835 Fields

This document provides definitions of header-level CSV columns and properties of Payment and related objects in JSON. CSV column headers use the upper case.

The “EDI Element” column contains the X12 “Reference Designator,” such as CLM01. Where appropriate, we also provide an X12 qualifier code, such as *435 from the DTP*435*D8*20030108~ string (admission date).

Payment

Name	Description	Type	EDI Element
id	Unique payment identifier assigned by the converter	String
transactionType	Transaction set identifier code	String	ST01
fileName	X12 EDI file name containing the payment	String
transactionControlNumber	Transaction set control number	String	ST02
patientControlNumber	Identifier used to track a claim from creation by the health care provider through payment	String	CLP01
claimStatus	Claim status	String	CLP02
chargeAmount	Charge amount	Number	CLP03
paymentAmount	Payment amount	Number	CLP04
patientResponsibilityAmount	Patient responsibility amount	Number	CLP05
claimFilingIndicatorCode	Claim filing indicator code	String	CLP06
payerControlNumber	Payer control number	String	CLP07
facilityTypeCode	Facility type code View codes and descriptions	String	CLP08
frequencyTypeCode	Frequency type code View codes and descriptions	String	CLP09
drgCode	Diagnosis-related group code. Institutional claims only.	String	CLP11
drgWeight	Adjudicated DRG weight. Institutional claims only.	Number	CLP12
dischargeFraction	Adjudicated discharge fraction. Institutional claims only. This is a percentage expressed as decimal.	Number	CLP13
totalPaymentAmount	Total payment amount	Number	BPR02
creditOrDebitFlagCode	Credit or debit flag code	String	BPR03
paymentMethodType	Payment method type	String	BPR04
receiverAccountNumber	Receiver account number	String	BPR15
paymentDate	Payment date	Date	BPR16
checkOrEftTraceNumber	Check or eft trace number	String	TRN02
payerEin	Payer identifier. This must be a '1' followed by the payer EIN	String	TRN03
productionDate	Production date	Date	DTP02 *405
totalAdjAmount	Sum total of all adjustments from all service lines	Number
adjs	Claim adjustments	List	CAS
serviceDateFrom	The earliest service date from service lines	Date
serviceDateTo	The latest service date from service lines	Date
statementDateFrom	Statement date from	Date	DTP02 *434
statementDateTo	Statement date to	Date	DTP02 *434
coverageExpirationDate	Coverage expiration date	Date	DTP02 *036
claimReceivedDate	Claim received date	Date	DTP02 *050
coverageAmount	Coverage amount from the list of supplemental amounts	Number	AMT02 *AU
supplementalAmts	Supplemental claim/payment amounts, such as coverage amount, discount amount, etc.	List	AMT
supplementalQties	Supplemental claim/payment quantities	List	QTY

Adjustment

Name	Description	Type	EDI Element
group	Claim adjustment group code as a string constant (enum)	String	CAS01
reasonCode	Claim adjustment reason code View codes and descriptions	String	CAS02
amount	Adjustment amount	Number	CAS03
quantity	Adjustment quantity	Integer	CAS04

Amount

Name	Description	Type	EDI Element
type	Type of amount; qualifier code as a string constant (enum)	String	AMT01
amount	Amount	Number	AMT02

Quantity

Name	Description	Type	EDI Element
type	Type of quantity; qualifier code as a string constant (enum)	String	QTY01
quantity	Quantity	Number	QTY02