |
| Loop CLP | Claim Payment Information | Mandatory | >1 |
| CLP | Claim Payment Information | Mandatory | 1 |
| CAS | Claim Adjustment | Optional | 99 |
| NM1 | Patient Name | Mandatory | 1 |
| NM1 | Insured Name | Optional | 1 |
| NM1 | Corrected Patient Insured Name | Optional | 1 |
| NM1 | Service Provider Name | Optional | 1 |
| NM1 | Crossover Carrier Name | Optional | 1 |
| NM1 | Corrected Priority Payer Name | Optional | 2 |
| MIA | Inpatient Adjudication Information | Optional | 1 |
| MOA | Outpatient Adjudication Information | Optional | 1 |
| REF | Other Claim Related Identification | Optional | 5 |
| REF | Rendering Provider Identification | Optional | 10 |
| DTM | Claim Date | Optional | 4 |
| PER | Claim Contact Information | Optional | 3 |
| AMT | Claim Supplemental Information | Optional | 14 |
| QTY | Claim Supplemental Information Quantity | Optional | 15 |
| Loop SVC | Service Payment Information | Optional | 999 |
| SVC | Service Payment Information | Mandatory | 1 |
| DTM | Service Date | Optional | 3 |
| CAS | Service Adjustment | Optional | 99 |
| REF | Service Identification | Optional | 7 |
| REF | Rendering Provider Information | Optional | 10 |
| AMT | Service Supplemental Amount | Optional | 12 |
| QTY | Service Supplemental Quantity | Optional | 6 |
| LQ | Health Care Remark Codes | Optional | 99 |
| PLB | Provider Adjustment | Optional | >1 |
| SE | Transaction Set Trailer | Optional | 1 |