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Sample EDI 835 Data for the Health Care Claim Payment / Advice Transaction Set
| Agency | Set ID | FG | Trans Desc | Committee |
| ANSI | 835 | HP | Health Care Claim Payment / Advice | Insurance |
EDI 835 Main Page Online EDI 835 Translation 835 Mapping Specs Need Help?
Research and Development:
Below is a sample EDI 835 transaction set. The Jobisez.com site has an online translation tool that converts the EDI 835 (Health Care Claim Payment / Advice) document into a CSV file. If you are researching the 835s, you can view other trading partner's mapping specifications. 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 835 Transaction Set
| Entire Segment |
| ST*835*000000001 |
| BPR*H*0*C*NON************20250327 |
| TRN*1*302711761*1351840597 |
| REF*EV*CF01 |
| DTM*405*20250326 |
| N1*PR*NATIONAL GOVERNMENT SERVICES, INC. |
| N3*PO BOX 7111 |
| N4*INDIANAPOLIS,*IN*462077111 |
| REF*2U*14512 |
| PER*CX*NATIONAL GOVERNMENT SERVICES, INC.*TE*8778696504 |
| PER*BL*NATIONAL GOVERNMENT SERVICES, INC.*TE*8772734334*UR*WWW.NGSMEDICARE.CO |
| PER*IC**UR*WWW.NGSMEDICARE.COM |
| N1*PE*SAS GASTROENTEROLOGY LLC*XX*1225733207 |
| N3*STE 7*195 HOSPITAL LOOP |
| N4*BERLIN*VT*056028495 |
| REF*TJ*921588448 |
| LX*1 |
| CLP*941690*19*1042*0*5.02*MB*3225080015420*22*1 |
| NM1*QC*1*BISSON*MARILYN*R***MI*5Q82ME1WC88 |
| NM1*82*1******XX*1174056709 |
| NM1*TT*2*WPS - TRICARE FOR LIFE*****PI*60000 |
| MOA***MA01*MA18 |
| REF*EA*52670 |
| DTM*050*20250321 |
| SVC*HC^G0105*935*0**0**1 |
| DTM*472*20250318 |
| CAS*CO*50*935 |
| REF*LU*22 |
| REF*6R*53559 |
| REF*0K*NCD 210.3 |
| LQ*HE*M25 |
| LQ*HE*M64 |
| LQ*HE*N386 |
| SVC*HC^G0500*107*0**1 |
| DTM*472*20250318 |
| CAS*CO*45*101.98 |
| CAS*PR*1*5.02 |
| REF*LU*22 |
| REF*6R*53560 |
| AMT*B6*5.02 |
| LQ*HE*N535 |
| SE*42*000000001 |
Solutions:
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