835 ERA Fields

This document provides definitions of header-level CSV columns and properties of Payment and related objects in JSON.

The “EDI Element” column contains the X12 “Reference Designator,” such as CLP01. Where appropriate, we also provide an X12 qualifier code, such as *435 from the DTP*435*D8*20030108~ string (admission date).

“EDI Element” is blank for the fields that are not populated from EDI data. These fields are calculated based on other fields (e.g., totalAdjAmount) or generated by the converter (id).

To view elements of any EDI segment, navigate to this 835 example, select “EDI View” and click on any segment ID.

Payment

Main EDI Loop: 2100

Name	Description	Type	EDI Element
id	Unique payment identifier assigned by the converter	String
transactionType	Transaction set identifier code	String	ST01
fileName	Converted X12 EDI file name	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. This field is also copied to the payerIdentifier field if it wasn't provided in N104.	String	TRN03
productionDate	Production date	Date	DTP02 *405
totalAdjAmount	Sum total of all adjustments from all service lines	Number
adjs	Claim adjustments	List of Adjustment	CAS
payer	Payer	Party	N1 *PR
payee	Payee	Party	N1 *PE
patient	The insured (subscriber) or patient from the original claim	Party	NM1 *QC
subscriber	The insured (subscriber) from the original claim if the insured is different from the patient	Party	NM1 *44
correctedPatient	Corrected patient	Party	NM1 *74
serviceProvider	Service provider	Party	NM1 *SJ
crossoverCarrier	Crossover carrier	Party	NM1 *TT
correctedPayer	Corrected priority payer, meaning that current payer believes that another payer has priority for making a payment	Party	NM1 *PR
otherSubscriber	Other subscriber	Party	NM1 *GB
otherClaimRelatedIds	Other claim-related identifications	List of Reference	REF
serviceDateFrom	The earliest service date from service lines	Date
serviceDateTo	The latest service date from service lines	Date
statementDateFrom	Statement date from	Date	DTP02 *232
statementDateTo	Statement date to	Date	DTP02 *233
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 of Amount	AMT
supplementalQties	Supplemental claim/payment quantities	List of Quantity	QTY
lines	Service payment information	List of ServiceLine	SVC

Service Line

Main EDI Loop: 2110

Name	Description	Type	EDI Element
controlNumber	Line item control number from 837	String	REF02 *6R
procedure	Adjudicated procedure code View codes and descriptions	Procedure	SVC01 HC, SVC01 AD, SVC01 WK, SVC01 IV
revenueCode	Adjudicated revenue code View codes and descriptions	Code	SVC01 RC,NU, SVC04 RC,NU
drugCode	Adjudicated drug code (NDC) View codes and descriptions	String	SVC01
chargeAmount	Charge amount	Number	SVC02
paidAmount	Paid amount	Number	SVC03
unitCount	Unit count	Number	SVC05
originalProcedure	Submitted procedure code from the claim if it is different from the adjudicated procedure View codes and descriptions	Procedure	SVC06 HC, SVC06 AD, SVC06 WK, SVC06 IV
originalRevenueCode	Submitted revenue code from the claim if it is different from the adjudicated revenue code View codes and descriptions	Code	SVC06 *RC,NU
originalDrugCode	Submitted drug (NDC) code from the claim if it is different from the adjudicated drug code View codes and descriptions	String	SVC06
originalUnitCount	Original unit count	Number	SVC07
serviceDateFrom	Service period start date	Date	DTP02 472, DTP02 150
serviceDateTo	Service period end date. If not provided in EDI (single day), it is set to 'serviceDateFrom'	Date	DTP02 *151
totalAdjAmount	Sum total of all adjustments for this service line	Number
adjs	Line adjustments	List of Adjustment	CAS
serviceIds	Related service-specific identifiers that were used in the process of adjudicating this service	List of Reference	REF
healthcarePolicyId	Healthcare policy id	String	REF02 *0K
renderingProviderIds	Rendering provider identifiers	List of Reference	REF
allowedAmount	Allowed amount -- this is one of the amounts from the list of supplemental amounts	Number
supplementalAmts	Supplemental amounts, such as allowed amount, deduction amount, etc.	List of Amount	AMT
supplementalQties	Supplemental quantities	List of Quantity	QTY
remarkCodes	Remark codes View codes and descriptions	List of String	LQ

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	Number	CAS04

Party (Organization or Individual)

Name	Description	Type	EDI Element
entityRole	Entity role View codes and descriptions	String	NM102, N101
identificationType	Identifier type, usually NPI for providers. This is a qualifier code translated to a string constant (enum)	String	NM108, N103
identifier	Identifier	String	NM109, N104
lastNameOrOrgName	Last name or org name	String	NM103, N102
firstName	First name	String	NM104
middleName	Middle name	String	NM105
address	Address	Address
additionalIds	Other identifications	List of Reference	REF

Address

Name	Description	Type	EDI Element
line	Line	String	N301
line2	Line2	String	N302
city	City	String	N401
stateCode	State code	String	N402
zipCode	Zip code	String	N403
countryCode	Country code	String	N404

Procedure

Name	Description	Type	EDI Element
code	Healthcare code	String
desc	Code description	String
modifiers	Modifiers	List of Code	SV101-3

Code

Name	Description	Type	EDI Element
code	Healthcare code	String
desc	Code description	String

Amount

Name	Description	Type	EDI Element
qualifierCode	Code specifying the type of amount (amount qualifier code)	String	AMT01
type	Type of amount; qualifier code translated to a mnemonic string constant (enum)	String	AMT01
amount	Amount	Number	AMT02

Quantity

Name	Description	Type	EDI Element
qualifierCode	Code specifying the type of quantity (quantity qualifier code)	String	QTY01
type	Type of quantity; qualifier code translated to a mnemonic string constant (enum)	String	QTY01
quantity	Quantity	Number	QTY02

Reference Identifications

Name	Description	Type	EDI Element
qualifierCode	Code qualifying the reference identification	String	REF01
type	Type of reference; qualifier code as a string constant (enum)	String	REF01
identification	Reference identification	String	REF02