EDI 835 X221A1 - Health Care Claim Payment/Advice

Functional Group HP

X12N Insurance Subcommittee

This X12 Transaction Set contains the format and establishes the data contents of the Health Care Claim Payment/Advice Transaction Set (835) for use within the context of the Electronic Data Interchange (EDI) environment. This transaction set can be used to make a payment, send an Explanation of Benefits (EOB) remittance advice, or make a payment and send an EOB remittance advice only from a health insurer to a health care provider either directly or via a financial institution.

What is an EDI 835?

An EDI 835 Health Care Claim Payment/Advice communicates healthcare claim payment information, sent from insurance providers to healthcare agencies. It contains information about what charges have been paid, reduced or denied, deductible, co-insurance or co-pay amounts, bundling/splitting of claims, and how the payment was made (CLP segment). It must be 005010 HIPAA compliant.

How is an EDI 835 used?

For example, when Person A receives an x-ray, Hospital B will issue an EDI 837 Healthcare Claim to Medical Insurance Provider C. Insurance Provider C will respond to the EDI 837 Healthcare Claim an EDI 835 Health Care Claim Payment/Advice to provide payment or further details.

Heading

1. 0100 · ST · Transaction Set Header · Max 1 · Mandatory

   To indicate the start of a transaction set and to assign a control number

2. 0200 · BPR · Financial Information · Max 1 · Mandatory

   To indicate the beginning of a Payment Order/Remittance Advice Transaction Set and total payment amount, or to enable related transfer of funds and/or information from payer to payee to occur

   Use the BPR to address a single payment to a single payee. A payee may represent a single provider, a provider group, or multiple providers in a chain. The BPR contains mandatory information, even when it is not being used to move funds electronically.

3. 0400 · TRN · Reassociation Trace Number · Max 1 · Mandatory

   To uniquely identify a transaction to an application

   This segment's purpose is to uniquely identify this transaction set and to aid in reassociating payments and remittances that have been separated.

4. 0500 · CUR · Foreign Currency Information · Max 1 · Optional

   To specify the currency (dollars, pounds, francs, etc.) used in a transaction

   When the CUR segment is not present, the currency of payment is defined as US dollars.
   Required when the payment is not being made in US dollars. If not required by this implementation guide, do not send.

5. 0600 · REF · Receiver Identification · Max 1 · Optional

   To specify identifying information

   This is the business identification information for the transaction receiver. This may be different than the EDI address or identifier of the receiver. This is the initial receiver of the transaction. This information must not be updated if the transaction is routed through multiple intermediaries, such as clearinghouses, before reaching the payee.
   Required when the receiver of the transaction is other than the payee (e.g., a clearinghouse or billing service). If not required by this implementation guide, may be provided at sender's discretion, but cannot be required by the receiver.

6. 0600 · REF · Version Identification · Max 1 · Optional

   To specify identifying information

   Update this reference number whenever a change in the version or release number affects the 835. (This is not the ANSI ASCX12 version number as reported in the GS segment.)
   Required when necessary to report the version number of the adjudication system that generated the claim payments in order for the payer to resolve customer service questions from the payee. If not required by this implementation guide, do not send.

7. 0700 · DTM · Production Date · Max 1 · Optional

   To specify pertinent dates and times

   If your adjudication cycle completed on Thursday and your 835 is produced on Saturday, you are required to populate this segment with Thursday's date.
   Required when the cut off date of the adjudication system remittance run is different from the date of the 835 as identified in the related GS04 element. If not required by this implementation guide, may be provided at the sender's discretion, but cannot be required by the receiver.

8. 1000A Loop Mandatory Repeat 1

   1. 0800 · N1 · Payer Identification · Max 1 · Mandatory

      To identify a party by type of organization, name, and code

      Use this N1 loop to provide the name/address information for the payer.
      The payer's secondary identifying reference number is provided in N104, if necessary.

   2. 1000 · N3 · Payer Address · Max 1 · Mandatory

      To specify the location of the named party

   3. 1100 · N4 · Payer City, State, ZIP Code · Max 1 · Mandatory

      To specify the geographic place of the named party

   4. 1200 · REF · Additional Payer Identification · Max 4 · Optional

      To specify identifying information

      The ID available in the TRN and N1 segments must be used before using the REF segment.
      Required when additional payer identification numbers beyond those in the TRN and Payer N1 segments are needed. If not required by this implementation guide, may be sent at sender's discretion, but cannot be required by the receiver.

