CreateClaimEdi Field Map (837I)
With "claimType": "institutional", POST /api/SharpRcm/v1/CreateClaimEdi builds an 837I (005010X223A2). This page lists every field of the request and the loop, segment and element it is written to. The 837P field map explains how to read the tables and describes the shared building blocks (provider, address, contact, date, reference, adjustment).
The request model is the same for every claim type, so some fields mean something different on an 837I: claimEditorView.placeOfService is the facility type code, and salesTaxAmount / postageClaimedAmt on a line are the service and facility tax amounts. Fields the 837I has no place for are listed under Not sent.
The tables below are generated from a test that builds an 837I from a request with every field filled in and confirms each value lands where the table says. They cannot drift from what the API sends.
Request
Fields on the request itself. They build the envelope and the submitter and receiver loops.
| JSON field | 837 | Notes |
|---|---|---|
submitterName | 1000A NM1*41 NM103 | |
submitterId | 1000A NM1*41 NM109 | Also ISA06 and GS02 when envelop.isa06 / envelop.gs02 are empty. |
submitterContactName | 1000A PER PER02 | |
submitterPhone | 1000A PER PER04 | PER03 is always TE. |
receiverName | 1000B NM1*40 NM103 | Used only when envelop.receiverName is empty. |
transactionControlNumber | ST ST02 | Also SE02. |
bhtControlNumber | BHT BHT03 | |
groupControlNumber | GS GS06 | Also GE02. |
envelop.isa01 | ISA ISA01 | |
envelop.isa02 | ISA ISA02 | Pad to 10. |
envelop.isa03 | ISA ISA03 | |
envelop.isa04 | ISA ISA04 | Pad to 10. |
envelop.isa05 | ISA ISA05 | |
envelop.isa06 | ISA ISA06 | Pad to 15. Falls back to submitterId. |
envelop.isa07 | ISA ISA07 | |
envelop.isa08 | ISA ISA08 | Pad to 15. |
envelop.isa13 | ISA ISA13 | Nine digits. Also IEA02. |
envelop.isa14 | ISA ISA14 | |
envelop.isa15 | ISA ISA15 | P production, T test. |
envelop.gs01 | GS GS01 | HC when empty. |
envelop.gs02 | GS GS02 | Falls back to submitterId. |
envelop.gs03 | GS GS03 | Also 1000B NM109 when envelop.receiverId is empty. |
envelop.gs08 | GS GS08 | Also ST03. Send 005010X223A2, or leave it empty and it is set from claimType. |
envelop.receiverName | 1000B NM1*40 NM103 | |
envelop.receiverId | 1000B NM1*40 NM109 | |
envelop.bht02 | BHT BHT02 | |
envelop.bht06 | BHT BHT06 |
Billing provider (2000A, 2010AA)
Paths are relative to each entry in claims[].
| JSON field | 837 | Notes |
|---|---|---|
billingProviderEditorView.nm1Data.entityCode | 2010AA NM1*85 NM101 | Filled in as 85. |
billingProviderEditorView.nm1Data.entityType | 2010AA NM1*85 NM102 | |
billingProviderEditorView.nm1Data.lastName | 2010AA NM1*85 NM103 | |
billingProviderEditorView.nm1Data.firstName | 2010AA NM1*85 NM104 | |
billingProviderEditorView.nm1Data.middleName | 2010AA NM1*85 NM105 | |
billingProviderEditorView.nm1Data.suffix | 2010AA NM1*85 NM107 | |
billingProviderEditorView.nm1Data.npi | 2010AA NM1*85 NM109 | |
billingProviderEditorView.nm1Data.taxonomyCode | 2000A PRV*BI PRV03 | |
billingProviderEditorView.address1, address2, city, state, zip | 2010AA N3, N4 (address) | |
billingProviderEditorView.secondaryIdentifiers[].qualifierCode | 2010AA REF*EI REF01 | The tax id: the first EI or SY entry is written. otherRefValue is not sent. Send EI. |
billingProviderEditorView.secondaryIdentifiers[].refValue | 2010AA REF*EI REF02 | |
billingProviderEditorView.contact1 | 2010AA PER (contact) | Written when contactType1 and contactInfo1 are set. |
billingProviderEditorView.contact2 | 2010AA PER (contact) | Written when contactType1 and contactInfo1 are set. |
Pay-to address and plan (2010AB, 2010AC)
Paths are relative to each entry in claims[].
