Companion Document
835
835 Health Care Claim Payment/Advice
Basic Instructions
This section provides information to help you prepare for the ANSI ASC X12 Health Care Claim
Payment/Advice (835) transaction. The remaining sections of this appendix include tables that provide
information about 835 segments and data elements that are used to efficiently process transactions
through Anthem Blue Cross and Blue Shield, Colorado and Nevada (West Region) systems.
Use this companion document in conjunction with both the Transaction Set Implementation Guide
“Health Care Claim Payment/Advice, 835, ASCX12N 835 (004010X091),” May 2000, and the subsequent
Addenda (004010X091A1), October 2002, published by the Washington Publishing Co.
EDI Transmission Structure
Communications Transport Protocol
Interchange Control Header (ISA)
Functional Group Header (GS)
Transaction Set
Transaction Set
Functional Group 1 Wrap
Transaction Set Header (ST)
Transaction Set Header (ST)
Detail Segment 1
Transaction Set Trailer (SE)
EDI Transaction Structure
Interchange Control Header (ISA)
Detail Segment 2
Functional Group Header (GS)
Transaction Set Trailer (SE)
Transaction Set Header (ST)
Transaction Set Trailer (SE)
Envelope
Transaction Set Header (ST)
Detail Segment 1
Envelope
Transaction Set
Transaction Set Header (ST)
Transaction Set
Functional Group Header (GS)
Envelope
Functional Group Trailer (GE)
Functional Group 2 Wrap
Interchange Control Wrap
Communications Session
Functional Group Header (GS)
Header
Detail
Summary
Transaction Set Trailer (SE)
Functional Group Trailer (GE)
Interchange Control Trailer (IEA)
Detail Segment 2
Transaction Set Trailer (SE)
Functional Group Trailer (GE)
Interchange Control Trailer (IEA)
Communications Transport Protocol
Anthem Blue Cross and Blue Shield - West Region Page 1 of 13
Release 02 (February 2011)
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1
835 Health Care Claim Payment/Advice Companion Document
Registration Process - Remittances and Electronic Funds Transfer (EFT)
The 835 Electronic Remittance Advice (ERA) provides information for the payee regarding claims in
their final status, including information about the payee, the payer, the amount, and any payment
identifying information.
All trading partners are eligible to receive the ERA and payment by EFT but require prior registration
with EDI Solutions, (800) 332-7575, for the necessary set up and instructions.
As part of the process, the ERA/EFT Enrollment Form must be completed. It is available from the EDI
website (http://www.anthem.com/edi, Register, Registration Form). Changes to the NPI, provider or
tax identification numbers may affect the distribution of the 835 Payment/Advice, therefore, providers
should notify Anthem Provider Services and EDI Solutions when these types of changes do occur.
2
Electronic Funds Transfer (EFT)
In order to sign up for EFT, complete and submit the ERA/EFT Enrollment Form. The same form is
used to submit any changes to your EFT setup.
Questions about the direct deposit system can be made directly to (800) 332-7575.
3
Basic Format of the 835 File - Payment by NPI, Payee ID, Multiple Providers
Claim payments are made based on the NPI (or Payee ID) and Tax ID Number. Depending on the
reimbursement arrangement, multiple providers may be paid under their group NPI (or group Payee
ID) and Tax ID. Therefore, when a provider group requests an 835, by default all provider payments
linked to the group NPI (or group Payee ID) will appear on the 835. Note that all registered NPIs will
be returned on the 835.
The format of the 835 file will show multiple checks and/or payment information tied to the provider
group or individual provider on a given day in one or multiple ERA files. Checks and/or payment
information can be bundled and uniquely identified within the same 835 file.
Multiple checks and/or payment information within one 835 file may cause difficulty and require
system changes for providers who directly download 835 files.
4
Delimiters
Anthem will use the delimiters as defined in the table below for all outbound transactions.
