Examples

Providing implementers with examples that clarify the use of ASC X12 transaction sets.

 

ASC X12 Examples Web Site

The examples library will expand as ASC X12 and other entities contribute additional examples.

If your organization would like to contribute examples, submit them, including the data stream and the descriptive scenario, to examples@ascx12.org. Please be sure to follow the submission instructions.

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Examples

> Health Care Eligibility Benefit Inquiry and Response
> ASC X12 Version: 005010 | Transaction Set: 270/271 | TR3 ID: 005010X279

> Health Care Claim Status Request and Response
> ASC X12 Version: 005010 | Transaction Set: 276/277 | TR3 ID: 005010X212

> Health Care Services Review — Request for Review and Response
> ASC X12 Version: 005010 | Transaction Set: 278 | TR3 ID: 005010X217

> Aerospace Industry Invoice
> ASC X12 Version: 004010 | Transaction Set: 810 | TR3 ID: 004010X348

> Payroll Deducted and Other Group Premium Payment for Insurance Products
> ASC X12 Version: 005010 | Transaction Set: 820 | TR3 ID: 005010X218

> Health Insurance Exchange Related Payments
> ASC X12 Version: 005010 | Transaction Set: 820 | TR3 ID: 005010X306

> Application Reporting For Insurance
> ASC X12 Version: 005010 | Transaction Set: 824 | TR3 ID: 005010X186

> Health Care Fee Schedule
> ASC X12 Version: 006020 | Transaction Set: 832 | TR3 ID: 006020X304

> Health Insurance Exchange: Enrollment
> ASC X12 Version: 005010 | Transaction Set: 834 | TR3 ID: 005010X307

> Benefit Enrollment and Maintenance
> ASC X12 Version: 005010 | Transaction Set: 834 | TR3 ID: 005010X220

> Health Care Claim Payment\Advice
> ASC X12 Version: 005010 | Transaction Set: 835 | TR3 ID: 005010X221

> Health Care Claim: Professional
> ASC X12 Version: 005010 | Transaction Set: 837 | TR3 ID: 005010X222

> Health Care Claim: Institutional
> ASC X12 Version: 005010 | Transaction Set: 837 | TR3 ID: 005010X223

> Health Care Claim: Dental
> ASC X12 Version: 005010 | Transaction Set: 837 | TR3 ID: 005010X224

> 837 Health Care Predetermination: Professional
> ASC X12 Version: 005010 | Transaction Set: 837 | TR3 ID: 005010X291

> 837 Health Care Predetermination: Institutional
> ASC X12 Version: 005010 | Transaction Set: 837 | TR3 ID: 005010X292

> Functional Acknowledgment for Health Care Insurance
> ASC X12 Version: 005010 | Transaction Set: 997 | TR3 ID: 005010X230

> Implementation Acknowledgment for Health Care Insurance
> ASC X12 Version: 005010 | Transaction Set: 999 | TR3 ID: 005010X231