X12 EDI Examples

The examples library will expand as 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@x12.org. Please be sure to follow the submission instructions that includes instructions for adding or changing a segment example in an X12 TR3.

Read the Disclaimers

Examples

270/271 — Health Care Eligibility Benefit Inquiry and Response
ASC X12 Version: 005010 | Transaction Set: 270/271 | TR3 ID: 005010X279
276/277 — Health Care Claim Status Request and Response
ASC X12 Version: 005010 | Transaction Set: 276/277 | TR3 ID: 005010X212
277 — Data Reporting Acknowledgment
ASC X12 Version: 005010 | Transaction Set: 277 | TR3 ID: 005010X364
277 — Health Care Information Status Notification
ASC X12 Version: 005010 | Transaction Set: 277 | TR3 ID: 005010X214
278 — Health Care Services Review - Inquiry and Response
ASC X12 Version: 008010 | Transaction Set: 278 | TR3 ID: 008010X327
278 — Health Care Services Review - Request for Review and Response
ASC X12 Version: 008010 | Transaction Set: 278 | TR3 ID: 008010X342
278 — Health Care Services Review Notification and Acknowledgment
ASC X12 Version: 008030 | Transaction Set: 278 | TR3 ID: 008030X328
278 — Health Care Services Review Notification and Acknowledgment
ASC X12 Version: 008010 | Transaction Set: 278 | TR3 ID: 008010X328
278 — Request for Review and Response Examples
ASC X12 Version: 005010 | Transaction Set: 278 | TR3 ID: 005010X217
310 — Freight Receipt and Invoice
ASC X12 Version: 004010 | Transaction Set: 310 | TR3 ID: 310 - (Ocean)
810 — Aerospace Industry Invoice
ASC X12 Version: 004010 | Transaction Set: 810 | TR3 ID: 004010X348
820 — Health Insurance Exchange Related Payments
ASC X12 Version: 005010 | Transaction Set: 820 | TR3 ID: 005010X306
820 — Payroll Deducted and Other Group Premium Payment For Insurance Products Examples
ASC X12 Version: 008030 | Transaction Set: 820 | TR3 ID: 008030X334
820 — Payroll Deducted and Other Group Premium Payment For Insurance Products Examples
ASC X12 Version: 005010 | Transaction Set: 820 | TR3 ID: 005010X218
824 — Application Reporting For Insurance
ASC X12 Version: 005010 | Transaction Set: 824 | TR3 ID: 005010X186
832 — Health Care Fee Schedule
ASC X12 Version: 006020 | Transaction Set: 832 | TR3 ID: 006020X304
832 — Price/Sales Catalog
ASC X12 Version: 004010 | Transaction Set: 832 | TR3 ID: 004010X353
834 — Benefit Enrollment and Maintenance
ASC X12 Version: 005010 | Transaction Set: 834 | TR3 ID: 005010X220
834 — Health Insurance Exchange: Enrollment
ASC X12 Version: 005010 | Transaction Set: 834 | TR3 ID: 005010X307
834 — Plan Member Reporting
ASC X12 Version: 005010 | Transaction Set: 834 | TR3 ID: 005010X318
835 — Health Care Claim Payment/Advice
ASC X12 Version: 005010 | Transaction Set: 835 | TR3 ID: 005010X221
837 — Health Care Claim: Dental
ASC X12 Version: 005010 | Transaction Set: 837 | TR3 ID: 005010X224
837 — Health Care Claim: Institutional
ASC X12 Version: 005010 | Transaction Set: 837 | TR3 ID: 005010X223
837 — Health Care Claim: Professional
ASC X12 Version: 005010 | Transaction Set: 837 | TR3 ID: 005010X222
837 — Health Care Predetermination: Institutional
ASC X12 Version: 005010 | Transaction Set: 837 | TR3 ID: 005010X292
837 — Health Care Predetermination: Professional
ASC X12 Version: 005010 | Transaction Set: 837 | TR3 ID: 005010X291
837 — Post Adjudicated Claims Data Reporting: Professional
ASC X12 Version: 005010 | Transaction Set: 837 | TR3 ID: 005010X298
840 — Aerospace Industry Basic Request For Quotation
ASC X12 Version: 004010 | Transaction Set: 840 | TR3 ID: 004010X354
850 — Aerospace Industry Purchase Order
ASC X12 Version: 004010 | Transaction Set: 850 | TR3 ID: 004010X357
852 — Product Activity Data
ASC X12 Version: 008010 | Transaction Set: 852 | TR3 ID: 008010X369
855 — Aerospace Industry Purchase Order Acknowledgment
ASC X12 Version: 004010 | Transaction Set: 855 | TR3 ID: 004010X358
865 — Aerospace Industry Purchase Order Change Acknowledgment / Request — Initiated
ASC X12 Version: 004010 | Transaction Set: 865 | TR3 ID: 004010X362
997 — Aerospace Industry Functional Acknowledgment
ASC X12 Version: 004010 | Transaction Set: 997 | TR3 ID: 004010X363
997 — Functional Acknowledgment for Health Care Insurance
ASC X12 Version: 005010 | Transaction Set: 997 | TR3 ID: 005010X230
999 — Implementation Acknowledgment for Health Care Insurance
ASC X12 Version: 005010 | Transaction Set: 999 | TR3 ID: 005010X231