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X12 EDI Conversion and Parsing API (2.15.0-beta.8)

Download OpenAPI specification:

E-mail: ediconvert@datainsight.health URL: https://datainsight.health/products/edi-convert/

API for converting healthcare X12 EDI transactions to JSON or CSV and for generating EDI from JSON.

Application Info

Returns application info, including version and license

Get version and license info

Returns application info, including version and license

Responses

Response Schema: application/json
version
string
buildDateTime
string <date-time>
object (LicenseInfo)

Response samples

Content type
application/json
{
  • "version": "2.10",
  • "buildDateTime": "2024-11-26T12:23:10.875",
  • "licenseInfo": {
    }
}

EDI-to-CSV

Converts X12 EDI input to CSV. You can post the EDI file's content as text or use multi-part request to upload files.

See Python and curl examples in our GitHub repo.
See also introduction to the CSV conversion API here.

You can find output examples for all formats here.

Convert X12 EDI 837/835/834 to CSV

Converts X12 EDI input into comma-separated (CSV) flat file format. EDI can be posted as text in the body of the request or uploaded using a multi-part/form-data request.

The output is streamed as the input is parsed.

See the data dictionary for more details about the response schema, including mappings to X12 EDI elements.

The CSV output is highly customizable. See this guide for more details.

Output examples:

query Parameters
schemaFileName
string
Default: "csv_conversion.yaml"

Name of the file containing the CSV conversion schemas. See this document for more details.

schemaName
string
Default: "lines-with-header-repeat-first-row"

Name of the 'schema' (configuration) for CSV conversion in the CSV schema file. See this document for more details.

ediFileName
string

The name of the EDI file submitted as text. This name will be propagated to the fileName column. Ignored for multipart requests.

warningsInResponse
boolean
Default: false

Write EDI parsing warnings to the response stream. Warnings are written into the first column and start with "WARNING:" prefix. If not set, warnings are only written to logs. See User Guide for more details.

maxWarnings
integer
Default: 50

Maximum number of EDI parsing warnings per file before raising Too Many Warnings" error and stopping.

chunkSize
integer <int32>
Default: 200

How many claims or payments (837/835) or members (834) to parse at a time

Request Body schema:
files
required
Array of strings <binary> [ items <binary > ]

Responses

Response Schema: text/plain
One of
id
string

Unique payment identifier assigned by the converter.

transactionType
string

Transaction set identifier code. EDI: ST01.

fileName
string

Converted X12 EDI file name.

transactionControlNumber
string

Transaction set control number. EDI: ST02.

patientControlNumber
string

Identifier used to track a claim from creation by the health care provider through payment. EDI: CLP01.

claimStatus
string

Claim status.

chargeAmount
number <float>

Charge amount. EDI: CLP03.

paymentAmount
number <float>

Payment amount. EDI: CLP04.

patientResponsibilityAmount
number <float>

Patient responsibility amount. EDI: CLP05.

claimFilingIndicatorCode
string

Claim filing indicator code. EDI: CLP06.

payerControlNumber
string

Payer control number. EDI: CLP07.

object (Code)

Place of service code (professional/dental) or UB facility code (institutional) from the original claim. EDI: CLP08.

frequencyTypeCode
string

Frequency type code. EDI: CLP09.

drgCode
string

Diagnosis-related group code. Institutional claims only. EDI: CLP11.

drgWeight
number <float>

Adjudicated DRG weight. Institutional claims only. EDI: CLP12.

dischargeFraction
number <float>

Adjudicated discharge fraction. Institutional claims only. This is a percentage expressed as decimal. EDI: CLP13.

totalPaymentAmount
number <float>

Total payment amount. EDI: BPR02.

creditOrDebitFlagCode
string

Credit or debit flag code. EDI: BPR03.

paymentMethodType
string

Payment method type. EDI: BPR04.

receiverAccountNumber
string

Receiver account number. EDI: BPR15.

paymentDate
string <date>

Payment date. EDI: BPR16.

checkOrEftTraceNumber
string

Check or eft trace number. EDI: TRN02.

payerEin
string

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. EDI: TRN03.

productionDate
string <date>

Production date. EDI: DTP03*405.

totalAdjAmount
number <float>

Sum total of all adjustments from all service lines.

Array of objects (Adjustment)

Claim adjustments. EDI: CAS.

object (Party)

Payer. EDI: N1*PR.

object (Party)

Payee. EDI: N1*PE.

object (PartyIdName)

The insured (subscriber) or patient from the original claim. EDI: NM1*QC.

object (PartyIdName)

The insured (subscriber) from the original claim if the insured is different from the patient. EDI: NM1*44.

object (PartyIdName)

Corrected patient. EDI: NM1*74.

object (PartyIdName)

Service provider. EDI: NM1*SJ.

object (PartyIdName)

Crossover carrier. EDI: NM1*TT.

object (PartyIdName)

Corrected priority payer, meaning that current payer believes that another payer has priority for making a payment. EDI: NM1*PR.

object (PartyIdName)

Other subscriber. EDI: NM1*GB.

Array of objects (Reference)

Other claim-related identifications. EDI: REF.

serviceDateFrom
string <date>

The earliest service date from service lines.

serviceDateTo
string <date>

The latest service date from service lines.

statementDateFrom
string <date>

Statement date from. EDI: DTP03*232.

statementDateTo
string <date>

Statement date to. EDI: DTP03*233.

coverageExpirationDate
string <date>

Coverage expiration date. EDI: DTP03*036.

claimReceivedDate
string <date>

Claim received date. EDI: DTP03*050.

coverageAmount
number <float>

Coverage amount from the list of supplemental amounts. EDI: AMT02*AU.

