835 ERA Objects and Fields

Payment

NameDescriptionTypeEDI Element
idUnique payment identifier assigned by the converterString
objectTypeType of this object, set to 'PAYMENT'String
patientControlNumberIdentifier used to track a claim from creation by the health care provider through paymentStringCLP01
chargeAmountCharge amountNumberCLP02
paymentAmountPayment amountNumberCLP04
facilityCodePlace of service code (professional/dental) or UB facility code (institutional) from the original claim
View codes and descriptions
CodeCLP08
frequencyCodeFrequency code
View codes and descriptions
CodeCLP09
statementDateFromStatement date fromDateDTP03 *232
statementDateToStatement date toDateDTP03 *233
serviceDateFromThe earliest service date from service linesDate
serviceDateToThe latest service date from service linesDate
subscriberThe insured (subscriber) from the original claim if the insured is different from the patientPatientSubscriber835Loop: 2100
patientThe insured (subscriber) or patient from the original claimPatientSubscriber835Loop: 2100
otherSubscribersOther subscriber; only one other subscriber is allowed on 835List of PatientSubscriber835Loop: 2100
serviceLinesService linesList of PaymentLineLoop: 2110
transactionParent EDI transaction for this objectTransaction835
claimStatusCodeClaim status codeStringCLP02
claimStatusClaim status code translated to a string constant (enum), such as PRIMARY,SECONDARYStringCLP02
patientResponsibilityAmountPatient responsibility amountNumberCLP05
claimFilingIndicatorCodeClaim filing indicator codeStringCLP06
insurancePlanTypeClaim filing indicator code translated to a string constant (enum), such as PPO, HMOStringCLP06
payerControlNumberPayer control numberStringCLP07
drgDiagnosis-related group code. Institutional claims only.CodeCLP11
drgWeightAdjudicated DRG weight. Institutional claims only.NumberCLP12
dischargeFractionAdjudicated discharge fraction. Institutional claims only. This is a percentage expressed as decimal.NumberCLP13
otherClaimRelatedIdsOther claim-related identificationsList of ReferenceREF
supplementalAmountsSupplemental claim/payment amounts, such as coverage amount, discount amount, etc.List of AmountAMT
supplementalQuantitiesSupplemental claim/payment quantitiesList of QuantityQTY
payerPayerPartyN1 *PR
payeePayeePartyN1 *PE
adjustmentsClaim adjustmentsList of AdjustmentCAS
coverageExpirationDateCoverage expiration dateDateDTP03 *036
claimReceivedDateClaim received dateDateDTP03 *050
serviceProviderService providerPartyIdNameNM1 *SJ
crossoverCarrierCrossover carrierPartyIdNameNM1 *TT
correctedPayerCorrected priority payer, meaning that current payer believes that another payer has priority for making a paymentPartyIdNameNM1 *PR
correctedInsuredCorrected insuredPartyIdNameNM1 *74
claimContactsClaim contactsList of ContactInfo

Service Line

Loop: 2110, Segment: SVC Open API Schema
NameDescriptionTypeEDI Element
sourceLineIdLine item control numberStringREF02 *6R
repricedReferenceNumberRepriced reference numberStringREF02 *9A
adjustedRepricedReferenceNumberAdjusted repriced reference numberStringREF02 *9D
healthcarePolicyIdHealthcare policy idStringREF02 *0K
chargeAmountCharge amountNumber
paidAmountPaid amountNumberSVC03
supplementalAmountsSupplemental amounts, such as allowed amount, deduction amount, etc.List of AmountAMT
supplementalQuantitiesSupplemental quantitiesList of QuantityQTY
serviceDateFromService date fromDateDTP03 *472
serviceDateToService date toDateDTP03 *472
unitTypeUnit typeString
unitCountUnit countNumberSVC05
originalUnitCountOriginal unit countNumberSVC07
drugDrug code (NDC)
View codes and descriptions
CodeSVC01
procedureProcedure
View codes and descriptions
ProcedureSVC01 *HC, SVC01 *AD, SVC01 *WK, SVC01 *IV
revenueCodeRevenue code
View codes and descriptions
CodeSVC01 *RC,NU, SVC04 *RC,NU
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
originalDrugSubmitted drug (NDC) code from the claim if it is different from the adjudicated drug code
View codes and descriptions
CodeSVC06
providersProviders for this service lineList of Party
adjustmentsLine adjustmentsList of AdjustmentCAS
remarkCodesRemark codes
View codes and descriptions
List of StringLQ
remarksRemark codes
View codes and descriptions
List of CodeLQ
serviceIdsRelated service-specific identifiers that were used in the process of adjudicating this serviceList of ReferenceREF
renderingProviderIdsRendering provider identifiersList of ReferenceREF

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

Patient or Subscriber

Insured subscriber of patient for 835
NameDescriptionTypeEDI Element
personPersonPartyNM1

Organization or Person (Party)

NameDescriptionTypeEDI Element
entityRoleEntity role
View codes and descriptions
StringNM101, 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
StringNM101, 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

EDI Transaction Info

NameDescriptionTypeEDI Element
controlNumberControl numberStringST02
transactionTypeTransaction type translated to string constant, PROF for 837P, INST for 837I, etc.StringST01,ST03
productionDateProduction dateDateDTP03 *405
totalPaymentAmountTotal payment amountNumberBPR02
creditOrDebitFlagCodeCredit or debit flag codeStringBPR03
paymentMethodTypePayment method typeStringBPR04
receiverAccountNumberReceiver account numberStringBPR15
paymentDatePayment dateDateBPR16
checkOrEftTraceNumberCheck or eft trace numberStringTRN02
payerIdentifierPayer identifierStringTRN03
transactionSetIdentifierCodeTransaction set identifier codeStringST01
implementationConventionReferenceImplementation convention referenceStringST03