EDI 835 Key Fields — Data Dictionary
This page explains every column in the “Key Fields” output your converter produces for X12 EDI 835 / ERA files.
Use this when reviewing your CSV/Excel export, building downstream reports, or mapping fields into your billing/RCM systems.
Download the Key Fields Data Map
CSV/Excel mapping of every Key Fields column, including the EDI 835 segment source. No PHI.
Column Definitions
Applies to Client‑Side EDI 835 “Key Fields” format
| Column | EDI Source | Description |
|---|---|---|
| ID | N/A (converter) | Sequential row ID assigned by the converter for easy reference. Not an EDI-native field. |
| File Name | N/A (converter) | Name of the input 835 file you converted. Useful when batch‑processing multiple ERAs. |
| Patient Control Number | CLP01 | Patient Control Number (PCN) or Claim Submitter’s Identifier from CLP01. Often matches the original claim control number. |
| Claim Status | CLP02 | Claim status / adjudication result from CLP02 (e.g., 1=Processed as Primary, 2=Processed as Secondary, 4=Denied, etc.). |
| Charge Amount | CLP03 | Total claim billed/charged amount from CLP03. |
| Payment Amount | CLP04 | Total claim payment amount from CLP04 (amount paid by payer for the claim). |
| Patient Responsibility Amount | CLP05 | Total patient responsibility amount from CLP05 (copay, coinsurance, deductible, etc.). |
| DRG Code | CLP07 / HI*DR | Diagnosis Related Group code from CLP07 when present (mainly inpatient ERAs). |
| Payment Date | BPR16 / DTM*405 | Payer payment/effective date from BPR16 or DTM405 depending on payer. |
| Check Or EFT Trace Number | TRN02 | Payment trace/check/EFT number from TRN02. Helps reconcile deposits to remits. |
| Total Adj Amount | CAS (claim) | Total claim‑level adjustment amount summed from CAS segments associated with the claim. |
| Adj1 Reason Code | CAS02 (claim 1) | First claim‑level adjustment reason code from CAS02. |
| Adj1 Amount | CAS03 (claim 1) | First claim‑level adjustment amount from CAS03. |
| Adj2 Reason Code | CAS02 (claim 2) | Second claim‑level adjustment reason code (next CAS pair). |
| Adj2 Amount | CAS03 (claim 2) | Second claim‑level adjustment amount. |
| Adj3 Reason Code | CAS02 (claim 3) | Third claim‑level adjustment reason code. |
| Adj3 Amount | CAS03 (claim 3) | Third claim‑level adjustment amount. |
| Adj4 Reason Code | CAS02 (claim 4) | Fourth claim‑level adjustment reason code. |
| Adj4 Amount | CAS03 (claim 4) | Fourth claim‑level adjustment amount. |
| Adj5 Reason Code | CAS02 (claim 5) | Fifth claim‑level adjustment reason code. |
| Adj5 Amount | CAS03 (claim 5) | Fifth claim‑level adjustment amount. |
| Payer Identifier | N1*PR (N104) | Payer ID from N1*PR (often the payer’s NAIC/plan identifier). |
| Payer Name | N1*PR (N102) | Payer name from N1*PR or related loops. |
| Patient Identifier | NM1*QC (NM109) | Patient/member identifier from NM109 in the patient loop (e.g., subscriber/member ID). |
| Patient Last Name | NM1*QC (NM103) | Patient last name from NM103. |
| Patient First Name | NM1*QC (NM104) | Patient first name from NM104. |
| Service Date From | DTM*232 / DTM*150 | Claim service start date from DTM*232, DTM*150, or payer‑specific claim DTM loops. |
| Service Date To | DTM (claim) | Claim service end date (typically paired with Service Date From). |
| Coverage Amount | AMT (claim) | Claim coverage/allowed/benefit amount when provided by the payer (varies by payer). |
| Line Control Number | SVC01 / REF (line) | Service line control number from SVC01 or line‑level identifiers. |
| Line Procedure Code | SVC01-2 | Procedure/CPT/HCPCS code from SVC01-2. |
| Line Revenue Code | SVC01-1 | Revenue code from SVC01-1 (common on facility/inpatient lines). |
| Line Charge Amount | SVC02 | Service line billed amount from SVC02. |
| Line Paid Amount | SVC03 | Service line paid amount from SVC03. |
| Line Unit Count | SVC05 / QTY (line) | Service line unit count from SVC05 or related quantity fields. |
| Line Service Date From | DTM*472 | Service line start date from DTM*472 (line service date). |
| Line Service Date To | DTM (line) | Service line end date when payer provides a range. |
| Line Total Adj Amount | CAS (line) | Total line‑level adjustment amount summed from line‑level CAS segments. |
| Line Adj1 Reason Code | CAS02 (line 1) | First service line adjustment reason code from line‑level CAS02. |
| Line Adj1 Amount | CAS03 (line 1) | First service line adjustment amount from line‑level CAS03. |
| Line Adj2 Reason Code | CAS02 (line 2) | Second service line adjustment reason code. |
| Line Adj2 Amount | CAS03 (line 2) | Second service line adjustment amount. |
| Line Adj3 Reason Code | CAS02 (line 3) | Third service line adjustment reason code. |
| Line Adj3 Amount | CAS03 (line 3) | Third service line adjustment amount. |
| Line Adj4 Reason Code | CAS02 (line 4) | Fourth service line adjustment reason code. |
| Line Adj4 Amount | CAS03 (line 4) | Fourth service line adjustment amount. |
| Line Adj5 Reason Code | CAS02 (line 5) | Fifth service line adjustment reason code. |
| Line Adj5 Amount | CAS03 (line 5) | Fifth service line adjustment amount. |
| Line Allowed Amount | AMT (line) / derived | Allowed amount for the service line when payer provides it (often derived from paid + adjustments). |
| Line Remark Code1 | LQ / MOA / REF (remark 1) | First line remark code from LQ or MOA/REF remark loops (payer‑specific). |
| Line Remark Code2 | LQ / MOA / REF (remark 2) | Second line remark code if multiple are present. |
| Line Remark Code3 | LQ / MOA / REF (remark 3) | Third line remark code if multiple are present. |
Notes
- 835 implementations vary by payer; some fields may be blank if the payer doesn’t supply the segment.
- Claim‑level adjustments come from
CASsegments tied to the claim (CLPloop), while line‑level adjustments come fromCAStied to the service line (SVCloop). - “Key Fields” is designed for reconciliation and review. Use “All Fields” for a full raw segment export.