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5010 Sample Files
Sample Files
271 Sample (Eligible)
277 Sample (In response to a 276 Claim Inquiry)
277CA Sample (Accepted)
277CA Sample (Rejected)
278 DVS Response Sample
278 PA Response Sample
820 Child Health Plus Payment (EFT)
820 Essential Health Plan
820 Premium Payment (EFT)
820 Premium Remit (No Payment)
835 Sample Inpatient Retro Rate Adjustment
835 Sample (Institutional Claims Only)
835 Sample Outpatient Retro Rate Adjustment
835 Sample (Professional Claims Only- No Payment)
835 Sample (Professional Claims Only- With Payment)
835 Sample Pharmacy
999 Sample (Accepted)
999 Sample (Rejected)
TA1 Sample (Rejected)