Updated : Friday, July 08 2011 at 1:09 PM
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Version 5010
Examples
A Simple Example of an X12 837 Institutional Claim
A Simple Example of an X12 837 Professional Claim
A Simple Example of an X12 837 Dental Claim
A Simple Example of an X12 835 Remittance Advise
A Simple Example of an X12 270 Health Care Eligibility Benefit Inquiy
A Simple Example of an X12 271 Health care Eligibility Benefit Response
A Simple Example of an X12 278 Health Care Services Review Request for Review
A Simple Example of an X12 X12 278 Health Care Services Review Request Response
A Simple Example of an X12 276 Claim Claims Status Inquiry
A Simple Example of an X12 277 Claims Status Response
A Simple Example of an X12 834 Benefit Enrollment and Maintenance Transaction
Version 4010
Examples
Example A of an X12 270 Health Care Eligibility Benefit Inquiy
Example A of an X12 271 Health care Eligibility Benefit Response
Example B of an X12 270 Health Care Eligibility Benefit Inquiy
Example B of an X12 271 Health care Eligibility Benefit Response
Example C of an X12 270 Health Care Eligibility Benefit Inquiy
Example C of an X12 271 Health care Eligibility Benefit Response
Example D of an X12 270 Health Care Eligibility Benefit Inquiy
Example D of an X12 271 Health care Eligibility Benefit Response
A Simple Example of an X12 278 Health Care Services Review Request for Review
A Simple Example of an X12 278 Health Care Services Review Request Response
A Simple Example of an X12 837 Professional Claim
A Simple Example of an X12 837 Institutional Claim
A Simple Example of an X12 837 Dental Claim
A Simple Example of an X12 997 that has been Accepted
A Simple Example of an X12 276 Claim Claims Status Inquiry
A Simple Example of an X12 277 Claims Status Response Version 004010
A Simple Example of an X12 277 Claims Status Response Version 003070
A Simple Example of an X12 835 Remittance Advice
An Example of an X12 835 Remittance Advice
Example 1 of a
Benefit Enrollment
and Maintenance X12 834 Transaction
Example 2 of a
Benefit Enrollment
and Maintenance X12 834 Transaction
Example 3 of a
Benefit Enrollment
and Maintenance X12 834 Transaction
Example 4 of a
Benefit Enrollment
and Maintenance X12 834 Transaction
Example 5 of a
Benefit Enrollment
and Maintenance X12 834 Transaction
Example 6 of a
Benefit Enrollment
and Maintenance X12 834 Transaction
Example 7 of a
Benefit Enrollment
and Maintenance X12 834 Transaction
Example 8 of a
Benefit Enrollment
and Maintenance X12 834 Transaction
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Example 1 : 837I with mult ISA
Example 2 : 837I with LIN and CTP
Example 3 : 835 Remittance Advice With multiple ST batches
Example 4 : 835 Remittance Advice with the first Set with having summary data and the second set having detail data
Example 5 : 835 Remittance Advice with a Provider Adjustment Summary Record (PLB)
Example 6 : 837p with multiple Insurance Carriers
Example 7 : A more complex 837I.
Example 8 : 835 Remittance Advice with a more complex Provider Adjustment Summary Record (PLB)
Example 9 : 837P for Workers Compensation
Example 10 : 837P for Testing the CMS-1500 with the X12 Parser
Example 11 : 835 Remittance Advice with multiple Provider Adjustment Summary Records (PLB)
Example 12 :835 Remittance for Testing the X12 Database Parser
Example 13 : 837I with DRG
Example 14 : 835 Remittance Advice for 3 Claims with 5 Service Lines Each
Example 15 : 835 Remittance Advice for Testing Filter Option on FACILITYTYPECODE Field
Example 16 : 835 Remittance Advice with DRG and Adjusts
Example 17 : 835 Remittance Advice with a Mix of Inpatient and Outpatient and Adjustments
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Large X12 files.
Large x12 files for testing.
http://com1software.com/examples/largex12.zip
Baseline Test Examples
X12 837I
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