Delimiter
Character Name
Character
Data Element Separator
Sub-Element Separator
Segment Terminator
Asterisk
Bar
Tilde
*
|
~
Anthem Blue Cross and Blue Shield - West Region Page 2 of 13
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835 Health Care Claim Payment/Advice Companion Document
Claim Adjustment Group Code
The Claim Adjustment and Service Adjustment Segments (CAS) provide the reasons, amounts, and
quantities of any adjustments that the payer made either to the original submitted charge or to the
units related to the claim or service(s). Specifically, the Claim Adjustment Group Code (CAS01)
categorizes the adjustment reason codes contained in a particular CAS and are evaluated according
to the following order:
1. Patient Responsibility (PR) — indicates the amount adjusted in CAS segment is the
patient’s responsibility.
2. Contractual Obligations (CO) — indicates the amount adjusted in CAS segment is not
the patient’s responsibility due to a contractual obligation between the provider and the
payer.
3. Payer Initiated Reductions (PI) — indicates the amount adjusted in CAS segment is
not the patient’s responsibility, without a supporting contract between the provider and the
payer.
4. Correction and Reversals (CR) — indicates the claim is the reversal of a previously
reported claim or claim payment.
5. Other Adjustments (OA) — indicates the amount adjusted does not fall in any of the
above categories.
6
Claim Adjustment Reason Codes and Remittance Advice Remark Codes
A claim adjustment reason code (CAS segment) is used to communicate that an adjustment was
made at the claim/service line, and provides the reason for why the payment differs from what
was billed. The adjustment reason code list is available on the internet (http://www.wpc-edi.com/
codes, select Claim Adjustment Reason Codes) and reviewed by the Claim Adjustment Status Code
maintenance committee three times a year.
A claim remittance advice remark code (LQ segment) provides supplemental explanation for an
adjustment already described by an adjustment reason code. Previously, the remittance remark code
list was created and supported for Medicare only, but now it is appropriate for use by all payers.
The remark code list is available on the internet (http://www.wpc-edi.com/codes, select Remittance
Advice Remark Codes) and reviewed by the Remittance Advice Code Maintenance Committee whose
members represent various components from CMS.
It is important to continue referring to the code lists maintained by the committees. Updated code
lists are published tri-annually at the end of March, July, and November.
The use of HIPAA standards has imposed a limitation on what detailed explanation is reported on the
835 Payment/Advice. It has been determined that proprietary disposition codes may not map onefor-one to a standard HIPAA claim adjustment reason and/or remittance advice remark code.
Anthem Blue Cross and Blue Shield - West Region Page 3 of 13
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835 Health Care Claim Payment/Advice Companion Document
Provider Level Adjustment (PLB)
The provider level adjustment, PLB segment, is reported after all the claim payments in the Summary
of the 835 transaction. This segment is used for takeback notification and actual takebacks, and the
detailed information of the adjusted claim is reported at the claim level, CLP segment.
Example:
PLB03 Data Element
PLB*941400001*20081231*WO:9730000048070714400575*1205.31
Provider
Tax ID
(EIN)
End of
Fiscal
Year
Adjusted
Amount
Adj
Reas
Code
DCN
Claim
Date
Patient
Account #
The third data element, PLB03, in the PLB segment is a composite segment with four distinct values,
the Adjustment Reason Code, followed by a value composed of the Document Control Number
(DCN), Claim Date, and Patient Account Number.
PLB03-1: The Adjustment Reason Code (FB, IR, PI, L6, WO) identifies the type of adjustment.
PLB03-2: DCN is the claim number Anthem uses to identify the payment made to the provider.
Date of when the claim was originally processed (070714).
Patient Account Number assigned by provider to track claim processing (400575).
PLB04:
8
If the code is WO, then the adjusted amount is assumed to be negative.
If the code is FB, then the adjusted amount will be preceded by a (-) sign when the adjustment is negative.
The PLB will decrease when the adjustment amount is positive.
The PLB will increase when the adjustment amount is negative.
