JSON Schema for 835 (ERA)

Unique payment identifier assigned by the converter

Type of this object, set to 'PAYMENT'

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

Charge amount

Payment amount

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

View codes and descriptions

Frequency code

View codes and descriptions

Statement date from

Statement date to

The earliest service date from service lines

The latest service date from service lines

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

The insured (subscriber) or patient from the original claim

Other subscriber; only one other subscriber is allowed on 835

Service lines

Parent EDI transaction for this object

Claim status code

Claim status code translated to a string constant (enum)

Values:

DENIED(4), NOT_OUR_CLAIM(23), PREDETERMINATION_NO_PAYMENT(25), PRIMARY(1), PRIMARY_FORWARDED(19), REVERSAL(22), SECONDARY(2), SECONDARY_FORWARDED(20), TERTIARY(3), TERTIARY_FORWARDED(21)

Patient responsibility amount

Claim filing indicator code

Claim filing indicator code translated to a string constant (enum)

Values:

AUTOMOBILE_MEDICAL(AM), BCBS(BL), CHAMPUS(CH), COMMERCIAL(CI), EPO(14), FEDERAL_EMPLOYEE_PROGRAM(FI), HMO(HM), HMO_MEDICARE(16), INDEMNITY_INSURANCE(15), MEDICAID(MC), MEDICARE_A(MA), MEDICARE_B(MB), MUTUALLY_DEFINED(ZZ), OTHER_FEDERAL(OF), OTHER_NON_FEDERAL(11), POS(13), PPO(12), VETERAN_AFFAIRS(VA), WORKERS_COMPENSATION(WC)

Payer control number

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.

Other claim-related identifications

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

Supplemental claim/payment quantities

Payer

Payee

Outpatient adjudication

Inpatient adjudication

Claim adjustments

Coverage expiration date

Claim received date

Service provider

Crossover carrier

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

Corrected insured

Claim contacts

Line item control number

Repriced reference number

Adjusted repriced reference number

Healthcare policy id

Charge amount

Paid amount

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

Supplemental quantities

Service date from

Service date to

Unit count

Original unit count

Drug code (NDC)

View codes and descriptions

Procedure

View codes and descriptions

Revenue code

View codes and descriptions

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

View codes and descriptions

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

View codes and descriptions

Providers for this service line

Line adjustments

Remark codes

View codes and descriptions

Remark codes

View codes and descriptions

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

Rendering provider identifiers

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

View codes and descriptions

Adjustment amount

Adjustment quantity

Reimbursement rate

Claim HCPCS Payable Amount

Esrd payment amount

Nonpayable Professional Component Amount

Remark codes

View codes and descriptions

Covered days or visits count

Pps operating outlier amount

Lifetime psychiatric days count

Drg amount

Disproportionate share amount

Msp pass through amount

Pps capital amount

Pps capital fsp drg amount

Pps capital hsp drg amount

Pps capital dsh drg amount

Old capital amount

Pps capital ime amount

Pps operating hospital specific drg amount

Cost report day count

Pps operating federal specific drg amount

Pps capital outlier amount

Indirect teaching amount

Non payable professional component amount

Pps capital exception amount

Remark codes

View codes and descriptions

Person

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)

View codes and descriptions

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)

View codes and descriptions

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

Unique payment identifier assigned by the converter

Type of this object, always set to 'PROVIDER_ADJUSTMENT'

Provider identifier

Fiscal period date

Adjustments

Payer

Payee

Parent EDI transaction for this adjustment

Provider adjustment reason code

View codes and descriptions

Reference identification

Amount

Control number

Transaction type translated to string constant, PROF for 837P, INST for 837I, etc.

Production date

Transaction handling type

Total payment amount

Credit or debit flag code

Payment method type: ACH, CHECK, WIRE_TRANSFER, NON_PAYMENT

Payment format code

Sender bank routing number

Sender account number

If provided, should be identical to payerIdentifier

Originating company supplemental code

Receiver bank routing number

Receiver account number

Payment date

Check or eft trace number

This must be a 1 followed by the payer's EIN or TIN. This ID will be used as the identifier in the payer object if no other identifier was provided

Receiver's identifier when different from payee (e.g., a clearinghouse)

Transaction set identifier code

Implementation convention reference

File info

File name

URL of the file, including the full path

Last modified date and time of the file