| JSON field | 837 | Notes |
|---|---|---|
payToAddressView.entityType | 2010AB NM1*87 NM102 | The loop is written when address1 is set. NM101 is always 87. |
payToAddressView.address1, address2, city, state, zip | 2010AB N3, N4 (address) | |
payToPlanView.organizationName | 2010AC NM1*PE NM103 | The loop is written when organizationName is set. |
payToPlanView.primaryIdentifier | 2010AC NM1*PE NM109 | |
payToPlanView.address1, address2, city, state, zip | 2010AC N3, N4 (address) | |
payToPlanView.secondaryIdentifierType | 2010AC REF*2U REF01 | Send 2U. |
payToPlanView.secondaryIdentifier | 2010AC REF*2U REF02 | |
payToPlanView.taxIdNumber | 2010AC REF*EI REF02 |
Subscriber (2000B, 2010BA)
Paths are relative to each entry in claims[].
| JSON field | 837 | Notes |
|---|---|---|
subscriberEditorView.payerResponsibility | 2000B SBR01 | relationshipCode is written exactly as sent: 18 when the subscriber is the patient, empty when patientEditorView is used. |
subscriberEditorView.relationshipCode | 2000B SBR02 | |
subscriberEditorView.policyNumber | 2000B SBR03 | |
subscriberEditorView.groupName | 2000B SBR04 | |
subscriberEditorView.insuranceTypeCode | 2000B SBR05 | |
subscriberEditorView.claimFilingIndicator | 2000B SBR09 | |
subscriberEditorView.dateOfDeath | 2000B PAT06 | Written when any of dateOfDeath, weight or pregnancyIndicator is set. |
subscriberEditorView.measurementCode | 2000B PAT07 | |
subscriberEditorView.weight | 2000B PAT08 | |
subscriberEditorView.pregnancyIndicator | 2000B PAT09 | |
subscriberEditorView.entityType | 2010BA NM1*IL NM102 | NM108 is always MI. |
subscriberEditorView.lastName | 2010BA NM1*IL NM103 | |
subscriberEditorView.firstName | 2010BA NM1*IL NM104 | |
subscriberEditorView.middleName | 2010BA NM1*IL NM105 | |
subscriberEditorView.suffix | 2010BA NM1*IL NM107 | |
subscriberEditorView.subscriberPrimaryIdent | 2010BA NM1*IL NM109 | |
subscriberEditorView.address1, address2, city, state, zip | 2010BA N3, N4 (address) | |
subscriberEditorView.birthDay | 2010BA DMG02 | Written when either is set. |
subscriberEditorView.gender | 2010BA DMG03 | |
subscriberEditorView.ssn | 2010BA REF*SY REF02 | |
subscriberEditorView.casualtyClaimNumber | 2010BA REF*Y4 REF02 |
Payer (2010BB)
Paths are relative to each entry in claims[].
| JSON field | 837 | Notes |
|---|---|---|
payerEditerView.organizationName | 2010BB NM1*PR NM103 | Note the spelling: payerEditerView. |
payerEditerView.payerIdentifier | 2010BB NM1*PR NM109 | Routes the claim. NM108 is always PI. |
payerEditerView.address1, address2, city, state, zip | 2010BB N3, N4 (address) | |
payerEditerView.taxIdNumber | 2010BB REF*EI REF02 | |
payerEditerView.claimOfficeNumber | 2010BB REF*FY REF02 | |
payerEditerView.naicCode | 2010BB REF*NF REF02 | |
payerEditerView.locationNumber | 2010BB REF*LU REF02 | |
payerEditerView.providerCommericalNumber | 2010BB REF*G2 REF02 |
Patient (2000C, 2010CA)
Paths are relative to each entry in claims[].
