EDI 835 All Fields — Data Dictionary
This page documents every column in the “All Fields” output produced by the Client‑Side EDI 835 converter, including a high‑level EDI segment/element source for each field.
Need something lighter? See the 835 Key Fields dictionary.
Download the All Fields Data Map
Full CSV/Excel mapping of every All Fields column, including its 835 source segment. No PHI.
Column Definitions
Applies to Client‑Side EDI 835 “All Fields” format
| Column | EDI Source | Description |
|---|---|---|
| Id | N/A (converter) | Sequential row ID assigned by the converter (not from EDI). |
| TransactionType | ST01 | Transaction set type, typically 835 for ERA. |
| FileName | N/A (converter) | Name of the input EDI file. |
| TransactionControlNumber | ST02 | Transaction set control number from the ST segment. |
| PatientControlNumber | CLP01 | Submitter’s claim or patient control number. |
| ClaimStatus | CLP02 | Claim status code showing how the claim adjudicated. |
| ChargeAmount | CLP03 | Total billed/charged amount for the claim. |
| PaymentAmount | CLP04 | Total paid amount for the claim. |
| PatientResponsibilityAmount | CLP05 | Amount assigned to patient responsibility. |
| ClaimFilingIndicatorCode | CLP06 | Insurance/filing type for the claim (e.g., MC, CI). |
| PayerControlNumber | CLP07 / REF*1K | Payer-assigned claim control/reference number. |
| FacilityCode | CLP08 / payer echo | Facility/place-of-service or claim facility code if echoed. |
| FrequencyTypeCode | payer echo | Claim frequency type (original, replacement, void) if echoed. |
| DrgCode | CLP07 / HI*DR | Diagnosis Related Group (DRG) code when returned. |
| DrgWeight | AMT (claim) | DRG weight value when returned. |
| DischargeFraction | AMT (claim) | Discharge fraction/percent when returned. |
| TotalPaymentAmount | BPR02 | Total payment amount for the entire ERA. |
| CreditOrDebitFlagCode | BPR03 | Indicates whether the payment is a credit or debit. |
| PaymentMethodType | BPR04 | Payment method used (EFT, check, etc.). |
| ReceiverAccountNumber | BPR09 | Payee/receiver bank account number when provided. |
| PaymentDate | BPR16 / DTM*405 | Effective payment date of the ERA. |
| CheckOrEftTraceNumber | TRN02 | Check/EFT trace number for the payment. |
| PayerEin | REF*TJ | Payer tax ID/EIN when supplied. |
| ProductionDate | DTM*405 / GS08 | Date the ERA was produced by the payer. |
| TotalAdjAmount | CAS (claim) | Sum of all claim-level adjustments. |
| Adj1Group | CAS01 (claim 1) | Claim-level adjustment group 1 (CO/PR/OA/PI/etc.). |
| Adj1ReasonCode | CAS02 (claim 1) | Claim-level adjustment reason code 1. |
| Adj1Amount | CAS03 (claim 1) | Claim-level adjustment amount 1. |
| Adj1Quantity | CAS04 (claim 1) | Claim-level adjustment quantity 1 when provided. |
| Adj2Group | CAS01 (claim 2) | Claim-level adjustment group 2 (CO/PR/OA/PI/etc.). |
| Adj2ReasonCode | CAS02 (claim 2) | Claim-level adjustment reason code 2. |
| Adj2Amount | CAS03 (claim 2) | Claim-level adjustment amount 2. |
| Adj2Quantity | CAS04 (claim 2) | Claim-level adjustment quantity 2 when provided. |
| Adj3Group | CAS01 (claim 3) | Claim-level adjustment group 3 (CO/PR/OA/PI/etc.). |
| Adj3ReasonCode | CAS02 (claim 3) | Claim-level adjustment reason code 3. |
| Adj3Amount | CAS03 (claim 3) | Claim-level adjustment amount 3. |
| Adj3Quantity | CAS04 (claim 3) | Claim-level adjustment quantity 3 when provided. |
| Adj4Group | CAS01 (claim 4) | Claim-level adjustment group 4 (CO/PR/OA/PI/etc.). |
| Adj4ReasonCode | CAS02 (claim 4) | Claim-level adjustment reason code 4. |
| Adj4Amount | CAS03 (claim 4) | Claim-level adjustment amount 4. |
| Adj4Quantity | CAS04 (claim 4) | Claim-level adjustment quantity 4 when provided. |
