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.
N1*PR*NC TEACHERS & STATE EMPLOYEES HEALTH PLAN & HEALTH CHOICE~
N3*P O BOX 30025~
N1*PE*ACME UNIV HLTH SYS INC*XX*1234567890~
N3*P O BOX AAA1~
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.