Supported EDI File Types

EDI Paisan supports the core healthcare EDI transaction types you work with every day. Each file type has purpose-built features that go beyond basic viewing — from claim splitting to eligibility summaries.

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Quick Reference

Transaction	Code	Direction	Purpose
Professional Claims	837P	Provider → Payer	Submit claims for services rendered
Remittance Advice	835	Payer → Provider	Explain payments and adjustments
Eligibility Inquiry	270	Provider → Payer	Check patient coverage
Eligibility Response	271	Payer → Provider	Return coverage details

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837P — Professional Claims

The 837P (Professional) transaction is how providers submit claims to payers for reimbursement. Every time a physician, lab, or ambulatory provider bills for services, they're generating an 837P file.

What's Inside an 837P

An 837P contains all the information needed to process a claim:

• Billing provider — Who's submitting the claim (NPI, tax ID, contact info)
• Subscriber — The person with insurance coverage
• Patient — The person who received services (may differ from subscriber)
• Payer — The insurance company
• Claim details — Date of service, diagnosis codes, total charge
• Service lines — Individual procedures with CPT/HCPCS codes

What EDI Paisan Does with 837P Files

Feature	Description	Tier
Tree Navigation	Navigate claims hierarchically (Provider → Subscriber → Patient → Claim → Service Line)	Free
Claim Summary	View total charges, claim counts, and financial totals	Free
Segment Details	Click any segment to see human-readable element descriptions	Free
Search	Find specific claims, patient names, or codes	Free
Split by Claim	Extract individual claims into separate files	Pro
Split by Subscriber	Group all claims for one subscriber	Pro
Split by Rendering Provider	Separate claims by the provider who performed services	Pro
Split into Parts	Divide large files evenly (e.g., into 4 equal pieces)	Pro
PHI Anonymization	Mask patient names, addresses, DOBs, and IDs for testing	Pro

837P Hierarchy Structure

EDI Paisan understands the natural hierarchy of an 837P file:

Interchange (ISA...IEA)
└── Functional Group (GS...GE)
    └── Transaction (ST...SE)
        └── Billing Provider (HL*20)
            └── Subscriber (HL*22)
                └── Patient (HL*23) — if different from subscriber
                    └── Claim (CLM)
                        └── Service Lines (LX, SV1)

When you split by claim, EDI Paisan preserves all the header information (billing provider, subscriber) so each output file is a valid, submittable 837P.

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835 — Remittance Advice

The 835 (Remittance Advice) is the payer's explanation of what they paid, what they didn't, and why. It's the electronic version of the Explanation of Benefits (EOB).

What's Inside an 835

An 835 tells you exactly what happened to each claim:

• Payer — Who's sending the payment
• Payee — Who's receiving the payment (provider)
• Check/EFT details — Payment amount, check number, trace ID
• Claim payments — Each claim with billed, allowed, and paid amounts
• Adjustments — Why amounts differ (CARC/RARC codes)
• Service line details — Payment breakdown by procedure

What EDI Paisan Does with 835 Files

Feature	Description	Tier
Payment Summary	Total payments, denials, and adjustment amounts	Free
Claim Status	See which claims were paid, denied, or adjusted	Free
Adjustment Codes	Human-readable CARC/RARC code descriptions	Free
Split by Check	Separate files by payment/check number	Pro
Split by Payment	Extract individual claim payments (CLP level)	Pro
Group by Payer	Combine all payments from the same payer	Pro
Group by Provider	Combine all payments to the same payee	Pro
Payment Export	Extract payment details for reconciliation	Pro

Understanding 835 Adjustments

Every 835 payment includes adjustment codes that explain discrepancies:

• CARC (Claim Adjustment Reason Codes) — Why the payer adjusted the amount
• RARC (Remittance Advice Remark Codes) — Additional explanation

EDI Paisan translates these codes into readable descriptions. When you see CAS*CO*45*25.00, you'll know it means:

Contractual Obligation (CO): Charge exceeds fee schedule/maximum allowable ($25.00)

835 Financial Summary

For each 835 file, EDI Paisan calculates:

• Total billed amount
• Total paid amount
• Total adjustment amount
• Number of payments
• Number of denials

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270 — Eligibility Inquiry

The 270 (Eligibility Inquiry) is a request sent to a payer to verify a patient's insurance coverage. Providers send 270s before services to confirm coverage, benefits, and cost-sharing.