   5. 1300 · PER · Payer Business Contact Information · Max 1 · Optional

      To identify a person or office to whom administrative communications should be directed

      When the communication number represents a telephone number in the United States and other countries using the North American Dialing Plan (for voice, data, fax, etc.), the communication number always includes the area code and phone number using the format AAABBBCCCC. Where AAA is the area code, BBB is the telephone number prefix, and CCCC is the telephone number (e.g. (800) 555-1212 would be represented as 8005551212). The extension number, when applicable, is identified in the next element pair (Communications Number Qualifier and Communication Number) immediately after the telephone number.
      Required when there is a business contact area that would apply to this remittance and all the claims. If not required by this implementation guide, do not send.

   6. 1300 · PER · Payer Technical Contact Information · Max >1 · Mandatory

      To identify a person or office to whom administrative communications should be directed

      Required to report technical contact information for this remittance advice.

   7. 1300 · PER · Payer WEB Site · Max 1 · Optional

      To identify a person or office to whom administrative communications should be directed

      Required when any 2110 loop Healthcare Policy REF Segment is used. If not required by this implementation guide, do not send.
      This is a direct link to the policy location of the un-secure website.

9. 1000B Loop Mandatory Repeat 1

   1. 0800 · N1 · Payee Identification · Max 1 · Mandatory

      To identify a party by type of organization, name, and code

      Use this N1 loop to provide the name/address information of the payee. The identifying reference number is provided in N104.

   2. 1000 · N3 · Payee Address · Max 1 · Optional

      To specify the location of the named party

      Required when the sender needs to communicate the payee address to a transaction receiver, e.g., a VAN or a clearinghouse. If not required by this implementation guide, may be provided at the sender's discretion, but cannot be required by the receiver.

   3. 1100 · N4 · Payee City, State, ZIP Code · Max 1 · Optional

      To specify the geographic place of the named party

      Required when the sender needs to communicate the payee address to a transaction receiver, e.g., a VAN or a clearinghouse. If not required by this implementation guide, may be provided at the sender's discretion, but cannot be required by the receiver.

   4. 1200 · REF · Payee Additional Identification · Max >1 · Optional

      To specify identifying information

      Required when identification of the payee is dependent upon an identification number beyond that supplied in the N1 segment. If not required by this implementation guide, may be provided at the sender's discretion, but cannot be required by the receiver.

   5. 1400 · RDM · Remittance Delivery Method · Max 1 · Optional

      To identify remittance delivery when remittance is separate from payment

      Required when BPR01 = U or X; and the remittance is to be sent separately from the payment. The payer is responsible to provide the bank with the instructions on how to deliver the remittance information, if not required by this implementation guide, do not send.
      Payer should coordinate this process with their Originating Depository Financial Institution (ODFI).

Detail

1. 2000 Loop Optional Repeat >1

   1. 0030 · LX · Header Number · Max 1 · Mandatory

      To reference a line number in a transaction set

      Required when claim/service information is being provided in the transaction. If not required by this implementation guide, do not send.
      The purpose of LX01 is to provide an identification of a particular grouping of claims for sorting purposes.
      In the event that claim/service information must be sorted, the LX segment must precede each series of claim level and service level segments. This number is intended to be unique within each transaction.

   2. 0050 · TS3 · Provider Summary Information · Max 1 · Optional

      To supply provider-level control information

      TS301 identifies the subsidiary provider.
      The remaining mandatory elements (TS302 through TS305) must be valid with appropriate data, as defined by the TS3 segment.
      Only Medicare Part A uses data elements TS313, TS315, TS317, TS318 and TS320 through TS324. Each monetary amount element is for that provider for this facility type code for loop 2000.
      Required for Medicare Part A or when payers and payees outside the Medicare Part A community need to identify provider subsidiaries whose remittance information is contained in the 835 transactions transmitted to a single provider entity [i.e., the corporate office of a hospital chain]. If not required by this implementation guide, do not send.

   3. 0070 · TS2 · Provider Supplemental Summary Information · Max 1 · Optional

      To provide supplemental summary control information by provider fiscal year and bill type

      This segment provides summary information specific to an iteration of the LX loop (Table 2).
      Each element represents the total value for the provider/bill type combination in this loop 2000 iteration.
      Required for Medicare Part A. If not required by this implementation guide, do not send.

