835 ERA CSV Columns

Payment

NameDescriptionTypeEDI Element
idUnique payment identifier assigned by the converterString
transactionTypeTransaction set identifier codeStringST01
fileNameConverted X12 EDI file nameString
transactionControlNumberTransaction set control numberStringST02
patientControlNumberIdentifier used to track a claim from creation by the health care provider through paymentStringCLP01
claimStatusClaim statusString
chargeAmountCharge amountNumberCLP03
paymentAmountPayment amountNumberCLP04
patientResponsibilityAmountPatient responsibility amountNumberCLP05
claimFilingIndicatorCodeClaim filing indicator codeStringCLP06
payerControlNumberPayer control numberStringCLP07
facilityPlace of service code (professional/dental) or UB facility code (institutional) from the original claim
View codes and descriptions
CodeCLP08
frequencyTypeCodeFrequency type code
View codes and descriptions
StringCLP09
drgCodeDiagnosis-related group code. Institutional claims only.StringCLP11
drgWeightAdjudicated DRG weight. Institutional claims only.NumberCLP12
dischargeFractionAdjudicated discharge fraction. Institutional claims only. This is a percentage expressed as decimal.NumberCLP13
totalPaymentAmountTotal payment amountNumberBPR02
creditOrDebitFlagCodeCredit or debit flag codeStringBPR03
paymentMethodTypePayment method typeStringBPR04
receiverAccountNumberReceiver account numberStringBPR15
paymentDatePayment dateDateBPR16
checkOrEftTraceNumberCheck or eft trace numberStringTRN02
payerEinPayer 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.StringTRN03
productionDateProduction dateDateDTP03 *405
totalAdjAmountSum total of all adjustments from all service linesNumber
adjsClaim adjustmentsList of AdjustmentCAS
payerPayerPartyN1 *PR
payeePayeePartyN1 *PE
patientThe insured (subscriber) or patient from the original claimPartyIdNameNM1 *QC
subscriberThe insured (subscriber) from the original claim if the insured is different from the patientPartyIdNameNM1 *44
correctedPatientCorrected patientPartyIdNameNM1 *74
serviceProviderService providerPartyIdNameNM1 *SJ
crossoverCarrierCrossover carrierPartyIdNameNM1 *TT
correctedPayerCorrected priority payer, meaning that current payer believes that another payer has priority for making a paymentPartyIdNameNM1 *PR
otherSubscriberOther subscriberPartyIdNameNM1 *GB
otherClaimRelatedIdsOther claim-related identificationsList of ReferenceREF
serviceDateFromThe earliest service date from service linesDate
serviceDateToThe latest service date from service linesDate
statementDateFromStatement date fromDateDTP03 *232
statementDateToStatement date toDateDTP03 *233
coverageExpirationDateCoverage expiration dateDateDTP03 *036
claimReceivedDateClaim received dateDateDTP03 *050
coverageAmountCoverage amount from the list of supplemental amountsNumberAMT02 *AU
supplementalAmtsSupplemental claim/payment amounts, such as coverage amount, discount amount, etc.List of AmountAMT
supplementalQtiesSupplemental claim/payment quantitiesList of QuantityQTY
linesService payment informationList of PaymentLineCsvLoop: 2110

Service Line

Loop: 2110, Segment: SVC Open API Schema
NameDescriptionTypeEDI Element
controlNumberLine item control number from 837StringREF02 *6R
procedureAdjudicated procedure code
View codes and descriptions
ProcedureSVC01 *HC, SVC01 *AD, SVC01 *WK, SVC01 *IV
revenueCodeAdjudicated revenue code
View codes and descriptions
CodeSVC01 *RC,NU, SVC04 *RC,NU
drugCodeAdjudicated drug code (NDC)
View codes and descriptions
StringSVC01
chargeAmountCharge amountNumberSVC02
paidAmountPaid amountNumberSVC03
unitCountUnit countNumberSVC05
originalProcedureSubmitted procedure code from the claim if it is different from the adjudicated procedure
View codes and descriptions
ProcedureSVC06 *HC, SVC06 *AD, SVC06 *WK, SVC06 *IV
originalRevenueCodeSubmitted revenue code from the claim if it is different from the adjudicated revenue code
View codes and descriptions
CodeSVC06 *RC,NU
originalDrugCodeSubmitted drug (NDC) code from the claim if it is different from the adjudicated drug code
View codes and descriptions
CodeSVC06
originalUnitCountOriginal unit countNumberSVC07
serviceDateFromService period start dateDateDTP03 *472, DTP03 *150
serviceDateToService period end date. If not provided in EDI (single day), it is set to 'serviceDateFrom'DateDTP03 *151
totalAdjAmountSum total of all adjustments for this service lineNumber
adjsLine adjustmentsList of AdjustmentCAS
serviceIdsRelated service-specific identifiers that were used in the process of adjudicating this serviceList of ReferenceREF
healthcarePolicyIdHealthcare policy idStringREF02 *0K
renderingProviderIdsRendering provider identifiersList of ReferenceREF
allowedAmountAllowed amount -- this is one of the amounts from the list of supplemental amountsNumber
supplementalAmtsSupplemental amounts, such as allowed amount, deduction amount, etc.List of AmountAMT
supplementalQtiesSupplemental quantitiesList of QuantityQTY
remarkCodesRemark codes
View codes and descriptions
List of StringLQ

