Healthcare IT EMR PMS: EDI 835 Health Care Claim Payment/Advice

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If you are new to Medical Billing, then please read this article first.
If you are new to EDI, then read the following articles

1. What is an EDI ?
2. EDI Transactions
3. Understanding EDI Structure
4. EDI Instruction

EDI 835 Health Care Claim Payment/Advice

The 835 is used primarily by Healthcare insurance plans to make payments to healthcare providers, to provide Explanations of Benefits (EOBs), or both. When a healthcare service provider submits an 837 Health Care Claim, the insurance plan uses the 835 to detail the payment to that claim, including:

What charges were paid, reduced or denied
Whether there was a deductible, co-insurance, co-pay, etc.
Any bundling or splitting of claims or line items
How the payment was made, such as through a clearinghouse

A particular 835 document may not necessarily match up one-for-one with a specific 837. In fact, it is not uncommon for multiple 835 transactions to be used in response to a single 837, or for one 835 to address multiple 837 submissions. As a result, the 835 is important to healthcare providers, to track what payments were received for services they provided and billed. And also one EDI 835 File, may contain multiple Checks i.e Multiple EOBs

Before going into detail, Let us understand how insurance Payer make the Payment. Please understand and have good understanding on the following topics.

1. What is Copay, Co Insurance and Deductible in Insurance Payment Posting ?
2. EOB – Explanation of Benefits

The following EDI Parser for 835 Developed by me using java Spring Boot . Please contact me for source code .

The following video demo explain how to make restful web service api for the service.

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To Demonstrate the various use cases of EDI 835, I've developed an internal Web application tool to test my own API. Here are some use cases.
Example 1: One Claim with Co-pay Amount