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Updated on April 23, 2021

The Accredited Standards Committee (ASC) X12 message is used to transfer data across and between industries. Pega Foundation for Healthcarecan recognize, accept, and parse messages that comply with the X12 EDI Standard version 5010. The following message standards are supported:

Pega Foundation for Healthcare

The parsing of each message file type shown above is complete according to the EDI Standard defined for the message, and no further extension is needed. It is assumed that the message is compliant with the ASC X12 Standards for EDI Technical Report Type 3 documents (Implementation Standard) and has been validated against all WEDI SNIP validation edits for syntax validation, balancing validation, and inter-segment validations. This is typically done by EDI Gateway systems.

The X12 standards provide the syntax and control structures that allow data elements, segments, and transaction sets to be defined. The following diagram shows the overall structure of X12 data and examples of message content.

ISA*00* *01*SECRET *ZZ*107039 *ZZ*103269

*030101*1253*^*00501*000000905*1*T*:~ GS*HC*107039*103269*20100601*0802*1*X*005010X222~ ST*837*1002*005010X222~ BHT*0019*00*1002*20100601*09460000*CH~


NM1*40*2*MY HEALTHPLAN*****46*12345MYHP~

HL*1**20*1~ PRV*BI*PXC*193200000X~


N4*CAMBRIDGE*MA*021421234~ REF*EI*666666666~

HL*2*1*22*0~ SBR*P*18*******CI~

NM1*IL*1*GAST*RONALD*T***MI*S-007~ N3*125 CITY AVENUE~ N4*HOPKINTON*MA*017481234~ DMG*D8*19390412*M~


CLM*GASTR12*170***11:B:1*Y*A*Y*I*P~ HI*BK:V202*BF:25000~

Each line is a segment that starts off with a segment identifier and ends with the tilde (~) symbol. Each segment is composed of one or more delimited data elements. The most common delimiter used is the asterisk (*) and it is used in the example below.

The example above is a part of an 837 claim transaction. In the example, the following line is an NM1 segment.

NM1*40*2*MY HEALTHPLAN*****46*12345MYHP~

This NM1 segment represents the Receiver Name. The segment’s structure is of the 837 transaction type, Loop 1000B, which means that it is the Receiver Name. In addition, the first data element in the segment indicates that it is the Receiver Name. The NM1 segment contains the following data elements:

  • *40* — Entity identifier code (40=Receiver)
  • *2* — Entity type qualifier (2=non-person entity, 1=person)
  • *MY HEALTHPLAN* — Last name or Organization name
  • ***** — 4 unused data elements
  • *46* — Identification code qualifier (46=Electronic Transmission Identification Number)
  • *MYHP* — Identification code (Receiver Identifier)

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