| JSON field | 837 | Notes |
|---|---|---|
patientEditorView.relationshipCode | 2000C PAT PAT01 | Creates the patient loop. Without it nothing in patientEditorView is written. |
patientEditorView.dateOfDeath | 2000C PAT06 | |
patientEditorView.measurementCode | 2000C PAT07 | |
patientEditorView.weight | 2000C PAT08 | |
patientEditorView.pregnancyIndicator | 2000C PAT09 | |
patientEditorView.lastName | 2010CA NM1*QC NM103 | NM102 is always 1. |
patientEditorView.firstName | 2010CA NM1*QC NM104 | |
patientEditorView.middleName | 2010CA NM1*QC NM105 | |
patientEditorView.suffix | 2010CA NM1*QC NM107 | |
patientEditorView.address1, address2, city, state, zip | 2010CA N3, N4 (address) | |
patientEditorView.birthDay | 2010CA DMG02 | |
patientEditorView.gender | 2010CA DMG03 | |
patientEditorView.casualtyClaimNumber | 2010CA REF*Y4 REF02 |
Claim (2300)
Paths are relative to each entry in claims[].
| JSON field | 837 | Notes |
|---|---|---|
claimEditorView.patientControlNumber | 2300 CLM CLM01 | Your claim id. It comes back on the 277CA and 835. |
claimEditorView.totalClaimChargeAmt | 2300 CLM CLM02 | Must equal the sum of the line charges. |
claimEditorView.placeOfService | 2300 CLM CLM05-1 | The facility type code: the first two digits of the type of bill. CLM05-2 is always A. |
claimEditorView.claimFreqCode | 2300 CLM CLM05-3 | The frequency: the last digit of the type of bill. 1 original, 7 replacement, 8 void. |
claimEditorView.providerSignatureOnFile | 2300 CLM CLM06 | |
claimEditorView.planParticipationCode | 2300 CLM CLM07 | |
claimEditorView.benefitsAssignmentCertIndicator | 2300 CLM CLM08 | |
claimEditorView.releaseOfInfoCode | 2300 CLM CLM09 | |
claimEditorView.delayReasonCode | 2300 CLM CLM20 | |
claimEditorView.dateStatementDate.dateQualifier | 2300 DTP*434 DTP01 | The statement period, CCYYMMDD-CCYYMMDD. A dateValue with a hyphen is sent as RD8. Filled in as 434. |
claimEditorView.dateStatementDate.dateValue | 2300 DTP*434 DTP03 | Send 20300101-20300105. |
claimEditorView.dateStatementDate.periodFormat | 2300 DTP*434 DTP02 | Filled in as RD8. |
claimEditorView.dateAdmissionDate.dateQualifier | 2300 DTP*435 DTP01 | Admission date, CCYYMMDD, or date and hour, CCYYMMDDHHMM (sent as DT). Filled in as 435. |
claimEditorView.dateAdmissionDate.dateValue | 2300 DTP*435 DTP03 | Send 203001011230. |
claimEditorView.dateAdmissionDate.periodFormat | 2300 DTP*435 DTP02 | Filled in as DT. |
claimEditorView.dateDischarge.dateQualifier | 2300 DTP*096 DTP01 | Discharge hour, HHMM (sent as TM). Filled in as 096. |
claimEditorView.dateDischarge.dateValue | 2300 DTP*096 DTP03 | Send 1430. |
claimEditorView.dateDischarge.periodFormat | 2300 DTP*096 DTP02 | Filled in as TM. |
claimEditorView.dateRepricerReceived | 2300 DTP*050 (date) | |
claimEditorView.claimCode.admissionTypeCode | 2300 CL101 | Written when patientStatusCode is set. |
claimEditorView.claimCode.admissionSourceCode | 2300 CL102 | |
claimEditorView.claimCode.patientStatusCode | 2300 CL103 | |
claimEditorView.supplementalInfos[].reportTypeCode | 2300 PWK01 | Up to 10. PWK05 is AC when the transmission code is BM, EL, EM, FX or FT. |
claimEditorView.supplementalInfos[].transmissionCode | 2300 PWK02 | |
claimEditorView.supplementalInfos[].attachmentControlNumber1 | 2300 PWK06 | |
claimEditorView.contractInfo.contractTypeCode | 2300 CN101 | Written when contractTypeCode is set. |
claimEditorView.contractInfo.contractAmt | 2300 CN102 | |
claimEditorView.contractInfo.contractPercent | 2300 CN103 | |
