By | 2019-10-09T12:52:07+00:00 October 9th, 2019|

What is an EDI 835 Health Care Claim Payment/Advice? 

The EDI 835 Health Care Claim Payment/Advice transaction set is used to make payments to healthcare providers, provide Explanations of Benefits (EOB), or both. An EDI 835 document is organized into data elements and segments which include information, such as what charges were paid, mode of payment, and deductible amount.  

EDI X12 835 Health Care Claim Payment/Advice Sample

The following example details the format of an EDI 835 documen[1].

ST*835*1234~
BPR*I*15096.46*C*CHK************20100923~
TRN*1*70408535*15714001~
REF*F2*slca435w~
DTM*405*20100923~
N1*PR*NC TEACHERS & STATE EMPLOYEES HEALTH PLAN & HEALTH CHOICE~
N3*P O BOX 30025~
N4*DURHAM*NC*27702~
PER*CX**TE*8002144844~
N1*PE*ACME UNIV HLTH SYS INC*XX*1234567890~
N3*P O BOX AAA1~
N4*DURHAM*NC*27701~
REF*TJ*123456789~
CLP*474623UB001CW0321*1*3740.6*5451.04**15*80209000000*11*1**397*0.7309~
CAS*CO*94*-1710.44~
NM1*QC*1*Rabbit*Roger*B***MI* RUN123456789~
MIA*0~
REF*EA*CW0321~
DTM*232*20100307~
DTM*233*20100310~
DTM*50*20100918~
AMT*AU*5451.04~
SE*21*1234~

Workflow for the Exchange of an EDI 835-W1 Health Care Claim Payment/Advice

The EDI 835 transaction set is one of the most commonly used transaction sets in the healthcare industry. Information requested in an EDI 837 transaction is transmitted using the EDI 835 Health Care Claim Payment/Advice document. This helps healthcare service providers obtain important details associated with an insurance claim

Achieve EDI Compliance with Astera EDIConnect

Astera EDIConnect is an enterprise-grade EDI solution that facilitates frictionless B2B data exchange by providing support for a wide variety of EDI standards, including ANSI X12, HIPAA, and EDIFACT. Featuring a built-in EDI parser, validator, and transaction builder, Astera EDIConnect makes the process of onboarding new partners and configuring their requirements quick and simple. 

[1]https://www.bluecrossnc.com/sites/default/files/document/attachment/providers/public/pdfs/835_5010_v2.6%20Claim%20Payment%20Advice.pdf

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