Balancing
To ensure HIPAA compliance, editing is performed on the 835 transaction as it is routed through
the Enterprise EDI Gateway/Clearinghouse. Successful outbound routing to the 835 trading partner
depends on the balancing of the file where the total payment must agree with the remittance
information detailing that payment.
The amounts reported in the file must balance at three different levels; the service line, the claim,
and the transaction. When service payment information is provided, the submitted service charge
(SVC02) minus the sum of all monetary adjustments (CAS segments) must equal the amount paid
for the service line (SVC03). Similarly within the claim payment loop, the submitted charge for the
claim (CLP03) minus the sum of all monetary adjustments (CAS segments) must equal the claim paid
amount (CLP04). The total claim charge (CLP03) must balance the sum of the related service charges
(SVC02), if applicable. *Monetary amounts in the AMT segments convey information only; they do
not affect the financial balancing of the transaction.
Further balancing within the transaction ensures that the sum of all claim payments (CLP04) minus
the sum of all provider level adjustments (PLB segments) equals the total payment amount (BPR02).
All balancing measures must be met in order for an 835 file to be delivered to the Gateway.
Anthem Blue Cross and Blue Shield - West Region Page 4 of 13
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835 Health Care Claim Payment/Advice Companion Document
835 Health Care Claim Payment/Advice – Header
The 835 Payment/Advice Header contains general payment information, such as Amount, Payee,
Payer, Trace Number and Payment method. The following table explains the header segments and data
elements that require specific information for West Region processing.
835 Health Care Claim Payment/Advice—Header
IG
P.44
Segment
BPR
Financial
Information
Reference
Designator(s)
BPR01
Transaction Handling
Code
BPR02
Total Actual Provider
Payment Amount
BPR03
Credit/Debit Flag Code
BPR04
Payment Method Code
Value
I
H
Definitions and Notes
Specific to West Region
I - Remittance Information Only
H - Notification Only
Amount must be equal to or greater than
(Total Actual
Provider Payment zero.
Amount)
C - Credit to the provider's account
C
ACH
CHK
NON
CCP
ACH - Automated Clearing House
CHK - Check
NON - Non-Payment Data
CCP - Cash Concentration/Disbursement
plus Addenda
01 - ABA Transit Routing Number
*ABA is not to be confused with Anthem
Benefit Administrators.
BPR05
Payment Format Code
01
BPR06
Depository Financial
Institution (DFI) ID
Number Qualifier
Represents Anthem's Bank number.
(Sender DFI
BPR07
(DFI) ID Number
Identifier)
Represents Anthem's Bank Account
(Sender Bank
BPR09
Account Number
Account Number) number.
01 - ABA Transit Routing Number
01
BPR12
*ABA is not to be confused with Anthem
(DFI) ID Number
Benefit Administrators.
Qualifier
Represents Receiver/Provider's Bank
(Receiver DFI
BPR13
number.
(DFI) ID Number
Identifier)
Represents Receiver/Provider's Bank
(Receiver Bank
BPR15
Account Number
Account Number) Account number.
Date when check was created.
(Check Issue
BPR16
Check Issue or EFT
Date)
Effective Date
TRN segment provides Trace No. to reassociate dollars (payment) to remittance data (835).
P.52 TRN
1 - Current Transaction Trace Number
1
TRN01
Reassociation Trace Code Type
Trace Number TRN02
▪ Check No. - if provider receives paper.
(Check or EFT
▪ Advice No. - if provider receives EFT.
Reference Identification Trace Number)
▪ NO PAYMENT - if BPR02 = $0.00
NO PAYMENT
(Payer Identifier) Represents Anthem's Tax ID No.
TRN03
preceded by '1'.
Originating Company ID
Anthem Blue Cross and Blue Shield - West Region Page 5 of 13
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835 Health Care Claim Payment/Advice Companion Document
835 Health Care Claim Payment/Advice—Header
IG
Segment
Reference
Designator(s)
P.57
Value
Applies to FEP Payments only.