   4. 2100 Loop Mandatory Repeat >1

      1. 0100 · CLP · Claim Payment Information · Max 1 · Mandatory

         To supply information common to all services of a claim

         For CLP segment occurrence limitations, see section 1.3.2, Other Usage Limitations.

      2. 0200 · CAS · Claim Adjustment · Max 99 · Optional

         To supply adjustment reason codes and amounts as needed for an entire claim or for a particular service within the claim being paid

         Payers must use this CAS segment to report claim level adjustments that cause the amount paid to differ from the amount originally charged. See 1.10.2.1, Balancing, and 1.10.2.4, Claim Adjustment and Service Adjustment Segment Theory, for additional information.
         See the SVC TR3 Note #1 for details about per diem adjustments.
         A single CAS segment contains six repetitions of the "adjustment trio" composed of adjustment reason code, adjustment amount, and adjustment quantity. These six adjustment trios are used to report up to six adjustments related to a specific Claim Adjustment Group Code (CAS01). The six iterations (trios) of the Adjustment Reason Code related to the Specific Adjustment Group Code must be exhausted before repeating a second iteration of the CAS segment using the same Adjustment Group Code. The first adjustment must be the first non-zero adjustment and is reported in the first adjustment trio (CAS02-CAS04). If there is a second non-zero adjustment, it is reported in the second adjustment trio (CAS05-CAS07), and so on through the sixth adjustment trio (CAS17-CAS19).
         Required when dollar amounts and/or quantities are being adjusted at the claim level. If not required by this implementation guide, do not send.

      3. 0300 · NM1 · Patient Name · Max 1 · Mandatory

         To supply the full name of an individual or organizational entity

         Provide the patient's identification number in NM109.
         This segment must provide the information from the original claim. For example, when the claim is submitted as an ASC X12 837 transaction, this is the 2010CA loop NM1 Patient Name Segment unless not present on the original claim, then it is the 2010BA loop NM1 Subscriber name segment.
         The Corrected Patient/Insured Name NM1 segment identifies the adjudicated Insured Name and ID information if different than what was submitted on the claim.

      4. 0300 · NM1 · Insured Name · Max 1 · Optional

         To supply the full name of an individual or organizational entity

         In the case of Medicare and Medicaid, the insured patient is always the subscriber and this segment is not used.
         Required when the original claim reported the insured or subscriber (for example 837 2010BA loop Subscriber Name NM1 Segment) that is different from the patient. If not required by this implementation guide, do not send.
         This segment contains the same information as reported on the claim (for example 837 2010BA loop Subscriber Name NM1 Segment when the patient was reported in the 2010CA loop Patient Name NM1 Segment).

      5. 0300 · NM1 · Corrected Patient/Insured Name · Max 1 · Optional

         To supply the full name of an individual or organizational entity

         Since the patient is always the insured for Medicare and Medicaid, this segment always provides corrected patient information for Medicare and Medicaid. For other carriers, this will always be the corrected insured information.
         Required when needed to provide corrected information about the patient or insured. If not required by this implementation guide, do not send.

      6. 0300 · NM1 · Service Provider Name · Max 1 · Optional

         To supply the full name of an individual or organizational entity

         This segment provides information about the rendering provider. An identification number is provided in NM109.
         This information is provided to facilitate identification of the claim within a payee's system. Other providers (e.g., Referring provider, supervising provider) related to the claim but not directly related to the payment are not supported and are not necessary for claim identification.
         Required when the rendering provider is different from the payee. If not required by this implementation guide, do not send.

      7. 0300 · NM1 · Crossover Carrier Name · Max 1 · Optional

         To supply the full name of an individual or organizational entity

         This segment provides information about the crossover carrier. Provide any reference numbers in NM109. The crossover carrier is defined as any payer to which the claim is transferred for further payment after being finalized by the current payer.
         Required when the claim is transferred to another carrier or coverage (CLP02 equals 19, 20, 21 or 23). If not required by this implementation guide, do not send.

      8. 0300 · NM1 · Corrected Priority Payer Name · Max 1 · Optional

         To supply the full name of an individual or organizational entity

         Provide any reference numbers in NM109. Use of this segment identifies the priority payer. Do not use this segment when the Crossover Carrier NM1 segment is used.
         Required when current payer believes that another payer has priority for making a payment and the claim is not being automatically transferred to that payer. If not required by this implementation guide, do not send.