Array of objects (Amount)

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

Array of objects (Quantity)

Supplemental claim/payment quantities. EDI: QTY.

Array of objects (PaymentLineCsv)

Service payment information. EDI: Loop: 2110.

Request samples 

# Post EDI as text
curl -X POST -H "Content-Type: text/plain" \
--data-binary  @../edi_files/835/835.edi  \ 
"$API_URL/edi/csv?ediFileName=837.edi"

# Upload EDI files using multipart request
curl -F files=@"../edi_files/837/837-1.dat" -F files=@"../edi_files/837/837-2.dat" \
$API_URL/edi/csv

Response samples

Content type
text/plain
Example
Id,TransactionType,FileName,TransactionControlNumber,PatientControlNumber,ClaimStatus,ChargeAmount,PaymentAmount,PatientResponsibilityAmount,ClaimFilingIndicatorCode,PayerControlNumber,FacilityCode,FrequencyTypeCode,DrgCode,DrgWeight,DischargeFraction,TotalPaymentAmount,CreditOrDebitFlagCode,PaymentMethodType,ReceiverAccountNumber,PaymentDate,CheckOrEftTraceNumber,PayerEin,ProductionDate,TotalAdjAmount,Adj1Group,Adj1ReasonCode,Adj1Amount,Adj1Quantity,Adj2Group,Adj2ReasonCode,Adj2Amount,Adj2Quantity,Adj3Group,Adj3ReasonCode,Adj3Amount,Adj3Quantity,Adj4Group,Adj4ReasonCode,Adj4Amount,Adj4Quantity,Adj5Group,Adj5ReasonCode,Adj5Amount,Adj5Quantity,PayerIdentificationType,PayerIdentifier,PayerName,PayerAddressLine,PayerAddressLine2,PayerAddressCity,PayerAddressStateCode,PayerAddressZipCode,PayerContact1Name,PayerContact1ContactNumber1Type,PayerContact1ContactNumber1Number,PayerContact1ContactNumber2Type,PayerContact1ContactNumber2Number,PayerContact2Name,PayerContact2ContactNumber1Type,PayerContact2ContactNumber1Number,PayerContact2ContactNumber2Type,PayerContact2ContactNumber2Number,PayerAdditionalId1Type,PayerAdditionalId1Identification,PayerAdditionalId2Type,PayerAdditionalId2Identification,PayeeIdentificationType,PayeeIdentifier,PayeeLastNameOrOrgName,PayeeAddressLine,PayeeAddressLine2,PayeeAddressCity,PayeeAddressStateCode,PayeeAddressZipCode,PayeeContacts,PayeeAdditionalId1Type,PayeeAdditionalId1Identification,PayeeAdditionalId2Type,PayeeAdditionalId2Identification,PatientIdentificationType,PatientIdentifier,PatientLastName,PatientFirstName,PatientMiddleName,SubscriberIdentificationType,SubscriberIdentifier,SubscriberLastName,SubscriberFirstName,SubscriberMiddleName,CorrectedPatientIdentificationType,CorrectedPatientIdentifier,CorrectedPatientLastName,CorrectedPatientFirstName,CorrectedPatientMiddleName,ServiceProviderIdentificationType,ServiceProviderIdentifier,ServiceProviderLastNameOrOrgName,ServiceProviderFirstName,ServiceProviderMiddleName,ServiceProviderContacts,ServiceProviderAdditionalId1Type,ServiceProviderAdditionalId1Identification,ServiceProviderAdditionalId2Type,ServiceProviderAdditionalId2Identification,CrossoverCarrierIdentificationType,CrossoverCarrierIdentifier,CrossoverCarrierName,CorrectedPayerIdentificationType,CorrectedPayerIdentifier,CorrectedPayerName,OtherSubscriberIdentificationType,OtherSubscriberIdentifier,OtherSubscriberLastName,OtherSubscriberFirstName,OtherSubscriberMiddleName,OtherClaimRelatedId1Type,OtherClaimRelatedId1Identification,OtherClaimRelatedId2Type,OtherClaimRelatedId2Identification,ServiceDateFrom,ServiceDateTo,StatementDateFrom,StatementDateTo,CoverageExpirationDate,ClaimReceivedDate,CoverageAmount,SupplementalAmt1QualifierCode,SupplementalAmt1Type,SupplementalAmt1Amount,SupplementalAmt2QualifierCode,SupplementalAmt2Type,SupplementalAmt2Amount,SupplementalQty1QualifierCode,SupplementalQty1Type,SupplementalQty1Quantity,SupplementalQty2QualifierCode,SupplementalQty2Type,SupplementalQty2Quantity,LineControlNumber,LineProcedureCode,LineProcedureModifier1Code,LineProcedureModifier2Code,LineProcedureModifier3Code,LineRevenueCode,LineDrugCode,LineChargeAmount,LinePaidAmount,LineUnitCount,LineOriginalProcedureCode,LineOriginalProcedureModifier1Code,LineOriginalProcedureModifier2Code,LineOriginalProcedureModifier3Code,LineOriginalRevenueCode,LineOriginalDrugCode,LineOriginalUnitCount,LineServiceDateFrom,LineServiceDateTo,LineTotalAdjAmount,LineAdj1Group,LineAdj1ReasonCode,LineAdj1Amount,LineAdj1Quantity,LineAdj2Group,LineAdj2ReasonCode,LineAdj2Amount,LineAdj2Quantity,LineAdj3Group,LineAdj3ReasonCode,LineAdj3Amount,LineAdj3Quantity,LineAdj4Group,LineAdj4ReasonCode,LineAdj4Amount,LineAdj4Quantity,LineAdj5Group,LineAdj5ReasonCode,LineAdj5Amount,LineAdj5Quantity,LineServiceId1Type,LineServiceId1Identification,LineServiceId2Type,LineServiceId2Identification,LineServiceId3Type,LineServiceId3Identification,LineHealthcarePolicyId,LineRenderingProviderId1Type,LineRenderingProviderId1Identification,LineRenderingProviderId2Type,LineRenderingProviderId2Identification,LineAllowedAmount,LineSupplementalAmt1QualifierCode,LineSupplementalAmt1Type,LineSupplementalAmt1Amount,LineSupplementalAmt2QualifierCode,LineSupplementalAmt2Type,LineSupplementalAmt2Amount,LineSupplementalQty1QualifierCode,LineSupplementalQty1Type,LineSupplementalQty1Quantity,LineSupplementalQty2QualifierCode,LineSupplementalQty2Type,LineSupplementalQty2Quantity,LineRemarkCode1,LineRemarkCode2,LineRemarkCode3,LineRemarkCode4,LineRemarkCode5
69efef04ad4799caa7f5ae67,835,835-provider-level-adjustment.dat,0002,5554555444,PRIMARY,800,500,300,12,94060555410000,11,1,,,,500,C,CHECK,RECEIVER_ACCT_1,2024-12-25,CHECK_1,PAYER_ID,2024-12-23,300,,,,,,,,,,,,,,,,,,,,,PAYOR_ID,ADDNL_PAYER_ID,ANY PLAN USA,1 WALK THIS WAY,,ANYCITY,OH,45209,,PHONE,8661112222,,,EDI,PHONE,8002223333,EMAIL,EDI.SUPPORT@ANYPAYER.COM,PAYER_IDENTIFICATION_NUMBER,ADDNL_PAYER_ID,,,NPI,PROVIDER2_NPI,PROVIDER,2255 ANY ROAD,,ANY CITY,CA,12211,,PAYEE_IDENTIFICATION_NUMBER,PAYEE_ID2,,,MEMBER_ID,33344555510,BUDD,WILLIAM,,MEMBER_ID,33344555510,BUDD,WILLIAM,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2024-03-01,2024-03-01,,,,,,,,,,,,,,,,,,1,99211,,,,,,800,500,1,,,,,,,,2024-03-01,2024-03-01,300,PATIENT_RESPONSIBILITY,1,300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,800,B6,ALLOWED_ACTUAL,800,,,,,,,,,,,,,,
69efef04ad4799caa7f5ae99,835,claim_adj_reason.dat,10060875,PATACCT,PRIMARY,400,80,,MC,CLAIMNUMBER,11,1,,,,80,C,CHECK,,2019-08-16,CK NUMBER 1,1234567890,2019-08-27,320,,,,,,,,,,,,,,,,,,,,,PAYOR_ID,1234567890,ANY PLAN USA,1 WALK THIS WAY,,ANYCITY,OH,45209,,PHONE,8661112222,,,EDI,PHONE,8002223333,EMAIL,EDI.SUPPORT@ANYPAYER.COM,,,,,NPI,1123454567,PROVIDER,2255 ANY ROAD,,ANY CITY,CA,12211,,,,,,MEMBER_ID,ABC123456789,DOE,JOHN,N,MEMBER_ID,ABC123456789,DOE,JOHN,N,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2019-01-01,2019-01-01,,,,2019-02-09,150,AU,COVERAGE_AMOUNT,150,,,,,,,,,,1,99213,,,,,,150,80,1,,,,,,,,2019-01-01,2019-01-01,70,CONTRACTUAL,45,70,,,,,,,,,,,,,,,,,,,,,,,,,,,,,80,B6,ALLOWED_ACTUAL,80,,,,,,,,,,,,,,
69efef04ad4799caa7f5ae99,,,,PATACCT,,,,,,CLAIMNUMBER,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,85003,,,,,,100,0,1,,,,,,,,2019-01-01,2019-01-01,100,CONTRACTUAL,204,100,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
69efef04ad4799caa7f5ae99,,,,PATACCT,,,,,,CLAIMNUMBER,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,36415,,,,,,150,0,1,,,,,,,,2019-01-01,2019-01-01,150,CONTRACTUAL,97,150,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