REF
Receiver
REF02
EV
Identification Reference ID
Qualifier
REF02
FEP
Reference
Identification
P.60 DTM
DTM01
405
Production
Date Time Qualifier
Date
DTM02
(CCYYMMDD)
Production Date
P.69 PER
Applies to FEP Payments only.
Payer
PER02
(Payer Contact
Contact
Name
Name)
Information
(Payer
PER04
Communication
Communications
Number
Number)
Loop ID 1000B—Payee Identification
P.72 N1
N102
(Payee Name)
Payee
Name
Identification N103
XX
ID Code Qualifier
FI
N104
(Payee
Identification Code Identification
Code)
P.77 REF
TJ
REF01
Payee
Reference ID
PQ
Additional
Qualifier
Identification REF02
(Additional
Reference
Payee Identifier)
Identification
Anthem Blue Cross and Blue Shield - West Region Definitions and Notes
Specific to West Region
EV - Receiver ID Number
Represents payments for FEP claims.
405 - Production
Scheduled remittance run date.
Contact Name of Payer.
Contact Phone Number.
Represents the Pay-to Provider.
XX - National Provider Identifier
FI - Federal Taxpayer's Identification number
• NPI ('XX') for Non-Exempt providers
• Tax ID ('FI') for Exempt providers
TJ - Federal Taxpayer's Identification number
PQ - Payee Identification
• Tax ID ('TJ') for Non-Exempt providers
• Payee ID ('PQ') for Exempt providers
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835 Health Care Claim Payment/Advice Companion Document
835 Health Care Claim Payment/Advice – Detail
The 835 Payment/Advice Detail level contains the explanations of benefits/charges paid, reduced or
denied, related to the adjudicated claims and services. The following table identifies the situational
segments and data elements, and specific values of the required segments and data elements, in these
Loops that are used for West Region processing.
835 Health Care Claim Payment/Advice—Detail
IG
Reference
Value
Designator(s)
Loop ID 2100—Claim Payment Information
P.89 CLP
(Patient Control
CLP01
Claim
Claim Submitter's
Number)
Payment
Identifier
Information
CLP02
1
4
Claim Status Code
2
22
3
12 15
CLP06
Claim Filing Indicator 13 HM
Code
14 MC
P.102
P.105
P.108
P.111
Segment
CLP07
Reference
NM1
NM108
Patient
ID Code Qualifier
Name
NM109
Identification Code
NM1
NM108
Insured
ID Code Qualifier
Name
NM109
Identification Code
NM101
NM1
Corrected Pat Entity Identifier Code
/ Ins Name
NM1
NM103, (NM104)
Name Last (First) or
Service
Org Name
Provider
Name
NM108
ID Code Qualifier
NM109
Identification Code
Definitions and Notes
Specific to West Region
Value populated from inbound electronic 837
CLM01 or from paper claim: Block 26 (HCFA,
CMS1500), Block 3 (UB92, UB04).
1 - Claim processed as Primary; 2 Secondary; 3 - Tertiary; 4 - Denied; 22 Reversal
12 - Preferred Provider Org. (PPO); 13 - Point
of Service (POS); 14 - Exclusive Provider Org.
(EPO); 15 - Indemnity Insurance (may include
Traditional Plans); HM - HMO; MC - Medicaid
Represents the internal claim number
(Payer Claim
Control Number) assigned by Anthem.
MI - Member Identification Number
MI
(Patient
Identifier)
MI
Membership Number assigned by Anthem.
(Subscriber
Identifier)
74
Membership Number assigned by Anthem.
(Rendering Prov
Last (First) or
Org Name)
XX
FI
(Rendering Prov
Identifier)
Represents the name populated on the 837 at
the line level (Loop 2400).
MI - Member Identification Number
74 - Corrected Insured
XX - National Provider Identifier
FI - Federal Taxpayer's Identification number
• NPI ('XX') for Non-Exempt providers
• Tax ID ('FI') for Exempt providers
050 - Received
050
DTM01
Date/Time Qualifier
Represents the date the claim was received
DTM02
(Claim Date)
by Anthem.