      9. 0300 · NM1 · Other Subscriber Name · Max 1 · Optional

         To supply the full name of an individual or organizational entity

         This is the name and ID number of the other subscriber when a corrected priority payer has been identified. When used, either the name or ID must be supplied.
         Required when a corrected priority payer has been identified in another NM1 segment AND the name or ID of the other subscriber is known. If not required by this implementation guide, do not send.

      10. 0330 · MIA · Inpatient Adjudication Information · Max 1 · Optional

          To provide claim-level data related to the adjudication of Medicare inpatient claims

          When used outside of the Medicare and Medicaid community only MIA01, 05, 20, 21, 22 and 23 may be used.
          Either MIA or MOA may appear, but not both.
          This segment must not be used for covered days or lifetime reserve days. For covered or lifetime reserve days, use the Supplemental Claim Information Quantities Segment in the Claim Payment Loop.
          All situational quantities and/or monetary amounts in this segment are required when the value of the item is different than zero.
          Required for all inpatient claims when there is a need to report Remittance Advice Remark Codes at the claim level or, the claim is paid by Medicare or Medicaid under the Prospective Payment System (PPS). If not required by this implementation guide, do not send.

      11. 0350 · MOA · Outpatient Adjudication Information · Max 1 · Optional

          To convey claim-level data related to the adjudication of Medicare claims not related to an inpatient setting

          Required for outpatient/professional claims where there is a need to report a Remittance Advice Remark Code at the claim level or when the payer is Medicare or Medicaid and MOA01, 02, 08 or 09 are non-zero. If not required by this implementation guide, do not send.
          Either MIA or MOA may appear, but not both.
          All situational quantities and/or monetary amounts in this segment are;required when the value of the item is different than zero.

      12. 0400 · REF · Other Claim Related Identification · Max 5 · Optional

          To specify identifying information

          Required when additional reference numbers specific to the claim in the CLP segment are provided to identify information used in the process of adjudicating this claim. If not required by this implementation guide, do not send.

      13. 0400 · REF · Rendering Provider Identification · Max 10 · Optional

          To specify identifying information

          The NM1 segment always contains the primary reference number.
          Required when additional rendering provider identification numbers not already reported in the Provider NM1 segment for this claim were submitted on the original claim and impacted adjudication. If not required by this implementation guide, do not send.

      14. 0500 · DTM · Statement From or To Date · Max 2 · Optional

          To specify pertinent dates and times

          Dates at the claim level apply to the entire claim, including all service lines. Dates at the service line level apply only to the service line where they appear.
          When claim dates are not provided, service dates are required for every service line.
          When claim dates are provided, service dates are not required, but if used they override the claim dates for individual service lines.
          For retail pharmacy claims, the Claim Statement Period Start Date is equivalent to the prescription filled date.
          Required when the "Statement From or To Dates" are not supplied at the service (2110 loop) level. If not required by this implementation guide, may be provided at senders discretion, but cannot be required by the receiver.
          For predeterminations, where there is no service date, the value of DTM02 must be 19000101. Use only when the CLP02 value is 25 - Predetermination Pricing Only - No Payment.
          When payment is being made in advance of services, the use of future dates is allowed.

      15. 0500 · DTM · Coverage Expiration Date · Max 1 · Optional

          To specify pertinent dates and times

          Required when payment is denied because of the expiration of coverage. If not required by this implementation guide, do not send.

      16. 0500 · DTM · Claim Received Date · Max 1 · Optional

          To specify pertinent dates and times

          Required whenever state or federal regulations or the provider contract mandate interest payment or prompt payment discounts based upon the receipt date of the claim by the payer. If not required by this implementation guide, may be provided at sender's discretion, but cannot be required by the receiver.

      17. 0600 · PER · Claim Contact Information · Max 2 · Optional

          To identify a person or office to whom administrative communications should be directed

          Required when there is a claim specific communications contact. If not required by this implementation guide, do not send.
          When the communication number represents a telephone number in the United States and other countries using the North American Dialing Plan (for voice, data, fax, etc.), the communication number always includes the area code and phone number using the format AAABBBCCCC. Where AAA is the area code, BBB is the telephone number prefix, and CCCC is the telephone number (e.g. (800)555-1212 would be represented as 8005551212). The extension number, when applicable, is identified in the next element pair (Communications Number Qualifier and Communication Number) immediately after the telephone number.