69efef04ad4799caa7f5aec6,835,not_covered_inpatient.dat,10060875,PATACCT,PRIMARY,40000,8000,,MC,CLAIMNUMBER,11,1,,,,8000,C,CHECK,,2019-08-16,CK NUMBER 1,1234567890,2019-08-27,32000,CONTRACTUAL,197,2000,1,CONTRACTUAL,45,30000,,,,,,,,,,,,,,PAYOR_ID,1234567890,ANY PLAN USA,1 WALK THIS WAY,,ANYCITY,OH,45209,,PHONE,8661112222,,,EDI,PHONE,8002223333,EMAIL,EDI.SUPPORT@ANYPAYER.COM,,,,,NPI,1123454567,PROVIDER,2255 ANY ROAD,,ANY CITY,CA,12211,,,,,,MEMBER_ID,ABC123456789,DOE,JOHN,N,MEMBER_ID,ABC123456789,DOE,JOHN,N,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2019-01-01,2019-01-05,2019-02-28,2019-02-09,38000,AU,COVERAGE_AMOUNT,38000,,,,CA,COVERED,4,,,,1,,,,,,,,,,,,,,,,,,,0,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
69efef04ad4799caa7f5af1f,835,negotiated_discount.dat,35681,7722337,PRIMARY,226,132,10,12,119932404007801,11,1,,,,132,C,CHECK,456,2019-03-31,12345,1512345678,2019-03-14,32405,CONTRACTUAL,197,2000,1,CONTRACTUAL,45,30000,,PATIENT_RESPONSIBILITY,132,259,,,,,,,,,,PAYOR_ID,0101,DELTA DENTAL OF ABC,225 MAIN STREET,,CENTERVILLE,PA,17111,JANE DOE,PHONE,9005555555,,,,,,,,PAYER_IDENTIFICATION_NUMBER,0101,HEALTH_INDUSTRY_NUMBER,0202,EIN,999994703,BAN DDS LLC,225 MAIN STREET,,CENTERVILLE,PA,17111,,PAYEE_IDENTIFICATION_NUMBER,0505,,,,,DOE,SALLY,,MEMBER_ID,SJD11111,DOE,John,,,,,,,NPI,1811901945,BAN,ERIN,,,MEDICARE_PROVIDER_NUMBER,12345678,,,CMS_PLAN_ID,9876,ACME INSURANCE,CMS_PLAN_ID,8765,ACME INSURANCE,,,Smith,Jane,,,,,,2019-03-24,2019-03-25,2022-09-15,2022-09-16,2022-10-01,2022-11-24,132,AU,COVERAGE_AMOUNT,132,D8,DISCOUNT_AMOUNT,100,CA,COVERED,4,,,,A123,D0120,02,28,,0222,,46,25,3.1,D0140,1,,,,,3.5,2019-03-24,2019-03-24,21,CONTRACTUAL,131,21,,,,,,,,,,,,,,,,,,RATE_CODE_NUMBER,100,APG_NUMBER,101,AMBULATORY_PAYMENT,102,"1234""5",CMS_NPI,P123,MEDICARE_PROVIDER_NUMBER,P234,25,B6,ALLOWED_ACTUAL,25,,,,ZL,MEDICARE_MEDICAID_CAT_2,3.75,,,,M1,M2,,,
69efef04ad4799caa7f5af1f,,,,7722337,,,,,,119932404007801,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,D0220,,,,,,25,14,1,,,,,,,,2019-03-24,2019-03-24,11,CONTRACTUAL,131,11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,14,B6,ALLOWED_ACTUAL,14,,,,,,,,,,,,,,
69efef04ad4799caa7f5af1f,,,,7722337,,,,,,119932404007801,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,D0230,,,,,,22,10,1,,,,,,,,2019-03-24,2019-03-24,12,CONTRACTUAL,131,12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10,B6,ALLOWED_ACTUAL,10,,,,,,,,,,,,,,
69efef04ad4799caa7f5af1f,,,,7722337,,,,,,119932404007801,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4,D0274,,,,,,60,34,1,,,,,,,,2019-03-24,2019-03-24,26,CONTRACTUAL,131,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,34,B6,ALLOWED_ACTUAL,34,,,,,,,,,,,,,,
69efef04ad4799caa7f5af1f,,,,7722337,,,,,,119932404007801,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,D1110,,,,,,73,49,1,,,,,,,,2019-03-24,2019-03-25,76,CONTRACTUAL,131,24,,CONTRACTUAL,3,25,,OTHER,131,27,,,,,,,,,,,,,,,,,,,,,49,B6,ALLOWED_ACTUAL,49,KH,DEDUCTION,50,,,,,,,,,,,
69efef04ad4799caa7f5af51,835,dollars_data_separate.dat,112233,5554555444,PRIMARY,800,500,300,12,94060555410000,11,1,,,,1100,C,ACH,144444,2019-03-16,71700666555,1935665544,2019-03-14,300,,,,,,,,,,,,,,,,,,,,,PAYOR_ID,1935665544,RUSHMORE LIFE,10 SOUTH AVENUET,,RAPID CITY,SD,55111,JOHN WAYNE,PHONE,8005551212,EXTENSION,123,,,,,,,,,,NPI,5544667733,ACME MEDICAL CENTER,,,,,,,,,,,MEMBER_ID,33344555510,BUDD,WILLIAM,,MEMBER_ID,33344555510,BUDD,WILLIAM,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2023-03-01,2023-03-01,,,,,800,AU,COVERAGE_AMOUNT,800,,,,,,,,,,1,99211,,,,,,800,500,1,,,,,,,,2023-03-01,2023-03-01,300,PATIENT_RESPONSIBILITY,1,300,,,,,,,,,,,,,,,,,,,,,,,,,,,,,800,B6,ALLOWED_ACTUAL,800,,,,,,,,,,,,,,
69efef04ad4799caa7f5af52,835,dollars_data_separate.dat,112233,8765432112,PRIMARY,1200,600,600,12,9407779923000,11,1,,,,1100,C,ACH,144444,2019-03-16,71700666555,1935665544,2019-03-14,600,,,,,,,,,,,,,,,,,,,,,PAYOR_ID,1935665544,RUSHMORE LIFE,10 SOUTH AVENUET,,RAPID CITY,SD,55111,JOHN WAYNE,PHONE,8005551212,EXTENSION,123,,,,,,,,,,NPI,5544667733,ACME MEDICAL CENTER,,,,,,,,,,,MEMBER_ID,44455666610,SETTLE,SUSAN,,MEMBER_ID,44455666610,SETTLE,SUSAN,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2023-03-10,2023-03-10,,,,,1200,AU,COVERAGE_AMOUNT,1200,,,,,,,,,,1,93555,,,,,,1200,600,1,,,,,,,,2023-03-10,2023-03-10,600,PATIENT_RESPONSIBILITY,1,600,,,,,,,,,,,,,,,,,,,,,,,,,,,,,1200,B6,ALLOWED_ACTUAL,1200,,,,,,,,,,,,,,