Claim Date
P.132 PER
Applies to BCBS Payments only.
Payer
Claim Contact Name of Payer.
PER02
(Claim Contact
Contact
Name
Name)
Information
Contact Phone Number.
(Claim Contact
PER04
Communication
Communications
Number
Number)
P.136 AMT
AMT segment conveys information only. It does not affect financial balancing.
I - Interest (for FEP)
Claim
AMT01
I
Supplemental Amount Qualifier Code
Information
Represents the specific amount associated to
AMT02
(Claim
the claim.
Monetary Amount
Supplemental
Amt)
P.130 DTM
Claim
Date
Anthem Blue Cross and Blue Shield - West Region Page 7 of 13
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835 Health Care Claim Payment/Advice Companion Document
835 Health Care Claim Payment/Advice—Detail
IG
Segment
Reference
Value
Definitions and Notes
Designator(s)
Specific to West Region
Loop ID 2110—Service Payment Information
P.139 SVC
SVC01-1
AD - American Dental Association Codes
Product Service ID
Service
HC - Health Care Financing Administration Common Procedural
Qualifier
Payment
Coding System (HCPCS) Codes
Information
ID - ICD-9-CM - Procedure
ND - National Drug Code (NDC)
NU - National Uniform Billing Committee (NUBC) UB92 Code
ZZ - Mutually Defined
Applicable when 1) adjudicated proc code in
(Product or
SVC06-1 ― 06-7
SVC01 differs from submitted proc code on
Product/Service ID
Service ID
original claim, 2) to reference originally
Qualifier
Qualifier)
submitted proc on rebundled claim, and 3) to
reference Anthem medical policy changes.
P.146 DTM
Service Date
P.148 CAS
Service
Adjustment
DTM02
Date
CAS01
Claim Adjustment
Group Code
(Service Date) Format CCYYMMDD
CO
CR
OA
PR
CO - Contractual Obligation (Prov Write-off)
CR - Corrections & Reversals (Adjustments)
OA - Other Adj (Bundled Lines, Non-Covered
Charges)
PR - Patient Resp (Copayment, Deductible)
Represents adjustments at service line level.
(Adjustment
CAS02,5,8,11,14,17
Claim Adjustment
Reason Code)
Reason Code
CAS03,6,9,12,15,18
(Adjustment
Monetary Amount
Amount)
CAS04,7,10,13,16,19 (Adjustment
Quantity
Quantity)
P.154 REF
6R - Provider Control Number
REF01
6R
Service
Reference ID Qualifier
Identification REF02
Represents Line Item Control Number
(Provider
submitted on 837 Claim.
Reference Identification Identifier)
P.158 AMT
AMT segment conveys information only. It does not affect financial balancing.
B6 - Allowed - Actual
Service
AMT01
B6
Supplemental Amount Qualifier Code
Amount
Represents the Anthem Allowed Amount for the
AMT02
(Service
Monetary Amount
Supplemental service.
Amt)
HE - Claim Payment Remark Codes
P.162 LQ
HE
LQ01
Health Care Code List Qualifier
Remark
Code
Codes
LQ02
(Remark Code) Maximum of 5 remark codes per line.
Industry Code
Anthem Blue Cross and Blue Shield - West Region Page 8 of 13
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835 Health Care Claim Payment/Advice Companion Document
835 Health Care Claim Payment/Advice – Summary
The 835 Payment/Advice Summary level contains the Provider level adjustments, which provides
information related to adjustments to the payment amount not specific to the claims in the 835
Payment/Advice Detail level. The following table identifies the situational segments and data elements,
and specific values of the required segments and data elements, in these Loops that are used for West
Region processing.
835 Health Care Claim Payment/Advice—Summary
IG
Segment
Reference
Value
Definitions and Notes
Designator(s)
Specific to West Region
The PLB Segment is used to allow adjustments that are NOT specific to a particular claim or service.
