Sample EDI 275 Data for the Patient Information Transaction Set

AgencySet IDFGTrans DescCommittee
ANSI275PIPatient Information Insurance

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Below is a sample EDI 275 transaction set. The site has an online translation tool that converts the EDI 275 (Patient Information) document into a CSV file. 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 275 Transaction Set

Entire Segment
TRN*1*Reference Identification*Originatin
NM1*01*1*Name Last or Organization Name****Name Suffi*1*Identification Code*0
DMG*CC*Date Time Period*A*A**1*COU
DTP*001*CC*Date Time Period
CAT*01*1*Version Identifier*0*Industry Code*Industry Code*Version Identifier
PID*F**10*Product Desc*Description*1S*Source Subquali*N

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