69efef04ad4799caa7f5af80,835,835-denial.dat,10060875,PATACCT,DENIED,150,0,,MC,CLAIMNUMBER,11,1,,,,0,C,NON_PAYMENT,,2019-08-16,TRACE123,1234567890,2019-08-27,150,,,,,,,,,,,,,,,,,,,,,PAYOR_ID,1234567890,ANY PLAN USA,1 WALK THIS WAY,,ANYCITY,OH,45209,,PHONE,8661112222,,,EDI,PHONE,8002223333,EMAIL,EDI.SUPPORT@ANYPAYER.COM,,,,,NPI,1123454567,PROVIDER,2255 ANY ROAD,,ANY CITY,CA,12211,,,,,,MEMBER_ID,ABC123456789,DOE,JOHN,N,MEMBER_ID,ABC123456789,DOE,JOHN,N,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2019-01-01,2019-01-01,,,,2019-02-09,150,AU,COVERAGE_AMOUNT,150,,,,,,,,,,1234,99213,,,,,,150,0,1,,,,,,,,2019-01-01,2019-01-01,150,OTHER,252,150,,,,,,,,,,,,,,,,,,,,,,,,,CMS_NPI,99123,,,,,,,,,,,,,,,,M143,,,,
69efef04ad4799caa7f5afed,835,835-all-fields.dat,35681,7722337,PRIMARY,226,132,10,12,119932404007801,11,1,025,0.5,0.4,132,C,ACH,2200008888,2025-04-09,882509401093167,106609999,2019-03-14,32405,CONTRACTUAL,197,2000,1,CONTRACTUAL,45,30000,,PATIENT_RESPONSIBILITY,132,259,,,,,,,,,,PAYOR_ID,0101,DELTA DENTAL OF ABC,225 MAIN STREET,,CENTERVILLE,PA,17111,JANE DOE,PHONE,9005555555,EXTENSION,123,,URL,myplan.com/policies,,,PAYER_IDENTIFICATION_NUMBER,0101,HEALTH_INDUSTRY_NUMBER,0202,EIN,999994703,BAN DDS LLC,225 MAIN STREET,,CENTERVILLE,PA,17111,,PAYEE_IDENTIFICATION_NUMBER,0505,,,,,DOE,SALLY,,MEMBER_ID,SJD11111,DOE,John,,INSURED_CHANGED_ID,SJD999,Due,,,NPI,1811901945,BAN,ERIN,,,MEDICARE_PROVIDER_NUMBER,12345678,PROVIDER_UPIN_NUMBER,12345678,CMS_PLAN_ID,9876,ACME INSURANCE,CMS_PLAN_ID,8765,ACME INSURANCE,,,Smith,Jane,,,,,,2019-03-24,2019-03-25,2022-09-15,2022-09-16,2022-10-01,2022-11-24,132,AU,COVERAGE_AMOUNT,132,D8,DISCOUNT_AMOUNT,100,CA,COVERED,4,,,,A123,D0120,02,28,,0022,,46,25,3.1,D0140,1,,,,,3.5,2019-03-24,2019-03-24,21,CONTRACTUAL,131,21,,,,,,,,,,,,,,,,,,RATE_CODE_NUMBER,100,APG_NUMBER,101,AMBULATORY_PAYMENT,102,"1234""5",CMS_NPI,P123,MEDICARE_PROVIDER_NUMBER,P234,25,B6,ALLOWED_ACTUAL,25,,,,ZL,MEDICARE_MEDICAID_CAT_2,3.75,,,,M1,M2,,,
69efef04ad4799caa7f5afed,,,,7722337,,,,,,119932404007801,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,2,D0220,,,,,,25,14,1,,,,,,,,2019-03-24,2019-03-24,11,CONTRACTUAL,131,11,,,,,,,,,,,,,,,,,,,,,,,,,,,,,14,B6,ALLOWED_ACTUAL,14,,,,,,,,,,,,,,
69efef04ad4799caa7f5afed,,,,7722337,,,,,,119932404007801,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3,D0230,,,,,,22,10,1,,,,,,,,2019-03-24,2019-03-24,12,CONTRACTUAL,131,12,,,,,,,,,,,,,,,,,,,,,,,,,,,,,10,B6,ALLOWED_ACTUAL,10,,,,,,,,,,,,,,
69efef04ad4799caa7f5afed,,,,7722337,,,,,,119932404007801,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,4,D0274,,,,,,60,34,1,,,,,,,,2019-03-24,2019-03-24,26,CONTRACTUAL,131,26,,,,,,,,,,,,,,,,,,,,,,,,,,,,,34,B6,ALLOWED_ACTUAL,34,,,,,,,,,,,,,,
69efef04ad4799caa7f5afed,,,,7722337,,,,,,119932404007801,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,5,,,,,0022,,99,59,1,,,,,0023,,2,2019-03-24,2019-03-24,0,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
69efef04ad4799caa7f5afed,,,,7722337,,,,,,119932404007801,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,6,D1110,,,,,,73,49,1,,,,,,,,2019-03-24,2019-03-25,76,CONTRACTUAL,131,24,,CONTRACTUAL,3,25,,OTHER,131,27,,,,,,,,,,,,,,,,,,,,,49,B6,ALLOWED_ACTUAL,49,KH,DEDUCTION,50,,,,,,,,,,,
69efef04ad4799caa7f5afed,,,,7722337,,,,,,119932404007801,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,7,,,,,,00002143481,60,59,10.5,,,,,,00002143482,9.2,2019-03-24,2019-03-24,0,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