Adjustment

Segment: CAS Open API Schema
NameDescriptionTypeEDI Element
groupClaim adjustment group code as a string constant (enum)StringCAS01
reasonCodeClaim adjustment reason code
View codes and descriptions
StringCAS02
amountAdjustment amountNumberCAS03
quantityAdjustment quantityNumberCAS04

Organization or Person (Party)

NameDescriptionTypeEDI Element
entityRoleEntity role
View codes and descriptions
StringNM102, N101
entityTypeEntity typeStringNM102
identificationTypeIdentification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum)StringNM108, N103
identifierIdentifierStringNM109, N104
lastNameOrOrgNameOrganization name or person last nameStringNM103, N102
firstNameFirst nameStringNM104
middleNameMiddle nameStringNM105
addressAddressAddress
contactsContactsList of ContactInfo
additionalIdsOther identificationsList of ReferenceREF

Organization Or Person ID and Name

NameDescriptionTypeEDI Element
entityRoleEntity role
View codes and descriptions
StringNM102, N101
entityTypeType of this entity: 'BUSINESS' for organization, 'INDIVIDUAL' for personStringNM102
identificationTypeIdentification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum)StringNM108, N103
identifierIdentifierStringNM109, N104
lastNameOrOrgNameOrganization name or person last nameStringNM103, N102
firstNameFirst nameStringNM104
middleNameMiddle nameStringNM105

Address

NameDescriptionTypeEDI Element
lineLineStringN301
line2Line2StringN302
cityCityStringN401
stateCodeState codeStringN402
zipCodeZip codeStringN403
countryCodeCountry codeStringN404

Contact Info

Segment: PER Open API Schema
NameDescriptionTypeEDI Element
nameNameStringPER02
contactNumbersContact numbersList of ContactNumber

Contact Number

Segment: PER Open API Schema
NameDescriptionTypeEDI Element
typeType of contact number, such as PHONE, EMAIL, URLStringPER03,PER05,PER07
numberNumberStringPER04,PER06,PER08

Procedure

Procedure code with description and optional modifiers
Segment: HI,SV1,SV2,SV3,SVC Open API Schema
NameDescriptionTypeEDI Element
codeHealthcare codeString
descCode description String
modifiersModifiersList of Code837P:SV101-3-6, 837I:SV201-3-6, 835:SVC01-3-6, 277:SVC01-3-6

Code

Code and description
NameDescriptionTypeEDI Element
codeHealthcare codeString
descCode description String

Amount

Segment: AMT Open API Schema
NameDescriptionTypeEDI Element
qualifierCodeCode specifying the type of amount (amount qualifier code)StringAMT01
typeType of amount; qualifier code translated to a mnemonic string constant (enum)
View codes and descriptions
StringAMT01
amountAmountNumberAMT02

Quantity

Segment: QTY Open API Schema
NameDescriptionTypeEDI Element
qualifierCodeCode specifying the type of quantity (quantity qualifier code)StringQTY01
typeType of quantity; qualifier code translated to a mnemonic string constant (enum)
View codes and descriptions
StringQTY01
quantityQuantityNumberQTY02

Reference Identifications

Segment: REF Open API Schema
NameDescriptionTypeEDI Element
qualifierCodeCode qualifying the reference identificationStringREF01
typeType of reference; qualifier code as a string constant (enum)
View codes and descriptions
StringREF01
identificationReference identificationStringREF02