835 (ERA) CSV Data Dictionary

Unique payment identifier assigned by the converter

Transaction set identifier code

Converted X12 EDI file name

Transaction set control number

Identifier used to track a claim from creation by the health care provider through payment

Claim status

Charge amount

Payment amount

Patient responsibility amount

Claim filing indicator code

Payer control number

Place of service code (professional/dental) or UB facility code (institutional) from the original claim

View codes and descriptions

Frequency type code

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Diagnosis-related group code. Institutional claims only.

Adjudicated DRG weight. Institutional claims only.

Adjudicated discharge fraction. Institutional claims only. This is a percentage expressed as decimal.

Total payment amount

Credit or debit flag code

Payment method type

Receiver account number

Payment date

Check or eft trace number

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.

Production date

Sum total of all adjustments from all service lines

Claim adjustments

Payer

Payee

The insured (subscriber) or patient from the original claim

The insured (subscriber) from the original claim if the insured is different from the patient

Corrected patient

Service provider

Crossover carrier

Corrected priority payer, meaning that current payer believes that another payer has priority for making a payment

Other subscriber

Other claim-related identifications

The earliest service date from service lines

The latest service date from service lines

Statement date from

Statement date to

Coverage expiration date

Claim received date

Coverage amount from the list of supplemental amounts

Supplemental claim/payment amounts, such as coverage amount, discount amount, etc.

Supplemental claim/payment quantities

Service payment information

Line item control number from 837

Adjudicated procedure code

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Adjudicated revenue code

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Adjudicated drug code (NDC)

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Charge amount

Paid amount

Unit count

Submitted procedure code from the claim if it is different from the adjudicated procedure

View codes and descriptions

Submitted revenue code from the claim if it is different from the adjudicated revenue code

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Submitted drug (NDC) code from the claim if it is different from the adjudicated drug code

View codes and descriptions

Original unit count

Service period start date

Service period end date. If not provided in EDI (single day), it is set to 'serviceDateFrom'

Sum total of all adjustments for this service line

Line adjustments

Related service-specific identifiers that were used in the process of adjudicating this service

Healthcare policy id

Rendering provider identifiers

Allowed amount -- this is one of the amounts from the list of supplemental amounts

Supplemental amounts, such as allowed amount, deduction amount, etc.

Supplemental quantities

Remark codes

View codes and descriptions

Claim adjustment group code as a string constant

Values:

CONTRACTUAL(CO), CORRECTION(CR), OTHER(OA), PATIENT_RESPONSIBILITY(PR), PAYOR_INITIATED(PI)

Claim adjustment reason code

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Adjustment amount

Adjustment quantity

Entity role

View codes and descriptions

Type of this entity: 'BUSINESS' for organization, 'INDIVIDUAL' for person

Values:

BUSINESS(2), INDIVIDUAL(1)

Identification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum)

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Identifier

Tax id

Organization name or person last name

First name

Middle name

Address

Contacts

Other identifications

Line

Line2

City

State code

Zip code

Country code

Function code

Name

Contact numbers

Type of contact number

Values:

ALTERNATE_PHONE, BEEPER, CELL_PHONE, EMAIL, EXTENSION, FAX, HOME_PHONE, PHONE, UNKNOWN, URL, WORK_PHONE

Number

Modifiers

Healthcare code subtype, such as CPT, HCPCS, ICD_10, NDC

Healthcare code

Code description

Code specifying the type of amount (amount qualifier code)

Type of amount; qualifier code translated to a mnemonic string constant (enum)

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Amount

Code specifying the type of quantity (quantity qualifier code)

Type of quantity; qualifier code translated to a mnemonic string constant (enum)

View codes and descriptions

Quantity

Code qualifying the reference identification

Type of reference; qualifier code as a string constant (enum)

View codes and descriptions

Reference identification