EDI-to-JSON

Converts (parses) X12 EDI input to JSON. You can post the EDI file's content as text or use multi-part request to upload files.

See Python and curl examples in our GitHub repo.

Intro to the schema of JSON response:

You can find output examples for all formats here.

Convert X12 EDI to JSON

Converts X12 EDI input to JSON. EDI can be posted as text in the body of the request or uploaded using a multi-part/form-data request.

The response is a JSON array or NDJSON (new-line delimited JSON).
The output is streamed as the input is parsed.

See the data dictionary for more details about the response schema, including mapping to X12 EDI elements.

query Parameters
ndjson
boolean
Default: false

Use JSON lines a.k.a. NDJSON. There is no enclosing array. Instead, each JSON object is terminated by a new line. Use it for large files or for streaming. If not set, the resulting file can contain a large array of JSON objects.

splitTran
boolean
Deprecated
Default: true

Do not parse the entire transaction. Instead, parse by claims (CLM or CLP segments, 837/835) or members (INS segment, 834). This is the default for 835, 837, and 834 transactions, which can be large. Ignored for all other transaction types. As of 2.14.4, the API server automatically detects the transaction type and sets this parameter to 'true' for 837/835/834 and 'false' for all other transactions.

descriptions
boolean
Default: true

Provide descriptions for all codes (ICD, CPT, NDC). Descriptions can increase the size of the response. You can globally suppress descriptions by setting codeset_enrichcodes environment variable to 'false'. In this case, this parameter has no effect.

ediFileName
string

The name of the EDI file submitted as text. This name will be propagated to the transaction.fileInfo.name field. Ignored for multipart requests.

validate
boolean
Default: false

Perform full validation of EDI. Validation issues are written to the response stream as 'VALIDATION' objects.

warningsInResponse
boolean
Deprecated
Default: false

Write EDI parsing warnings to the response stream as 'warning' objects. If not set, warnings are only written to logs. See User Guide for more details. This parameter is deprecated in favor of validate parameter. When validate is set, warnings are always written to the response stream.

maxWarnings
integer
Default: 3000

Maximum number of EDI validation issues per file before raising "Too Many Warnings" error and stopping.

chunkSize
integer <int32>
Default: 50

The number of EDI transactions or claims/payments/members for 837/835/834 that will be parsed and converted at once. This option determines the memory footprint and can be used for fine-tuning. Higher value improves performance but consumes more memory.

convertToSegments
string

Convert to the EDI loop and segment tree instead of the list of claims, payments, and other objects

Request Body schema:
files
required
Array of strings <binary> [ items <binary > ]

Responses

Response Schema: application/json
Array
One of
id
string

Unique payment identifier assigned by the converter.

objectType
string

Type of this object, set to 'PAYMENT'.

patientControlNumber
required
string

Identifier used to track a claim from creation by the health care provider through payment. EDI: CLP01.

chargeAmount
required
number <float>

Charge amount. EDI: CLP02.

paymentAmount
required
number <float>

Payment amount. EDI: CLP04.

object (Code)

Place of service code (professional/dental) or UB facility code (institutional) from the original claim. EDI: CLP08.

object (Code)

Frequency code. EDI: CLP09.

statementDateFrom
string <date>

Statement date from. EDI: DTP03*232.

statementDateTo
string <date>

Statement date to. EDI: DTP03*233.

serviceDateFrom
string <date>

The earliest service date from service lines.

serviceDateTo
string <date>

The latest service date from service lines.

object (PatientSubscriber835)

The insured (subscriber) from the original claim if the insured is different from the patient. EDI: Loop: 2100.

object (PatientSubscriber835)

The insured (subscriber) or patient from the original claim. EDI: Loop: 2100.

Array of objects (PatientSubscriber835)

Other subscriber; only one other subscriber is allowed on 835. EDI: Loop: 2100.

Array of objects (PaymentLine)

Service lines. EDI: Loop: 2110.