What's Inside a 270

A 270 eligibility inquiry contains:

• Information Source — The provider making the request
• Information Receiver — The payer being queried
• Subscriber — The primary insurance holder
• Dependent — Additional covered family members (if applicable)
• Inquiry details — What services/coverage to check

What EDI Paisan Does with 270 Files

Feature	Description	Tier
Inquiry Summary	Count of members and service types requested	Free
Hierarchy View	Navigate Source → Receiver → Subscriber → Dependent structure	Free
Service Type Lookup	Human-readable service type descriptions	Free
Coverage Level Display	Individual vs. Family coverage indicators	Free

270 Hierarchy Structure

Interchange (ISA...IEA)
└── Functional Group (GS...GE)
    └── Transaction (ST...SE)
        └── Information Source (HL*20) — Provider
            └── Information Receiver (HL*21) — Payer
                └── Subscriber (HL*22)
                    └── Dependent (HL*23)
                        └── Inquiries (EQ segments)

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271 — Eligibility Response

The 271 (Eligibility Response) is the payer's answer to a 270 inquiry. It contains detailed information about the patient's coverage, benefits, and cost-sharing responsibilities.

What's Inside a 271

A 271 response provides comprehensive benefit information:

• Eligibility status — Active, inactive, or terminated coverage
• Plan details — Plan name, group number, policy number
• Coverage dates — Effective and termination dates
• Benefits — What's covered, what's not
• Cost sharing — Copays, deductibles, coinsurance, out-of-pocket max
• Rejections — Errors if the inquiry couldn't be processed

What EDI Paisan Does with 271 Files

Feature	Description	Tier
Eligibility Summary	At-a-glance active/inactive status	Free
Member Details	Name, ID, DOB, gender for each member	Free
Benefit Breakdown	Deductibles, copays, coinsurance by service type	Free
Coverage Dates	Plan effective and termination dates	Free
Rejection Details	AAA segment descriptions when inquiries fail	Free
Service Type Coverage	Which services are covered vs. excluded	Free

271 Benefit Information

EDI Paisan extracts and displays benefit details including:

Benefit Type	What It Tells You
Active Coverage	Patient has valid insurance
Deductible	Amount patient pays before insurance kicks in
Copayment	Fixed amount per visit/service
Coinsurance	Percentage patient pays after deductible
Out-of-Pocket Max	Maximum patient pays annually
Coverage Limit	Maximum visits/amounts covered

For each benefit, EDI Paisan shows whether it applies to individual or family coverage, which service types it covers, and any remaining amounts.

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What EDI Paisan Doesn't Support (Yet)

Currently, EDI Paisan focuses on the core healthcare claim and eligibility transactions. The following are not yet supported:

Transaction	Code	Purpose	Status
Institutional Claims	837I	Hospital/facility claims	Planned
Claim Status Inquiry	276	Check claim processing status	Planned
Claim Status Response	277	Claim status details	Planned
Functional Acknowledgment	999	Confirm file receipt	Under consideration
Implementation Acknowledgment	TA1	ISA-level acknowledgment	Under consideration

We're actively expanding support based on user feedback. Let us know what you need most.

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Technical Details

Version Support

EDI Paisan supports the HIPAA-mandated X12 versions:

Version	Status
5010 (005010X222A1, etc.)	✅ Full support
4010	✅ Basic viewing

File Size Limits

Tier	Maximum File Size
Free	5 MB
Pro	50 MB
Enterprise	Unlimited

Large files? Split mode can handle files that exceed your browser's memory limits by processing segments incrementally.

Encoding

EDI Paisan supports standard EDI encoding with automatic delimiter detection:

• Element separator: Usually *
• Segment terminator: Usually ~
• Component separator: Usually :
• Repetition separator: Usually ^

If your file uses non-standard delimiters, EDI Paisan will detect them automatically from the ISA segment.

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Next Steps

• Upload Your First File — See these features in action
• Claim Splitting Guide — Learn to break files apart
• Eligibility Summaries — Get more from 270/271 files
• File Type Reference — Deep-dive into each transaction type