Registry



Back   Health Care Claim Payment/Advice (003070X052)

Purpose

The Health Care Claim Payment/Advice Implementation Guide describes the use of the ANSI ASC X12 Health Care Claim Payment/Advice (835) transaction set for the following business usages:
  • Make payment on a health care claim
  • Send an Explanation of Benefits (EOB) remittance advice
  • Make payment and send an EOB in the same transaction

Primary Trading Partners

Health care payers, such as federal and state agencies and their contractors, commercial insurers, and service organizations, third party adminsitrators, plan providers, and other entities that process health care reimbursements. Health care providers, such as hospitals, nursing homes, physicians, laboratories, dentists, and allied professional groups. Other users of the 835 include Depository Financial Institutions (DFI), billing services, and consulting services.

References

  • Health Care Claim Payment/Advice (003051X000)

Coordination

ASC X12 Insurance Subcommittee's Property & Casualty Task Group (TG1), Health Care Task Group's Claim Work Group (TG2/WG4), and Life & Annuity Task Group (TG5).

Additional Information

Registered 4/29/1996 Published 6/6/1997
Transaction Set ID 835 Standard Version 003070
ASC X12 DM# Owning Group X12N/TG2/WG3