4_PayerCity_State_ZIPCode.AdditionalPatientInformationContactCityName_01 = 'WEST PALM BCH' 4_PayerCity_State_ZIPCode = new N4_AdditionalPatientInformationContactCity() 3_PayerAddress.ResponseContactAddressLine_01 = '481A00 DEER RUN ROAD' 3_PayerAddress = new N3_AdditionalPatientInformationContactAddress() 1_PayerIdentification.PremiumPayerName_02 = 'YOUR TAX DOLLARS AT WORK'

1_PayerIdentification.EntityIdentifierCode_01 = 'PR' 1_PayerIdentification = new N1_PayerIdentification() Result.DTM_ProductionDate.DateTimeQualifier_01 = '405' Result.DTM_ProductionDate = new DTM_ProductionDate() _ReceiverIdentification.MemberGrouporPolicyNumber_02 = '030240928' _ReceiverIdentification.ReferenceIdentificationQualifier_01 = 'EV' _ReceiverIdentification = new REF_ReceiverIdentification() Occurrence of REF Segments in any order Result.TRN_ReassociationTraceNumber.OriginatingCompanyIdentifier_03 = '1566339911' Result.TRN_ReassociationTraceNumber.CurrentTransactionTraceNumber_02 = '0063158ABC' Result.TRN_ReassociationTraceNumber.TraceTypeCode_01 = '1' Result.TRN_ReassociationTraceNumber = new TRN_DependentTraceNumber() Result.BPR_FinancialInformation.CheckIssueorEFTEffectiveDate_16 = '20050318'

Result.BPR_FinancialInformation.PaymentMethodCode_04 = 'CHK' Result.BPR_FinancialInformation.CreditorDebitFlagCode_03 = 'C' Result.BPR_FinancialInformation.TotalPremiumPaymentAmount_02 = '34.00' Result.BPR_FinancialInformation.TransactionHandlingCode_01 = 'I'

Result.BPR_FinancialInformation = new BPR_FinancialInformation_2() Result.ST.TransactionSetControlNumber_02 = controlNumber.PadLeft(9, '0') Result.ST.TransactionSetIdentifierCode_01 = '835' The secondary payer paid $34.00.The impact of the primary payer's payment on the secondary payer is $516.00 ($141.00 contractual adjustment and $375.00 payment). YTDAW as the secondary payer allowed $550.00 for the service submitted. The patient, Raymond Burck owed a co-pay of $25.00. The primary payer applied $141.00 as a contractual adjustment that was part of the provider's fee schedule. They allowed $400 and paid $375.00 of the submitted charges.

In this claim, the primary payer received a claim for $541.00. Static TS835 BuildPayment(string controlNumber) Writer.Write(SegmentBuilders.BuildIsa('1')) Using (var writer = new X12Writer(stream)) Using (var ediReader = new X12Reader(ediStream, ''))ĮdiItems = ediReader.ReadToEnd().ToList() įoreach (var transaction in transactions) Var ediStream = File.OpenRead(Directory.GetCurrentDirectory() + ediItems How to parse & generate X12 HIPAA 835 with EDI Tools for. The Parse & Generate HIPAA 835 code is also available on GitHub The example below is part of the EDI Tools for. X12 HIPAA 835 specification is available at:

835 file converter