      18. 0620 · AMT · Claim Supplemental Information · Max 13 · Optional

          To indicate the total monetary amount

          Use this segment to convey information only. It is not part of the financial balancing of the 835.
          Send/receive one AMT for each applicable non-zero value. Do not report any zero values.
          Required when the value of any specific amount identified by the AMT01 qualifier is non-zero. If not required by this implementation guide, do not send.

      19. 0640 · QTY · Claim Supplemental Information Quantity · Max 14 · Optional

          To specify quantity information

          Use this segment to convey information only. It is not part of the financial balancing of the 835.
          Send one QTY for each non-zero value. Do not report any zero values.
          Required when the value of a specific quantity identified by the QTY01 qualifier is non-zero. If not required by this implementation guide, do not send.

      20. 2110 Loop Optional Repeat 999

          1. 0700 · SVC · Service Payment Information · Max 1 · Mandatory

             To supply payment and control information to a provider for a particular service

             See section 1.10.2.1.1 (Service Line Balancing) for additional information.
             The exception to the situational rule occurs with institutional claims when the room per diem is the only service line adjustment. In this instance, a claim level CAS adjustment to the per diem is appropriate (i.e., CAS*CO*78*25~). See section 1.10.2.4.1 for additional information.
             See 1.10.2.6, Procedure Code Bundling and Unbundling, and section 1.10.2.1.1, Service Line Balancing, for important SVC segment usage information.
             Required for all service lines in a professional, dental or outpatient claim priced at the service line level or whenever payment for any service line of the claim is different than the original submitted charges due to service line specific adjustments (excluding cases where the only service specific adjustment is for room per diem). If not required by this implementation guide, do not send.

          2. 0800 · DTM · Service Date · Max 2 · Optional

             To specify pertinent dates and times

             Dates at the service line level apply only to the service line where they appear.
             If used for inpatient claims and no service date was provided on the claim then report the through date from the claim level.
             When claim dates are not provided, service dates are required for every service line.
             When claim dates are provided, service dates are not required, but if used they override the claim dates for individual service lines.
             Required when claim level Statement From or Through Dates are not supplied or the service dates are not the same as reported at the claim level. If not required by this implementation guide, may be provided at sender's discretion, but cannot be required by the receiver.
             For retail pharmacy claims, the service date is equivalent to the prescription filled date.
             For predeterminations, where there is no service date, the value of DTM02 must be 19000101. Use only when the CLP02 value is 25 - Predetermination Pricing Only - No Payment.
             When payment is being made in advance of services, the use of future dates is allowed.

          3. 0900 · CAS · Service Adjustment · Max 99 · Optional

             To supply adjustment reason codes and amounts as needed for an entire claim or for a particular service within the claim being paid

             An example of this level of CAS is the reduction for the part of the service charge that exceeds the usual and customary charge for the service. See sections 1.10.2.1, Balancing, and 1.10.2.4, Claim Adjustment and Service Adjustment Segment Theory, for additional information.
             Required when dollar amounts are being adjusted specific to the service or when the paid amount for a service line (SVC03) is different than the original submitted charge amount for the service (SVC02). If not required by this implementation guide, do not send.
             A single CAS segment contains six repetitions of the "adjustment trio" composed of adjustment reason code, adjustment amount, and adjustment quantity. These six adjustment trios are used to report up to six adjustments related to a specific Claim Adjustment Group Code (CAS01). The six iterations (trios) of the Adjustment Reason Code related to the Specific Adjustment Group Code must be exhausted before repeating a second iteration of the CAS segment using the same Adjustment Group Code. The first adjustment is reported in the first adjustment trio (CAS02-CAS04). If there is a second non-zero adjustment, it is reported in the second adjustment trio (CAS05-CAS07), and so on through the sixth adjustment trio (CAS17-CAS19).

          4. 1000 · REF · Service Identification · Max 8 · Optional

             To specify identifying information

             Required when related service specific reference identifiers were used in the process of adjudicating this service. If not required by this implementation guide, do not send.

          5. 1000 · REF · Line Item Control Number · Max 1 · Optional

             To specify identifying information

             This is the Line Item Control Number submitted in the 837, which is utilized by the provider for tracking purposes. See section 1.10.2.11 and 1.10.2.14.1 for additional information on usage with split claims or services. Note - the value in REF02 can include alpha characters.
             Required when a Line Item Control Number was received on the original claim or when claim or service line splitting has occurred. If not required by this implementation guide, do not send.