| Adj5Group | CAS01 (claim 5) | Claim-level adjustment group 5 (CO/PR/OA/PI/etc.). |
| Adj5ReasonCode | CAS02 (claim 5) | Claim-level adjustment reason code 5. |
| Adj5Amount | CAS03 (claim 5) | Claim-level adjustment amount 5. |
| Adj5Quantity | CAS04 (claim 5) | Claim-level adjustment quantity 5 when provided. |
| PayerIdentificationType | N1*PR (N103) | Qualifier describing the payer identifier type. |
| PayerIdentifier | N1*PR (N104) | Payer identifier value (often NAIC or plan ID). |
| PayerName | N1*PR (N102) | Payer organization name. |
| PayerAddressLine | N3 (payer) | Payer address line 1. |
| PayerAddressLine2 | N3 (payer) | Payer address line 2 when provided. |
| PayerAddressCity | N4 (payer) | Payer city. |
| PayerAddressStateCode | N4 (payer) | Payer state. |
| PayerAddressZipCode | N4 (payer) | Payer ZIP/postal code. |
| PayerContact1Name | PER (payer) | Primary payer contact name. |
| PayerContact1ContactNumber1Type | PER03 (payer) | Qualifier for payer contact 1 primary number. |
| PayerContact1ContactNumber1Number | PER04 (payer) | Payer contact 1 primary phone/email/fax. |
| PayerContact1ContactNumber2Type | PER05 (payer) | Qualifier for payer contact 1 secondary number. |
| PayerContact1ContactNumber2Number | PER06 (payer) | Payer contact 1 secondary phone/email/fax. |
| PayerContact2Name | PER (payer) | Secondary payer contact name. |
| PayerContact2ContactNumber1Type | PER03 (payer) | Qualifier for payer contact 2 primary number. |
| PayerContact2ContactNumber1Number | PER04 (payer) | Payer contact 2 primary phone/email/fax. |
| PayerContact2ContactNumber2Type | PER05 (payer) | Qualifier for payer contact 2 secondary number. |
| PayerContact2ContactNumber2Number | PER06 (payer) | Payer contact 2 secondary phone/email/fax. |
| PayerAdditionalId1Type | REF01 (payer) | Qualifier for an additional payer identifier 1. |
| PayerAdditionalId1Identification | REF02 (payer) | Additional payer identifier value 1. |
| PayerAdditionalId2Type | REF01 (payer) | Qualifier for an additional payer identifier 2. |
| PayerAdditionalId2Identification | REF02 (payer) | Additional payer identifier value 2. |
| PayeeIdentificationType | N1*PE (N103) | Qualifier describing the payee identifier type. |
| PayeeIdentifier | N1*PE (N104) | Payee identifier value (often NPI or tax ID). |
| PayeeLastNameOrOrgName | N1*PE (N102) | Payee/provider name. |
| PayeeAddressLine | N3 (payee) | Payee address line 1. |
| PayeeAddressLine2 | N3 (payee) | Payee address line 2 when provided. |
| PayeeAddressCity | N4 (payee) | Payee city. |
| PayeeAddressStateCode | N4 (payee) | Payee state. |
| PayeeAddressZipCode | N4 (payee) | Payee ZIP/postal code. |
| PayeeContacts | PER (payee) | Payee contact details when provided. |
| PayeeAdditionalId1Type | REF01 (payee) | Qualifier for an additional payee identifier 1. |
| PayeeAdditionalId1Identification | REF02 (payee) | Additional payee identifier value 1. |
| PayeeAdditionalId2Type | REF01 (payee) | Qualifier for an additional payee identifier 2. |
| PayeeAdditionalId2Identification | REF02 (payee) | Additional payee identifier value 2. |
| PatientIdentificationType | NM1*QC (NM108) | Qualifier describing the patient identifier type. |
| PatientIdentifier | NM1*QC (NM109) | Patient/member identifier. |
| PatientLastName | NM1*QC (NM103) | Patient last name. |
| PatientFirstName | NM1*QC (NM104) | Patient first name. |
| PatientMiddleName | NM1*QC (NM105) | Patient middle name or initial when provided. |
| SubscriberIdentificationType | NM1*IL (NM108) | Qualifier describing the subscriber identifier type. |
| SubscriberIdentifier | NM1*IL (NM109) | Subscriber/member identifier. |
| SubscriberLastName | NM1*IL (NM103) | Subscriber last name. |
| SubscriberFirstName | NM1*IL (NM104) | Subscriber first name. |