Array of objects (ValidationIssue)

Validation issues.

object (Transaction835)

Parent EDI transaction for this object. EDI: ST.

claimStatusCode
string

Claim status code. EDI: CLP02.

claimStatus
string
Enum: "DENIED" "NOT_OUR_CLAIM" "PREDETERMINATION_NO_PAYMENT" "PRIMARY" "PRIMARY_FORWARDED" "REVERSAL" "SECONDARY" "SECONDARY_FORWARDED" "TERTIARY" "TERTIARY_FORWARDED"

Claim status code translated to a string constant (enum). EDI: CLP02.

patientResponsibilityAmount
number <float>

Patient responsibility amount. EDI: CLP05.

claimFilingIndicatorCode
string

Claim filing indicator code. EDI: CLP06.

insurancePlanType
string
Enum: "AUTOMOBILE_MEDICAL" "BCBS" "CHAMPUS" "COMMERCIAL" "EPO" "FEDERAL_EMPLOYEE_PROGRAM" "HMO" "HMO_MEDICARE" "INDEMNITY_INSURANCE" "MEDICAID" "MEDICARE_A" "MEDICARE_B" "MUTUALLY_DEFINED" "OTHER_FEDERAL" "OTHER_NON_FEDERAL" "POS" "PPO" "VETERAN_AFFAIRS" "WORKERS_COMPENSATION"

Claim filing indicator code translated to a string constant (enum). EDI: CLP06.

payerControlNumber
string

Payer control number. EDI: CLP07.

object (Code)

Diagnosis-related group code. Institutional claims only. EDI: CLP11.

drgWeight
number <float>

Adjudicated DRG weight. Institutional claims only. EDI: CLP12.

dischargeFraction
number <float>

Adjudicated discharge fraction. Institutional claims only. This is a percentage expressed as decimal. EDI: CLP13.

Array of objects (Reference)

Other claim-related identifications. EDI: REF.

Array of objects (Amount)

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

Array of objects (Quantity)

Supplemental claim/payment quantities. EDI: QTY.

object (Party)

Payer. EDI: N1*PR.

object (Party)

Payee. EDI: N1*PE.

object (OutpatientAdjudication)

Outpatient adjudication. EDI: MOA.

object (InpatientAdjudication)

Inpatient adjudication. EDI: MIA.

Array of objects (Adjustment)

Claim adjustments. EDI: CAS.

coverageExpirationDate
string <date>

Coverage expiration date. EDI: DTP03*036.

claimReceivedDate
string <date>

Claim received date. EDI: DTP03*050.

object (PartyIdName)

Service provider. EDI: NM1*SJ.

object (PartyIdName)

Crossover carrier. EDI: NM1*TT.

object (PartyIdName)

Corrected priority payer, meaning that current payer believes that another payer has priority for making a payment. EDI: NM1*PR.

object (PartyIdName)

Corrected insured. EDI: NM1*74.

Array of objects (ContactInfo)

Claim contacts. EDI: PER.

Request samples 

# Post EDI as text
curl -X POST -H "Content-Type: text/plain" \
--data-binary  @../edi_files/837/837.edi  \ 
"$API_URL/edi/json?ndjson=true&ediFileName=837.edi"

# Upload EDI files using multipart request
curl -F files=@"../edi_files/837/837-1.dat" -F files=@"../edi_files/837/837-2.dat" \
"$API_URL/edi/json?ndjson=true"

Response samples

Content type
application/json
Example
[
  • {
    }
]

Convert X12 EDI to JSON in memory (small files)

Parses X12 EDI and returns returns an array of claims (837), payments (835) or segments (all other transactions). The parsing is done entirely in memory, so this endpoint is only suitable for small files. Fully synchronous; the entire file is parsed before returning the response. For large files use 'api/edi' endpoints instead.

See Python example here.

query Parameters
asSegments
boolean
Default: false

Return JSON representation of loops and segments. This is the default mode for non-835, non-837 transactions.

gen999
boolean
Default: false

Generate 999–Functional Group Acknowledgement Report for all parsed transactions. The resulting EDI is available in the "ackEdi" field of the response

Request Body schema: text/plain
required

Text in X12 EDI format

string

Responses

Response Schema: application/json
Array of ProfClaim (object) or InstClaim (object) or DentClaim (object)
Array of objects (Payment)
Array of objects (MemberCoverage)
Array of ClaimStatus (object) or ReceiverStatus (object) or ProviderStatus (object)
segments
object (ArrayNode)
ackEdi
string

Generated 999–Functional Group Acknowledgement Report for all parsed transactions

Array of objects (ParsingIssue)

Response samples

Content type
application/json
{
  • "claims": [
    ],
  • "payments": [
    ],
  • "coverages": [
    ],
  • "statuses": [
    ],
  • "segments": { },
  • "ackEdi": "string",
  • "parsingIssues": [
    ]
}

Validate EDI

Validates EDI returns validation issues if any

query Parameters
fileName
string

The name of the EDI file submitted as text. This name will be used in all validation warnings and parsing errors. If not set, a randomly generated file name will be used.

ndjson
boolean
Default: false

Use JSON lines a.k.a. NDJSON. There is no enclosing array. Instead, each validation issue object is terminated by a new line. Use it for large files or for streaming.

chunkSize
integer <int32>
Default: 50

The number of EDI transactions or claims/payments/members for 837/835/834 that will be parsed at once. This option determines the memory footprint and can be used for fine-tuning. Higher value improves performance but consumes more memory.

