Document - HIPAA 835 to Excel



For Desktop Application

HIPAA 835 to Excel

For Automated Batch Application

HIPAA 835 to Excel Batch

For Server Application

HIPAA 835 to Excel Command Line Program

835 Data Mapping


Exported Name, Description 835 Loop Segment Data Element-Sub DE
Claim Payment Information Loop 2100
Patient Control # 2100 CLP 01
Charged Amount 2100 CLP 03
Paid Amount 2100 CLP 04
Patient Amount, Patient Responsibility Amount 2100 CLP 05
Patient Last, Name, Entity ID=QC 2100 NM1 03
First, Patient first name 2100 NM1 04
Patient ID, SSN, Health Insurance Claim Number 2100 NM1 09
Insured Last, Name, Entity ID=IL 2100 NM1 03
First, Insured first name 2100 NM1 04
Insured Person ID, Federal Payer ID, Member ID 2100 NM1 09
Claim Adjust Group 1 .. 6, Claim Adjustment Group Code, repeated in same segment 2100 CAS 01
Reason 1 .. 6, Claim Adjustment Reason Code 1 .. 6 2100 CAS 02,05,08,11,14,17
Amount 1 .. 6, Claim Adjustment Amount 1 .. 6 2100 CAS 03,06,09,12,15,18
Qty 1 .. 6, Claim Adjustment Quantity 1 .. 6 2100 CAS 03,06,09,12,15,18
Service Payment Information Loop 2110
Line #, Service Line number starting from 1, generated by program, not in 835 file
Proc Code Q, Procedure Code Qualifier 2110 SVC 01-1
Proc Code, Procedure Code 2110 SVC 01-2
M1 .. M4, Procedure Modifier 1 .. 4 2110 SVC 01-3 .. 01-6
Charged, Line Item Charged Amount 2110 SVC 02
Paid, Line Item Provider Payment Amount 2110 SVC 03
Revenue Code, NUBC Revenue Code 2110 SVC 04
Unit Paid, Unit of Service Paid Count 2110 SVC 05
Svc Start, Service Start Date, DTP01=150 or DTP01=472 2110 DTP 02
Svc End, Service End Date, DTP01=151 2110 DTP 02
Line Adjust Group Code 1 .. 6, Service Level, Claim Adjustment Group Code, repeated in same segment 2110 CAS 01
Reason 1 .. 6, Service Level, Claim Adjustment Reason Code 2110 CAS 02,05,08,11,14,17
Amount 1 .. 6, Service Level, Claim Adjustment Amount 2110 CAS 03,06,09,12,15,18
Qty 1 .. 6, Service Level, Claim Adjustment Quantity 2110 CAS 03,06,09,12,15,18