| SubscriberMiddleName | NM1*IL (NM105) | Subscriber middle name or initial when provided. |
| CorrectedPatientIdentificationType | NM1*74 (NM108) | Qualifier describing the corrected patient identifier type. |
| CorrectedPatientIdentifier | NM1*74 (NM109) | Corrected patient/member identifier. |
| CorrectedPatientLastName | NM1*74 (NM103) | Corrected patient last name. |
| CorrectedPatientFirstName | NM1*74 (NM104) | Corrected patient first name. |
| CorrectedPatientMiddleName | NM1*74 (NM105) | Corrected patient middle name or initial when provided. |
| ServiceProviderIdentificationType | NM1*82 (NM108) | Qualifier describing service provider identifier type. |
| ServiceProviderIdentifier | NM1*82 (NM109) | Service provider identifier (often NPI). |
| ServiceProviderLastNameOrOrgName | NM1*82 (NM103) | Service provider last name or organization name. |
| ServiceProviderFirstName | NM1*82 (NM104) | Service provider first name when individual provider. |
| ServiceProviderMiddleName | NM1*82 (NM105) | Service provider middle name or initial when provided. |
| ServiceProviderContacts | PER (provider) | Service provider contact details when provided. |
| ServiceProviderAdditionalId1Type | REF01 (provider) | Qualifier for an additional service provider identifier 1. |
| ServiceProviderAdditionalId1Identification | REF02 (provider) | Additional service provider identifier value 1. |
| ServiceProviderAdditionalId2Type | REF01 (provider) | Qualifier for an additional service provider identifier 2. |
| ServiceProviderAdditionalId2Identification | REF02 (provider) | Additional service provider identifier value 2. |
| CrossoverCarrierIdentificationType | NM1 / REF (crossover) | Qualifier describing crossover carrier identifier type. |
| CrossoverCarrierIdentifier | NM1 / REF (crossover) | Crossover carrier identifier value. |
| CrossoverCarrierName | NM1 (crossover) | Crossover carrier name. |
| CorrectedPayerIdentificationType | NM1*PR / REF (corrected) | Qualifier describing corrected payer identifier type. |
| CorrectedPayerIdentifier | NM1*PR / REF (corrected) | Corrected payer identifier value. |
| CorrectedPayerName | NM1*PR (corrected) | Corrected payer name. |
| OtherSubscriberIdentificationType | NM1*IL (other sub) | Qualifier describing other subscriber identifier type (COB). |
| OtherSubscriberIdentifier | NM1*IL (other sub) | Other subscriber identifier value (COB). |
| OtherSubscriberLastName | NM1*IL (other sub) | Other subscriber last name. |
| OtherSubscriberFirstName | NM1*IL (other sub) | Other subscriber first name. |
| OtherSubscriberMiddleName | NM1*IL (other sub) | Other subscriber middle name or initial when provided. |
| OtherClaimRelatedId1Type | REF01 (claim) | Qualifier for other claim-related identifier 1. |
| OtherClaimRelatedId1Identification | REF02 (claim) | Other claim-related identifier value 1. |
| OtherClaimRelatedId2Type | REF01 (claim) | Qualifier for other claim-related identifier 2. |
| OtherClaimRelatedId2Identification | REF02 (claim) | Other claim-related identifier value 2. |
| ServiceDateFrom | DTM*232 / DTM*150 | Claim-level service start date. |
| ServiceDateTo | DTM (claim) | Claim-level service end date. |
| StatementDateFrom | DTM*434 | Statement period start date for facility claims. |
| StatementDateTo | DTM*435 | Statement period end date for facility claims. |
| CoverageExpirationDate | DTM*036 | Coverage/benefit expiration date when provided. |
| ClaimReceivedDate | DTM*050 | Date the payer received the claim when provided. |
| CoverageAmount | AMT (claim) | Coverage/benefit/allowed amount at the claim level. |
| SupplementalAmt1QualifierCode | AMT01 (claim) | Qualifier code for claim supplemental amount 1. |
| SupplementalAmt1Type | AMT01/AMT02 (claim) | Claim supplemental amount 1 type/meaning. |