claimEditorView.contractInfo.contractCode | 2300 CN104 | |
claimEditorView.contractInfo.contractTermsPercent | 2300 CN105 | |
claimEditorView.contractInfo.contractVersionIdent | 2300 CN106 | |
claimEditorView.patientPaidAmount.amount | 2300 AMT*F3 AMT02 | The patient's estimated amount due. AMT01 is always F3. |
claimEditorView.refReferralNumber | 2300 REF*9F (reference) | |
claimEditorView.refPriorAuthorization | 2300 REF*G1 (reference) | |
claimEditorView.refOriginalReference | 2300 REF*F8 (reference) | The payer's claim number, for a replacement or void. |
claimEditorView.refRepricedClaimReference | 2300 REF*9A (reference) | |
claimEditorView.refAdjRepricedClaimRerence | 2300 REF*9C (reference) | |
claimEditorView.refQualifiedProductsList | 2300 REF*LX (reference) | |
claimEditorView.refTraceNumber | 2300 REF*D9 (reference) | |
claimEditorView.refLocationNumber | 2300 REF*LU (reference) | |
claimEditorView.refMedicalRecordIdent | 2300 REF*EA (reference) | |
claimEditorView.refProjectCode | 2300 REF*P4 (reference) | |
claimEditorView.refProApprovalNumber | 2300 REF*G4 (reference) | |
claimEditorView.fileInformations[] | 2300 K3 K301 | Up to 10. |
claimEditorView.note.noteText | 2300 NTE*ADD NTE02 | The billing note. NTE01 is always ADD. |
claimEditorView.notes[].referenceCode | 2300 NTE*UPI NTE01 | Other claim notes, each with its own referenceCode. A referenceCode of ADD is skipped; use note for that. Send UPI. |
claimEditorView.notes[].noteText | 2300 NTE*UPI NTE02 | |
claimEditorView.epsdt.conditionIndicator | 2300 CRC*ZZ CRC02 | Written when conditionIndicator is set. CRC01 is always ZZ. |
claimEditorView.epsdt.conditionCode1 | 2300 CRC*ZZ CRC03 | |
claimEditorView.epsdt.conditionCode2 | 2300 CRC*ZZ CRC04 | |
claimEditorView.epsdt.conditionCode3 | 2300 CRC*ZZ CRC05 | |
claimEditorView.diagnosisCodes[].diagnosisType | 2300 HI*ABK HI01-1 | The entry with diagnosisOrder 1 is the principal diagnosis, in its own HI; the rest go in one HI*ABF (12 to a segment). presentOnAdmission is the POA indicator. Send ABK. |
claimEditorView.diagnosisCodes[].diagnosisCode | 2300 HI*ABK HI01-2 | |
claimEditorView.diagnosisCodes[].presentOnAdmission | 2300 HI*ABK HI01-9 | |
claimEditorView.diagnosisCodes[].diagnosisType | 2300 HI*ABF HI01-1 | Send ABF. |
claimEditorView.diagnosisCodes[].diagnosisCode | 2300 HI*ABF HI01-2 | |
claimEditorView.diagnosisCodes[].presentOnAdmission | 2300 HI*ABF HI01-9 | |
claimEditorView.admittingDiagnosisCode.diagnosisType | 2300 HI*ABJ HI01-1 | diagnosisType is always ABJ. Filled in as ABJ. |
claimEditorView.admittingDiagnosisCode.diagnosisCode | 2300 HI*ABJ HI01-2 | |
claimEditorView.reasonForVisitDiagnosisCodes[].diagnosisType | 2300 HI*APR HI01-1 | Patient reason for visit, APR. Send APR. |
claimEditorView.reasonForVisitDiagnosisCodes[].diagnosisCode | 2300 HI*APR HI01-2 | |
claimEditorView.externalCauseInjDiagnosisCodes[].diagnosisType | 2300 HI*ABN HI01-1 | External cause of injury, ABN, with its POA indicator. Send ABN. |
claimEditorView.externalCauseInjDiagnosisCodes[].diagnosisCode | 2300 HI*ABN HI01-2 | |
claimEditorView.externalCauseInjDiagnosisCodes[].presentOnAdmission | 2300 HI*ABN HI01-9 | |
claimEditorView.principalProcedureCode.diagnosisType | 2300 HI*BBR HI01-1 | ICD-10-PCS principal procedure, BBR. With procedureDate, HI01-3 is D8. Send BBR. |
claimEditorView.principalProcedureCode.diagnosisCode | 2300 HI*BBR HI01-2 | |
claimEditorView.principalProcedureCode.procedureDate | 2300 HI*BBR HI01-4 | |
