X12

835 Health Care Claim Payment/Advice Examples

> Dollars and Data Sent Separately
> ASC X12 Version: 005010 | Transaction Set: 835 | TR3 ID: 005010X221

> Multiple Claims Single Check
> ASC X12 Version: 005010 | Transaction Set: 835 | TR3 ID: 005010X221A1

> Claim Specific Negotiated Discount
> ASC X12 Version: 005010 | Transaction Set: 835 | TR3 ID: 005010X221

> Claim Adjustment Reason Code 45
> ASC X12 Version: 005010 | Transaction Set: 835 | TR3 ID: 005010X221

> Line Service Penalty Tax or Bonuses impacting payment only
> ASC X12 Version: 005010 | Transaction Set: 835 | TR3 ID: 005010X221A1

> Not Covered/Not Authorized Inpatient Facility claim days
> ASC X12 Version: 005010 | Transaction Set: 835 | TR3 ID: 005010X221A1

> Coordination of Benefits
> ASC X12 Version: 005010 | Transaction Set: 835 | TR3 ID: 005010X221A1

> Correcting the subscriber
> ASC X12 Version: 005010 | Transaction Set: 835 | TR3 ID: 005010X221A1