By | 2019-10-09T12:39:56+00:00 October 9th, 2019|

What is an EDI 835-W1 Health Care Claim Payment/Advice? 

One of the X12 transactions, EDI 835-W1 is used by healthcare service providers to make payments or send an Explanation of Benefits (EOB)An EDI 835-W1 document is organized into different data elements and segments that contain the following information: 

  • The charges paid 
  • The mode of payment 
  • The claim details, such as deductibles, co-insurance, and co-pay  

EDI X12 835-W1 Health Care Claim Payment/Advice Sample

An EDI 835-W1 document is divided into functional groups that explain the contents of the transaction being conducted. The following example details the format of an EDI 835-W1 document[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-W1 falls under the category of the X12N Insurance transactions. Upon receiving an EDI 837 Health Care Claim transaction set, the healthcare service providers send the EDI 835 document for making a payment or providing an explanation of benefits (EOB).

Stay EDI Compliant with Astera EDIConnect

Designed to facilitate electronic data interchange, Astera EDIConnect is an enterprise-grade, code-free solution that supports EDIFACT, HL7, and ANSI X12 EDI formats. With a built-in parser, validator, and transaction builder, Astera EDIConnect makes the process of sending and receiving EDI documents simple and easy.

[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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