| SupplementalAmt1Amount | AMT02 (claim) | Claim supplemental amount 1 value. |
| SupplementalAmt2QualifierCode | AMT01 (claim) | Qualifier code for claim supplemental amount 2. |
| SupplementalAmt2Type | AMT01/AMT02 (claim) | Claim supplemental amount 2 type/meaning. |
| SupplementalAmt2Amount | AMT02 (claim) | Claim supplemental amount 2 value. |
| SupplementalQty1QualifierCode | QTY01 (claim) | Qualifier code for claim supplemental quantity 1. |
| SupplementalQty1Type | QTY02 (claim) | Claim supplemental quantity 1 type/meaning. |
| SupplementalQty1Quantity | QTY02 (claim) | Claim supplemental quantity 1 value. |
| SupplementalQty2QualifierCode | QTY01 (claim) | Qualifier code for claim supplemental quantity 2. |
| SupplementalQty2Type | QTY02 (claim) | Claim supplemental quantity 2 type/meaning. |
| SupplementalQty2Quantity | QTY02 (claim) | Claim supplemental quantity 2 value. |
| LineControlNumber | SVC01 / REF (line) | Service line control/identifier number. |
| LineProcedureCode | SVC01-2 | Line procedure/CPT/HCPCS code. |
| LineProcedureModifier1Code | SVC01-3 | First procedure modifier for the line. |
| LineProcedureModifier2Code | SVC01-4 | Second procedure modifier for the line. |
| LineProcedureModifier3Code | SVC01-5 | Third procedure modifier for the line when provided. |
| LineRevenueCode | SVC01-1 | Revenue code for the service line. |
| LineDrugCode | LIN / REF (line) | Drug/NDC code for the line when provided. |
| LineChargeAmount | SVC02 | Billed/charged amount for the service line. |
| LinePaidAmount | SVC03 | Paid amount for the service line. |
| LineUnitCount | SVC05 / QTY (line) | Units/quantity for the service line. |
| LineOriginalProcedureCode | SVC06-2 / REF (line) | Original procedure/CPT code before payer correction when provided. |
| LineOriginalProcedureModifier1Code | SVC06-3 | Original modifier 1 before correction when provided. |
| LineOriginalProcedureModifier2Code | SVC06-4 | Original modifier 2 before correction when provided. |
| LineOriginalProcedureModifier3Code | SVC06-5 | Original modifier 3 before correction when provided. |
| LineOriginalRevenueCode | SVC06-1 | Original revenue code before correction when provided. |
| LineOriginalDrugCode | LIN / REF (orig line) | Original drug/NDC code before correction when provided. |
| LineOriginalUnitCount | SVC07 / QTY (line) | Original unit count before correction when provided. |
| LineServiceDateFrom | DTM*472 | Service line start date. |
| LineServiceDateTo | DTM (line) | Service line end date when provided. |
| LineTotalAdjAmount | CAS (line) | Sum of all line-level adjustments. |
| LineAdj1Group | CAS01 (line 1) | Line-level adjustment group 1 (CO/PR/OA/PI/etc.). |
| LineAdj1ReasonCode | CAS02 (line 1) | Line-level adjustment reason code 1. |
| LineAdj1Amount | CAS03 (line 1) | Line-level adjustment amount 1. |
| LineAdj1Quantity | CAS04 (line 1) | Line-level adjustment quantity 1 when provided. |
| LineAdj2Group | CAS01 (line 2) | Line-level adjustment group 2 (CO/PR/OA/PI/etc.). |
| LineAdj2ReasonCode | CAS02 (line 2) | Line-level adjustment reason code 2. |
| LineAdj2Amount | CAS03 (line 2) | Line-level adjustment amount 2. |
| LineAdj2Quantity | CAS04 (line 2) | Line-level adjustment quantity 2 when provided. |
| LineAdj3Group | CAS01 (line 3) | Line-level adjustment group 3 (CO/PR/OA/PI/etc.). |
| LineAdj3ReasonCode | CAS02 (line 3) | Line-level adjustment reason code 3. |
| LineAdj3Amount | CAS03 (line 3) | Line-level adjustment amount 3. |
| LineAdj3Quantity | CAS04 (line 3) | Line-level adjustment quantity 3 when provided. |
| LineAdj4Group | CAS01 (line 4) | Line-level adjustment group 4 (CO/PR/OA/PI/etc.). |
| LineAdj4ReasonCode | CAS02 (line 4) | Line-level adjustment reason code 4. |
