Complete EDI X12 Reference Guide for Transaction Sets, Segments, and Elements

X12 Release Version

EDI 835 Health Care Claim Payment Advice

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📄 What is this 835 EDI document?

📄 How is this 835 EDI document used?

  • ST (Transaction Set Header) [Min: 0, Max: 1]
  • BPR (Beginning Segment for Payment Order/Remittance Advice) M
  • NTE (Note/Special Instruction) [Min: 0, Max: 999]
  • TRN (Trace) [Min: 0, Max: 1]
  • CUR (Currency) [Min: 0, Max: 1]
  • REF (Reference Identification) [Min: 0, Max: 999]
  • DTM (Date/Time Reference) [Min: 0, Max: 999]
  • ▶
    N1Loop1 () [Min: 0, Max: 200]
      • N1 (Name) M
      • N2 (Additional Name Information) [Min: 0, Max: 999]
      • N3 (Address Information) [Min: 0, Max: 999]
      • N4 (Geographic Location) [Min: 0, Max: 1]
      • REF (Reference Identification) [Min: 0, Max: 999]
      • PER (Administrative Communications Contact) [Min: 0, Max: 999]
  • ▶
    CLPLoop1 () M [Max: 999]
      • CLP (Claim Level Data) M
      • CAS (Claims Adjustment) M [Max: 99]
      • NM1 (Individual or Organizational Name) M [Max: 9]
      • REF (Reference Identification) [Min: 0, Max: 99]
      • DTM (Date/Time Reference) [Min: 0, Max: 9]
      • PER (Administrative Communications Contact) [Min: 0, Max: 3]
      • ▶
        SVCLoop1 () [Min: 0, Max: 999]
          • SVC (Service Information) M
          • DTM (Date/Time Reference) M [Max: 9]
          • CAS (Claims Adjustment) [Min: 0, Max: 9]
          • REF (Reference Identification) [Min: 0, Max: 99]
  • SE (Transaction Set Trailer) [Min: 0, Max: 1]

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