File Type Reference

This section provides in-depth technical information about each EDI transaction type supported by EDI Paisan. Use these pages when you need to understand the structure, segments, and data elements within specific file types.

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Supported Transaction Types

Transaction	Page	Key Segments
837P Professional Claims	837P Reference	CLM, SV1, NM1, HL
835 Remittance Advice	835 Reference	CLP, SVC, CAS, TRN
270 Eligibility Inquiry	270 Reference	EQ, NM1, HL, TRN
271 Eligibility Response	271 Reference	EB, AAA, NM1, DTP

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Understanding EDI Structure

All healthcare EDI files follow a nested envelope structure:

ISA...IEA  (Interchange — outermost wrapper)
  GS...GE  (Functional Group — groups related transactions)
    ST...SE  (Transaction Set — individual document)
      HL...  (Hierarchical Loops — organize content by relationships)
        ...  (Detail Segments — actual data)

Envelope Segments

Segment	Purpose	Contains
ISA/IEA	Interchange envelope	Sender/receiver IDs, date/time, control number
GS/GE	Functional group	Transaction type (HC=claims), version
ST/SE	Transaction set	Document content, segment count

Hierarchical Levels (HL)

Many healthcare transactions use HL segments to organize data by relationships:

HL Level	837P	835	270/271
20	Billing Provider	—	Information Source
21	—	—	Information Receiver
22	Subscriber	—	Subscriber
23	Dependent/Patient	—	Dependent

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Common Segments Across File Types

NM1 — Name Segment

Identifies people and organizations:

NM1*IL*1*SMITH*JOHN****MI*ABC123456~

Element	Position	Description
Entity ID	01	IL=Insured, PR=Payer, 85=Billing Provider
Entity Type	02	1=Person, 2=Organization
Last Name	03	Last name or organization name
First Name	04	First name (persons only)
ID Qualifier	08	MI=Member ID, XX=NPI, FI=Tax ID
ID	09	The actual identifier

REF — Reference Segment

Contains identifiers and reference numbers:

REF*EI*123456789~

Qualifier	Meaning
EI	Employer ID (Tax ID)
SY	Social Security Number
6P	Group Number
IG	Insurance Policy Number

DTP — Date/Time Segment

Contains dates and times:

DTP*472*D8*20240115~

Qualifier	Meaning
472	Service Date
232	Claim Statement From Date
233	Claim Statement To Date
291	Plan Begin Date
292	Plan End Date

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Reading This Reference

Each file type page includes:

1. Purpose — What the transaction is used for
2. Loop Structure — How data is organized
3. Key Segments — Important segments with element breakdowns
4. EDI Paisan Features — What you can do with this file type
5. Common Issues — Troubleshooting tips

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Need More?

• Segment Reference — All segment types explained
• Qualifier Codes — Code value lookups
• Loop Hierarchy — Visual loop structures