EDI 835 Healthcare Claim Payment/ Advice
The EDI 835 transaction is an electronic Healthcare Claim Payment/ Advice (also known as ANSI X12 EDI 835) that a standardized electronic medical transaction implemented by HIPAA (Healthcare Insurance Portability and Accountability Act). An EDI 835 Healthcare Claim Payment/ Advice is used by healthcare insurance companies to make payments, provide an explanation of benefits (EOB) or both to the healthcare provider, hospital and medical facility.
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- Enhances operational efficiencies for HIPAA claims processing
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EDI 835 Healthcare Claim Payment/ Advice specifications and key data elements include:
- Which healthcare claim charges were paid, reduced or denied
- Plan details of whether the plan and claim charges are toward copay, deductible, coinsurance, etc.
- Line item payments and how the payment was made (for example through a clearinghouse)
Other Common X12 EDI Transactions
- (EDI 271) Healthcare Eligibility/ Benefit Response
- (EDI 276) Healthcare Claim Status Request
- (EDI 277) Healthcare Claim Status Notification
- (EDI 278) Healthcare Service Review Information
- (EDI 834) Benefit Enrollment and Maintenance
- (EDI 837) Healthcare Claim Transaction
View the most commonly used EDI transactions.
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