P.164 PLB
Represents the Payee ID Number assigned by
PLB01
(Provider
Anthem.
Reference Identification Identifier)
Provider
Adjustment PLB03-1
FB - Forwarding Balance
FB
IR - Internal Revenue Service Withholding
Adjustment Reason
IR
L6 - Interest Owed
Code
L6
PI - Periodic Interim Payment
PI
WO - Overpayment Recovery
WO
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835 Health Care Claim Payment/Advice Companion Document
Enveloping
This section explains EDI enveloping of the 835 Payment/Advice transaction that will help you when
receiving responses from Anthem (West Region).
EDI envelopes control and track communications between you and Anthem (West Region). One
envelope may contain many transaction sets grouped into functional groups. The envelope includes
the following components:
Interchange Control Header (ISA)
Functional Group Header (GS)
Functional Group Trailer (GE)
Interchange Control Trailer (IEA)
835 EDI Transaction Structure
Interchange Control Header (ISA)
Functional Group Header (GS)
Envelope
Envelope
Envelope
Transaction Set Header (ST)
Header
Detail
Summary
Transaction Set Trailer (SE)
Functional Group Trailer (GE)
Interchange Control Trailer (IEA)
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835 Health Care Claim Payment/Advice Companion Document
835 Envelope Control Segments – Outbound
1
835 Health Care Claim Payment/Advice Interchange Control Header (ISA)
The ISA segment is the beginning, outermost envelope of the interchange control structure. Containing
authorization and security information, it clearly identifies the Sender, Receiver, Date, Time, and
Interchange Control Number. Use the following table, specific to Anthem, to supplement the 835
Implementation Guide. This information does not modify the 835 Implementation Guide.
835 Health Care Claim Payment / Advice
Interchange Control Header (ISA)
Segment
Reference
Designator(s)
ISA
Interchange
Control
Header
ISA01
Auth Information
ISA02
Authorization Information
ISA03
Security Info Qualifier
ISA04
Security Information
ISA05
Interchange ID Qualifier
ISA06
Interchange Sender ID
ISA07
Interchange ID Qualifier
ISA08
Interchange Receiver ID
ISA09
Interchange Date
ISA10
Interchange Time
ISA11
Interchange Control
Standards Identifier
ISA12
Interchange Control
Version Number
ISA13
Interchange Control
Number
ISA14
Acknowledgment
Requested
ISA15
Usage Indicator
ISA16
Component Element
Separator
Anthem Blue Cross and Blue Shield - West Region Value
00
Definitions and Notes
Specific to Anthem
00 - No Authorization Information Present
(10 Spaces)
00
00 - No Security Information Present
(10 Spaces)
ZZ
ZZ - Mutually Defined
ANTHEM
SRFACETS
ZZ
ANTHEM - represents payer generating 835
SRFACETS - SRFACETS MA PFFS
ZZ - Mutually Defined
(Receiver ID)
(YYMMDD)
EDI Assigned Receiver ID representing the 835
receiver.
Valid date in YYMMDD format.
(HHMM)
Valid time in HHMM format.
U
U - U.S. EDI Community of ASC X12, TDCC, and
UCS
00401
Draft
Standards
Trial
Used
Approved
00401 - D
ft St
d d ffor T
i lU
dA
d for
f
Publication by ASC X12 Procedures Review Board
through October 1997
▪ Format - 9 position numeric.
▪ Unique value greater than zero, not used in previous
HIPAA transaction within 30 calendar day period.
▪ Right-justified, filled with leading zeroes.
▪ Identical to value in IEA02
IEA02.
