835 ERA Objects and Fields

Payment

Loop: 2100, Segment: CLP JSON Example Interactive Example

Name	Description	Type	EDI Element
id	Unique payment identifier assigned by the converter	String
objectType	Type of this object, set to 'PAYMENT'	String
patientControlNumber	Identifier used to track a claim from creation by the health care provider through payment	String	CLP01
chargeAmount	Charge amount	Number	CLP02
paymentAmount	Payment amount	Number	CLP04
facilityCode	Place of service code (professional/dental) or UB facility code (institutional) from the original claim View codes and descriptions	Code	CLP08
frequencyCode	Frequency code View codes and descriptions	Code	CLP09
statementDateFrom	Statement date from	Date	DTP03 434, DTP03 232
statementDateTo	Statement date to	Date	DTP03 434, DTP03 233
serviceDateFrom	The earliest service date from service lines	Date
serviceDateTo	The latest service date from service lines	Date
subscriber	The insured (subscriber) from the original claim if the insured is different from the patient	PatientSubscriber835	Loop: 2100
patient	The insured (subscriber) or patient from the original claim	PatientSubscriber835	Loop: 2100
otherSubscribers	Other subscriber; only one other subscriber is allowed on 835	List of PatientSubscriber835	Loop: 2100
serviceLines	Service lines	List of ServiceLine	Loop: 2110
transaction	Parent EDI transaction for this object	Transaction
claimStatusCode	Claim status code	String	CLP02
claimStatus	Claim status code translated to a string constant (enum), such as PRIMARY,SECONDARY	String	CLP02
patientResponsibilityAmount	Patient responsibility amount	Number	CLP05
claimFilingIndicatorCode	Claim filing indicator code	String	CLP06
insurancePlanType	Claim filing indicator code translated to a string constant (enum), such as PPO, HMO	String	CLP06
payerControlNumber	Payer control number	String	CLP07
drg	Diagnosis-related group code. Institutional claims only.	Obj	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
otherClaimRelatedIds	Other claim-related identifications	List of Reference	REF
supplementalAmounts	Supplemental claim/payment amounts, such as coverage amount, discount amount, etc.	List of Amount	AMT
supplementalQuantities	Supplemental claim/payment quantities	List of Quantity	QTY
payer	Payer	Party	N1 *PR
payee	Payee	Party	N1 *PE
adjustments	Claim adjustments	List of Adjustment	CAS
coverageExpirationDate	Coverage expiration date	Date	DTP03 *036
claimReceivedDate	Claim received date	Date	DTP03 *050
serviceProvider	Service provider	PartyIdName	NM1 *SJ
crossoverCarrier	Crossover carrier	PartyIdName	NM1 *TT
correctedPayer	Corrected priority payer, meaning that current payer believes that another payer has priority for making a payment	PartyIdName	NM1 *PR
correctedInsured	Corrected insured	PartyIdName	NM1 *74
claimContacts	Claim contacts	List of Contact

Service Line

Loop: 2110, Segment: SVC

Name	Description	Type	EDI Element
sourceLineId	Source line id	String	REF02 *6R
copayStatusCode	Copay status code	String	SV115
repricedReferenceNumber	Repriced reference number	String	REF02 *9A
adjustedRepricedReferenceNumber	Adjusted repriced reference number	String	REF02 *9D
healthcarePolicyId	Healthcare policy id	String	REF02 *0K
chargeAmount	Charge amount	Number
paidAmount	Paid amount	Number	SVC03
supplementalAmounts	Supplemental amounts, such as allowed amount, deduction amount, etc.	List of Amount	AMT
supplementalQuantities	Supplemental quantities	List of Quantity	QTY
unitType	Unit type	String
unitCount	Unit count	Number	SVC05
originalUnitCount	Original unit count	Number	SVC07
drug	Drug code (NDC) View codes and descriptions	Code	SVC01
procedure	Procedure View codes and descriptions	Procedure	SVC01 HC, SVC01 AD, SVC01 WK, SVC01 IV
revenueCode	Revenue code View codes and descriptions	Code	SVC01 RC,NU, SVC04 RC,NU
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
originalDrug	Submitted drug (NDC) code from the claim if it is different from the adjudicated drug code View codes and descriptions	Code	SVC06
providers	Providers for this service line	Party
adjustments	Line adjustments	List of Adjustment	CAS
remarkCodes	Remark codes View codes and descriptions	List of String	LQ
remarks	Remark codes View codes and descriptions	List of Code	LQ
serviceIds	Related service-specific identifiers that were used in the process of adjudicating this service	List of Reference	REF
renderingProviderIds	Rendering provider identifiers	List of Reference	REF

Adjustment

Segment: CAS

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

Patient or Subscriber

Insured subscriber of patient for 835

Name	Description	Type	EDI Element
person	Person	Party	NM1

Organization or Person (Party)

Name	Description	Type	EDI Element
entityRole	Entity role View codes and descriptions	String	NM102, N101
entityType	Entity type	String	NM102
identificationType	Identification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum)	String	NM108, N103
identifier	Identifier	String	NM109, N104
lastNameOrOrgName	Organization name or person last name	String	NM103, N102
firstName	First name	String	NM104
middleName	Middle name	String	NM105
address	Address	Address
contacts	Contacts	List of Contact
additionalIds	Other identifications	List of Reference	REF

Organization Or Person ID and Name

Name	Description	Type	EDI Element
entityRole	Entity role View codes and descriptions	String	NM102, N101
entityType	Type of this entity: 'BUSINESS' for organization, 'INDIVIDUAL' for person	String	NM102
identificationType	Identification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum)	String	NM108, N103
identifier	Identifier	String	NM109, N104
lastNameOrOrgName	Organization name or person last name	String	NM103, N102
firstName	First name	String	NM104
middleName	Middle name	String	NM105

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

Contact

Segment: PER

Name	Description	Type	EDI Element
name	Name	String	PER02
contactNumbers	Contact numbers	List of ContactNumber

Contact Number

Segment: PER

Name	Description	Type	EDI Element
type	Type	String	PER03,PER05,PER07
number	Number	String	PER04,PER06,PER08

Procedure

Procedure code with description and optional modifiers

Segment: HI,SV1,SV2,SVC

Name	Description	Type	EDI Element
code	Healthcare code	String
desc	Code description	String
modifiers	Modifiers	List of Code	837P:SV101-3-6, 837I:SV201-3-6, 835:SVC01-3-6

Code

Code and description

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

Amount

Segment: AMT

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

Segment: QTY

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

Segment: REF

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

EDI Transaction Info

Name	Description	Type	EDI Element
controlNumber	Control number	String	ST02
transactionType	Transaction type translated to string constant, PROF for 837P, INST for 837I, etc.	String	ST01,ST03
productionDate	Production date	Date	DTP03 *405
purposeCode	Purpose code	String	BHT02
originalTransactionSetReferenceNumber	Original transaction set reference number	String	BGN06
actionCode	Action code	String	BGN08
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
payerIdentifier	Payer identifier	String	TRN03
transactionSetIdentifierCode	Transaction set identifier code	String	ST01
implementationConventionReference	Implementation convention reference	String	ST03