X12 5010 concepts (837, 835, 270/271, 278)

X12 5010 is the EDI transaction family HIPAA names for US healthcare administration: the 837 carries claims, the 835 carries remittance advice, the 270/271 pair carries eligibility inquiry and response, and the 278 carries prior authorization review. Transactions travel inside a three-level envelope (ISA interchange, GS functional group, ST transaction set). The implementation guides (TR3s) that define situational usage are licensed by ASC X12, so this page covers the concepts, not the guide content.

Example

The three-level envelope every X12 transaction rides in:

  ISA  interchange header       (sender, receiver, control number, version)
  GS   functional group header  (transaction family, e.g. HC for claims)
  ST   transaction set header   (transaction id, e.g. 837)
    ...transaction segments...
  SE   transaction set trailer  (segment count, matching control number)
  GE   functional group trailer
  IEA  interchange trailer

One interchange can carry many groups; one group, many transaction sets.

Hand-authored envelope skeleton. The envelope layer and transaction names are public knowledge; the situational rules that make a claim valid live in the licensed TR3 guides and are not reproduced here.

Validation context

Strict and compatibility validation notes land here with the phase-1 data export.