0 - No Acknowledgment Requested
(Assigned by
Sender)
0
P, T
|
Submitter ID must be approved to receive production
data. P - Production Data; T - Test Data
Vertical Bar (|) will be sent as the Component
Element
Separator.
e e t Sepa
ato
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835 Health Care Claim Payment/Advice Companion Document
835 Health Care Claim Payment/Advice Functional Group Header (GS)
The GS segment identifies the collection of transaction sets that are included within the functional
group. More specifically, the GS segment identifies the functional control group, sender, receiver,
date, time, group control number and version/release/industry code for the transaction sets. Use the
following table, specific to Anthem (West Region), to supplement the 835 Implementation Guide. This
information does not modify the 835 Implementation Guide.
835 Health Care Claim Payment / Advice
Functional Group Header (GS)
Segment
GS
Functional
Group
Header
Reference
Designator(s)
GS01
Functional
Identifier Code
GS02
Application
Sender's Code
GS03
Application
Receiver's Code
GS04
Date
GS05
Time
GS06
Group Control
Number
Value
HP
Definitions and Notes
Specific to Anthem
HP - Health Care Claim Payment / Advice (835)
Routing from:
BCBSCO
BCBSNV
ANTHEMFCS
SRFACETS
(Receiver ID)
BCBSCO - CO BCBS Plan
BCBSNV - NV BCBS Plan
ANTHEMFCS - Federal Employee's Program (FEP)
SRFACETS - SRFACETS MA PFFS
EDI Assigned Receiver ID representing the 835 receiver.
(CCYYMMDD)
Valid date in CCYYMMDD format.
(HHMM)
Valid time in HHMM format.
(Assigned by
Sender)
▪ Format - 1-9 position numeric.
▪ Unique value greater than zero, not used in previous
HIPAA transaction within 30 calendar day period.
▪ Right-justified, filled with leading zeroes.
▪ Identifical to value in GE02.
X - Accredited Standards Committee X12
GS07
X
Responsible
Agency Code
004010X091A1
GS08
Version /
Release /
Industry Identifier
Code
Anthem Blue Cross and Blue Shield - West Region Operationally used to identify the 835 Health Care Claim
Payment / Advice transaction.
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835 Health Care Claim Payment/Advice Companion Document
835 Health Care Claim Payment/Advice Functional Group Trailer (GE)
The GE segment indicates the end of the functional group and provides control information. Use the
following table, specific to Anthem, to supplement the 835 Implementation Guide. This information
does not modify the 835 Implementation Guide.
835 Health Care Claim Payment / Advice
Functional Group Trailer (GE)
Segment
Reference
Designator(s)
GE
GE01
Functional
Number of
Group Trailer Transaction Sets
Included
GE02
Group Control
Number
4
Value
(Total Number of
Transaction Sets in
Functional Group or
Transmission)
(Control Number)
Definitions and Notes
Specific to Anthem
▪ Format - 1-6 positions, numeric.
▪ Left-justified with no trailing zeroes or spaces.
▪ Format - 1-9 positions, numeric.
▪ Left-justified with no trailing zeroes or spaces.
▪ Identical to GS06.
835 Health Care Claim Payment/Advice Interchange Control Trailer (IEA)
The IEA segment is the ending, outermost level of the interchange control structure. It indicates
and verifies the number of functional groups included within the interchange and the interchange
control number (the same number indicated in the ISA segment). Use the following table, specific
to Anthem, to supplement the 835 Implementation Guide. This information does not modify the 835
Implementation Guide.
835 Health Care Claim Payment / Advice
Interchange Control Trailer (IEA)
Segment
IEA
Interchange
Control
Trailer
Reference
Designator(s)
IEA01
Number of Included
Functional Groups
IEA02
Interchange Control
Number
Anthem Blue Cross and Blue Shield - West Region Value
(Number of Functional
Groups GS/GE Pairs in
Interchange)
(Control Number)
Definitions and Notes
Specific to Anthem
▪ Format - 1-5 positions, numeric.
▪ Left-justified with no trailing zeroes.
▪ Format - Fixed length 9 positions, numeric.
▪ Unique value greater than zero.
▪ Identical to ISA13.
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Release 02 (February 2011)
Version 004010A1 - Oct 2002