| LineAdj4Amount | CAS03 (line 4) | Line-level adjustment amount 4. |
| LineAdj4Quantity | CAS04 (line 4) | Line-level adjustment quantity 4 when provided. |
| LineAdj5Group | CAS01 (line 5) | Line-level adjustment group 5 (CO/PR/OA/PI/etc.). |
| LineAdj5ReasonCode | CAS02 (line 5) | Line-level adjustment reason code 5. |
| LineAdj5Amount | CAS03 (line 5) | Line-level adjustment amount 5. |
| LineAdj5Quantity | CAS04 (line 5) | Line-level adjustment quantity 5 when provided. |
| LineServiceId1Type | REF01 (line) | Qualifier for line service identifier 1. |
| LineServiceId1Identification | REF02 (line) | Line service identifier value 1. |
| LineServiceId2Type | REF01 (line) | Qualifier for line service identifier 2. |
| LineServiceId2Identification | REF02 (line) | Line service identifier value 2. |
| LineServiceId3Type | REF01 (line) | Qualifier for line service identifier 3. |
| LineServiceId3Identification | REF02 (line) | Line service identifier value 3. |
| LineHealthcarePolicyId | REF*CE / REF (line) | Healthcare policy or plan identifier tied to the line. |
| LineRenderingProviderId1Type | NM1*82 / REF (line) | Qualifier for line rendering provider identifier 1. |
| LineRenderingProviderId1Identification | NM1*82 (line) | Rendering provider identifier value 1 (often NPI). |
| LineRenderingProviderId2Type | REF01 (line) | Qualifier for line rendering provider identifier 2. |
| LineRenderingProviderId2Identification | REF02 (line) | Rendering provider identifier value 2. |
| LineAllowedAmount | AMT (line) | Allowed amount for the service line when provided. |
| LineSupplementalAmt1QualifierCode | AMT01 (line) | Qualifier code for line supplemental amount 1. |
| LineSupplementalAmt1Type | AMT01/AMT02 (line) | Line supplemental amount 1 type/meaning. |
| LineSupplementalAmt1Amount | AMT02 (line) | Line supplemental amount 1 value. |
| LineSupplementalAmt2QualifierCode | AMT01 (line) | Qualifier code for line supplemental amount 2. |
| LineSupplementalAmt2Type | AMT01/AMT02 (line) | Line supplemental amount 2 type/meaning. |
| LineSupplementalAmt2Amount | AMT02 (line) | Line supplemental amount 2 value. |
| LineSupplementalQty1QualifierCode | QTY01 (line) | Qualifier code for line supplemental quantity 1. |
| LineSupplementalQty1Type | QTY02 (line) | Line supplemental quantity 1 type/meaning. |
| LineSupplementalQty1Quantity | QTY02 (line) | Line supplemental quantity 1 value. |
| LineSupplementalQty2QualifierCode | QTY01 (line) | Qualifier code for line supplemental quantity 2. |
| LineSupplementalQty2Type | QTY02 (line) | Line supplemental quantity 2 type/meaning. |
| LineSupplementalQty2Quantity | QTY02 (line) | Line supplemental quantity 2 value. |
| LineRemarkCode1 | LQ / MOA / REF (remark 1) | Remark/reason code 1 explaining line payment or adjustment details. |
| LineRemarkCode2 | LQ / MOA / REF (remark 2) | Remark/reason code 2 explaining line payment or adjustment details. |
| LineRemarkCode3 | LQ / MOA / REF (remark 3) | Remark/reason code 3 explaining line payment or adjustment details. |
| LineRemarkCode4 | LQ / MOA / REF (remark 4) | Remark/reason code 4 explaining line payment or adjustment details. |
| LineRemarkCode5 | LQ / MOA / REF (remark 5) | Remark/reason code 5 explaining line payment or adjustment details. |
Notes
- 835 implementations vary by payer; some All Fields columns may be blank if a payer omits the segment.
- Adjustment groups/reasons/amounts/quantities come from
CAS. Claim‑level CAS is tied toCLP; line‑level CAS is tied toSVC. - Supplemental amounts/quantities (claim and line) come from payer‑specific
AMTorQTYloops. Fields may be blank if the payer doesn’t send them.
Looking for the key fields layout? See the EDI 835 Key Fields data dictionary.