claimEditorView.otherPrincipalProcedureCodes[].diagnosisType | 2300 HI*BBQ HI01-1 | Other procedures, BBQ, one composite each. Send BBQ. |
claimEditorView.otherPrincipalProcedureCodes[].diagnosisCode | 2300 HI*BBQ HI01-2 | |
claimEditorView.otherPrincipalProcedureCodes[].procedureDate | 2300 HI*BBQ HI01-4 | |
claimEditorView.drgCode | 2300 HI*DR HI01-2 | Diagnosis related group. |
claimEditorView.occurrenceSpanCodes[].diagnosisType | 2300 HI*BI HI01-1 | Occurrence span code and range (procedureDate, CCYYMMDD-CCYYMMDD); HI01-3 is RD8. Send BI. |
claimEditorView.occurrenceSpanCodes[].diagnosisCode | 2300 HI*BI HI01-2 | |
claimEditorView.occurrenceSpanCodes[].procedureDate | 2300 HI*BI HI01-4 | |
claimEditorView.occurrenceCodes[].diagnosisType | 2300 HI*BH HI01-1 | Occurrence code and date (procedureDate); HI01-3 is D8. Send BH. |
claimEditorView.occurrenceCodes[].diagnosisCode | 2300 HI*BH HI01-2 | |
claimEditorView.occurrenceCodes[].procedureDate | 2300 HI*BH HI01-4 | |
claimEditorView.valueInformation[].diagnosisType | 2300 HI*BE HI01-1 | Value code and amount (monitaryAmount). Send BE. |
claimEditorView.valueInformation[].diagnosisCode | 2300 HI*BE HI01-2 | |
claimEditorView.valueInformation[].monitaryAmount | 2300 HI*BE HI01-5 | |
claimEditorView.conditionCodes[] | 2300 HI*BG | Condition codes, BG:<code> each, 12 to a segment. |
claimEditorView.treatmentCodes[] | 2300 HI*TC | Treatment codes, TC:<code> each, 12 to a segment. |
claimEditorView.repricing.pricingMethodology | 2300 HCP01 | Written when pricingMethodology and repricedAllowedAmt are set. |
claimEditorView.repricing.repricedAllowedAmt | 2300 HCP02 | |
claimEditorView.repricing.repriceSavingsAmt | 2300 HCP03 | |
claimEditorView.repricing.repricingOrgIdent | 2300 HCP04 | |
claimEditorView.repricing.rate | 2300 HCP05 | |
claimEditorView.repricing.groupCode | 2300 HCP06 | |
claimEditorView.repricing.patientGroupAmt | 2300 HCP07 | |
claimEditorView.repricing.rejectReasonCode | 2300 HCP13 | |
claimEditorView.repricing.complianceCode | 2300 HCP14 | |
claimEditorView.repricing.exceptionCode | 2300 HCP15 | |
claimEditorView.attendingProvider | 2310A NM1*71, PRV*AT, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as 71. |
claimEditorView.operatingProvider | 2310B NM1*72, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as 72. |
claimEditorView.otherOperatingProvider | 2310C NM1*ZZ, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as ZZ. |
claimEditorView.renderingProvider | 2310D NM1*82, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as 82. |
claimEditorView.serviceFacility.organizationName | 2310E NM1*77 NM103 | Written when organizationName is set. NM108 is XX when primaryIdentifier (the NPI) is set. |
claimEditorView.serviceFacility.primaryIdentifier | 2310E NM1*77 NM109 | |
claimEditorView.serviceFacility.address1 | 2310E N301 | |
claimEditorView.serviceFacility.address2 | 2310E N302 | |
claimEditorView.serviceFacility.city | 2310E N401 | |
claimEditorView.serviceFacility.state | 2310E N402 | |
claimEditorView.serviceFacility.zip | 2310E N403 | |
claimEditorView.serviceFacility.secondaryIdentifiers[].qualifierCode | 2310E REF*G2 REF01 | Send G2. |
claimEditorView.serviceFacility.secondaryIdentifiers[].refValue | 2310E REF*G2 REF02 | |
claimEditorView.serviceFacility.secondaryIdentifiers[].otherRefValue | 2310E REF*G2 REF04 | |
claimEditorView.referringProvider | 2310F NM1*DN, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as DN. |
Other payers (2320, 2330A-I)
Paths are relative to each entry in claims[].