          6. 1000 · REF · Rendering Provider Information · Max 10 · Optional

             To specify identifying information

             Required when the rendering provider for this service is different than the rendering provider applicable at the claim level. If not required by this implementation guide, do not send.

          7. 1000 · REF · HealthCare Policy Identification · Max 5 · Optional

             To specify identifying information

             Required when; - The payment is adjusted in accordance with the Payer's published Healthcare Policy Code list and - A Claim Adjustment Reason Code identified by the notation, "refer to 835 Healthcare Policy identification segment", in the Claim Adjustment Reason Code List is present in a related CAS segment and - The payer has a published enumerated healthcare policy code list available to healthcare providers via an un-secure public website and - The payer wishes to supply this policy detail to reduce provider inquiries. If not required by this implementation guide, may be provided at the sender's discretion, but cannot be required by the receiver.
             Healthcare Policy - A clinical/statutory rule use to determine claim adjudication that cannot be explained by the sole use of a claim adjustment reason code in the CAS segment and Remittance Advise Remark code when appropriate.
             The term Healthcare Policy is intended to include Medical Review Policy, Dental Policy Review, Property and Casualty Policies, Workers Comp Policies and Pharmacy Policies for example Medicare LMRP's.( Local Medicare Review policies) and NCD (National Coverage Determinations).
             This policy segment must not be used to provide a proprietary explanation code or reason for adjustment.
             Supply the Healthcare policy identifier in REF02 as provided by the payer's published Healthcare policy code list. This policy code will be used to explain the policy used to process the claim which resulted in the adjusted payment.
             If this segment is used, the PER (Payer Web Site) segment is required to provide an un-secure WEB contact point where the provider can access the payer's enumerated, published healthcare policy.

          8. 1100 · AMT · Service Supplemental Amount · Max 9 · Optional

             To indicate the total monetary amount

             This segment is used to convey information only. It is not part of the financial balancing of the 835.
             Required when the value of any specific amount identified by the AMT01 qualifier is non-zero. If not required by this implementation guide, do not send.

          9. 1200 · QTY · Service Supplemental Quantity · Max 6 · Optional

             To specify quantity information

             Use this segment to convey information only. It is not part of the financial balancing of the 835.
             Required when new Federal Medicare or Medicaid mandates require Quantity counts and value of specific quantities identified in the QTY01 qualifier are non-zero. If not required by this implementation guide, do not send.

          10. 1300 · LQ · Health Care Remark Codes · Max 99 · Optional

              To identify standard industry codes

              Use this segment to provide informational remarks only. This segment has no impact on the actual payment. Changes in claim payment amounts are provided in the CAS segments.
              Required when remark codes or NCPDP Reject/Payment codes are necessary for the provider to fully understand the adjudication message for a given service line. If not required by this implementation guide, may be provided at the sender's discretion, but cannot be required by the receiver.

Summary

1. 0100 · PLB · Provider Adjustment · Max >1 · Optional

   To convey provider level adjustment information for debit or credit transactions such as, accelerated payments, cost report settlements for a fiscal year and timeliness report penalties unrelated to a specific claim or service

   These adjustments can either decrease the payment (a positive number) or increase the payment (a negative number). Zero dollar adjustments are not allowed. Some examples of PLB adjustments are a Periodic Interim Payment (loans and loan repayment) or a capitation payment. Multiple adjustments can be placed in one PLB segment, grouped by the provider identified in PLB01 and the period identified in PLB02. Although the PLB reference numbers are not standardized, refer to 1.10.2.9 (Interest and Prompt Payment Discounts), 1.10.2.10 (Capitation and Related Payments or Adjustments), 1.10.2.12 (Balance Forward Processing), 1.10.2.16 (Post Payment Recovery) and 1.10.2.17 (Claim Overpayment Recovery) for code suggestions and usage guidelines.
   The codes and notations under PLB03 and its components apply equally to PLB05, 07, 09, 11 and 13.
   Required when reporting adjustments to the actual payment that are NOT specific to a particular claim or service. If not required by this implementation guide, do not send.

2. 0200 · SE · Transaction Set Trailer · Max 1 · Mandatory

   To indicate the end of the transaction set and provide the count of the transmitted segments (including the beginning (ST) and ending (SE) segments)