Request Body schema:
files
required
Array of strings <binary> [ items <binary > ]

Responses

Response Schema: application/json
Array
objectType
string

Type of this object, always 'VALIDATION'.

issueType
required
string
Enum: "BALANCE" "CONTROL" "INVALID" "LENGTH_EXCEEDED" "LENGTH_TOO_SHORT" "MISMATCH" "NOT_ALLOWED" "NUMBER_OF_ITEMS" "REQUIRED" "REQUIRED_CODE" "VALUE_NOT_IN_ENUM_LIST" "WRONG_TYPE"

Issue type.

issueObjectClass
string

Class (type) of the object where the issue was detected, such as Claim, ServiceLine, etc.

jsonPath
string

JSON path for the object where the issue was detected.

fieldName
string

Field name or element name.

object (SourceLocation)

Location of the issue in the EDI file.

loop
string

EDI loop where the issue was found.

segment
string

EDI segment ID.

element
string

EDI element designator.

ediCode
string

EDI qualifier or code for the segment if the segment is uniquely identified by the code.

maxNumberOfItems
integer

Maximum number of items allowed for the segment, list, or loop.

actualNumberOfItems
integer

Actual number of items.

length
integer

Expected length of the element's value.

actualLength
integer

Actual length.

dataType
string
Enum: "BINARY" "COMPOSITE" "DATE" "DECIMAL" "ENUM" "IDENTIFIER" "NUMERIC" "STRING" "TIME"

Expected data type.

actualDataType
string
Enum: "BINARY" "COMPOSITE" "DATE" "DECIMAL" "ENUM" "IDENTIFIER" "NUMERIC" "STRING" "TIME"

Actual data type.

value
string

Value with the issue.

ediString
string

Value that caused the issue.

message
string

Additional message describing the issue.

allowedValues
Array of strings

Allowed values.

Response samples

Content type
application/json
Example
[
  • {
    },
  • {
    },
  • {
    },
  • {
    },
  • {
    },
  • {
    },
  • {
    }
]

Generate EDI

Generates EDI from JSON claim objects

Generates 837I and 837P from JSON claims

Generates X12 EDI 837I and 837P EDI from JSON claims

query Parameters
failOnValidationErrors
boolean
Default: false

Fail the request if there are any validation errors. If not set, validation errors are ignored, but logged.

fileName
string

The name of the EDI file submitted as text. This name will be used in all validation warnings and parsing errors. If not set, a randomly generated file name will be used.

Request Body schema: application/json
object (InterchangeControl)

Interchange control.

object (FunctionalGroup)

Functional group.

object (Transaction837)

Transaction.

Array of ProfClaim (object) or InstClaim (object)

Claims.

Responses

Response Schema: text/plain
string

EDI file content

Request samples

Content type
application/json
{
  • "interchangeControl": {
    },
  • "functionalGroup": {
    },
  • "transaction": {
    },
  • "claims": [
    ]
}

Response samples

Content type
application/json
{
  • "objectType": "string",
  • "message": "string",
  • "fileName": "string"
}

Validates EDI generation request (837P or 837I)

Validates JSON request for EDI generation and returns validation issues if any

query Parameters
fileName
string

The name of the EDI file submitted as text. This name will be used in all validation warnings and parsing errors. If not set, a randomly generated file name will be used.

Request Body schema: application/json
object (InterchangeControl)

Interchange control.

object (FunctionalGroup)

Functional group.

object (Transaction837)

Transaction.

Array of ProfClaim (object) or InstClaim (object)

Claims.

Responses

Response Schema: application/json
Array
objectType
string

Type of this object, always 'VALIDATION'.

issueType
required
string
Enum: "BALANCE" "CONTROL" "INVALID" "LENGTH_EXCEEDED" "LENGTH_TOO_SHORT" "MISMATCH" "NOT_ALLOWED" "NUMBER_OF_ITEMS" "REQUIRED" "REQUIRED_CODE" "VALUE_NOT_IN_ENUM_LIST" "WRONG_TYPE"

Issue type.

issueObjectClass
string

Class (type) of the object where the issue was detected, such as Claim, ServiceLine, etc.

jsonPath
string

JSON path for the object where the issue was detected.

fieldName
string

Field name or element name.

object (SourceLocation)

Location of the issue in the EDI file.

loop
string

EDI loop where the issue was found.

segment
string

EDI segment ID.

element
string

EDI element designator.

ediCode
string

EDI qualifier or code for the segment if the segment is uniquely identified by the code.

maxNumberOfItems
integer

Maximum number of items allowed for the segment, list, or loop.

actualNumberOfItems
integer

Actual number of items.

length
integer

Expected length of the element's value.

actualLength
integer

Actual length.

dataType
string
Enum: "BINARY" "COMPOSITE" "DATE" "DECIMAL" "ENUM" "IDENTIFIER" "NUMERIC" "STRING" "TIME"

Expected data type.

actualDataType
string
Enum: "BINARY" "COMPOSITE" "DATE" "DECIMAL" "ENUM" "IDENTIFIER" "NUMERIC" "STRING" "TIME"

Actual data type.

value
string

Value with the issue.

ediString
string

Value that caused the issue.

message
string

Additional message describing the issue.

allowedValues
Array of strings

Allowed values.

Request samples

Content type
application/json
{
  • "interchangeControl": {
    },
  • "functionalGroup": {
    },
  • "transaction": {
    },
  • "claims": [
    ]
}

Response samples

Content type
application/json
[
  • {
    }
]

NCPDP-to-JSON

Parses text in NCPDP telecom format and returns JSON with an array of NCPDP transactions.

You can see an example of an NCPDP transaction and the parsing output here.

Additional examples are available from our GitHub repo.

Convert NCPDP input to JSON

Converts NCPDP input to JSON.

Request Body schema: text/plain
required

Text in NCPDP Telecom format

string

Responses

Response Schema: application/json
Array of objects (Segment)

Request samples 

curl -H "Content-Type: text/plain" --data-binary @../edi_files/ncpdp/b1_telco_cob.dat "$API_URL/ncpdp/parse"

Response samples

Content type
application/json
{
  • "transactions": [
    ]
}