| JSON field | 837 | Notes |
|---|---|---|
secondaryEditorView[].otherSubscriber.payerResponsibility | 2320 SBR01 | payerResponsibility and relationshipCode are both required; without them the whole entry is dropped. |
secondaryEditorView[].otherSubscriber.relationshipCode | 2320 SBR02 | |
secondaryEditorView[].otherSubscriber.policyNumber | 2320 SBR03 | |
secondaryEditorView[].otherSubscriber.groupName | 2320 SBR04 | |
secondaryEditorView[].otherSubscriber.claimFilingIndicator | 2320 SBR09 | |
secondaryEditorView[].lineAdjustments[] | 2320 CAS (adjustment) | Claim-level adjustments, one entry per group code. |
secondaryEditorView[].payerPaidAmt.amountQualCode | 2320 AMT*D AMT01 | Filled in as D. |
secondaryEditorView[].payerPaidAmt.monetaryAmt | 2320 AMT*D AMT02 | |
secondaryEditorView[].nonCoveredAmount.amountQualCode | 2320 AMT*A8 AMT01 | Filled in as A8. |
secondaryEditorView[].nonCoveredAmount.monetaryAmt | 2320 AMT*A8 AMT02 | |
secondaryEditorView[].amountOwed.amountQualCode | 2320 AMT*EAF AMT01 | Filled in as EAF. |
secondaryEditorView[].amountOwed.monetaryAmt | 2320 AMT*EAF AMT02 | |
secondaryEditorView[].benefitsAssignmentCertIndicator | 2320 OI03 | Written when benefitsAssignmentCertIndicator is set. |
secondaryEditorView[].releaseOfInfoCode | 2320 OI06 | |
secondaryEditorView[].inpatientAdjudication.coveredDaysVisitCount | 2320 MIA01 | Medicare inpatient adjudication. Written when coveredDaysVisitCount is set. |
secondaryEditorView[].inpatientAdjudication.lifetimePsychiatricDaysCount | 2320 MIA03 | |
secondaryEditorView[].inpatientAdjudication.claimDrgAmount | 2320 MIA04 | |
secondaryEditorView[].inpatientAdjudication.claimPaymentRemarkCode | 2320 MIA05 | |
secondaryEditorView[].inpatientAdjudication.disproportionateShareAmt | 2320 MIA06 | |
secondaryEditorView[].inpatientAdjudication.passThroughAmt | 2320 MIA07 | |
secondaryEditorView[].inpatientAdjudication.ppsCapitalAmt | 2320 MIA08 | |
secondaryEditorView[].inpatientAdjudication.ppsCapitalFspDrgAmt | 2320 MIA09 | |
secondaryEditorView[].inpatientAdjudication.ppsCapitalDshDrgAmt | 2320 MIA11 | |
secondaryEditorView[].inpatientAdjudication.oldCapitalAmt | 2320 MIA12 | |
secondaryEditorView[].inpatientAdjudication.ppsCapitalImeAmt | 2320 MIA13 | |
secondaryEditorView[].inpatientAdjudication.ppsOperatingHospitalDrgAmt | 2320 MIA14 | |
secondaryEditorView[].inpatientAdjudication.costReportDayCount | 2320 MIA15 | |
secondaryEditorView[].inpatientAdjudication.ppsOperatingFederalDrgAmt | 2320 MIA16 | |
secondaryEditorView[].inpatientAdjudication.claimPpsCapitalOutlierAmt | 2320 MIA17 | |
secondaryEditorView[].inpatientAdjudication.claimIndirectTeachingAmt | 2320 MIA18 | |
secondaryEditorView[].inpatientAdjudication.nonPayableProComponentBilledAmt | 2320 MIA19 | |
secondaryEditorView[].inpatientAdjudication.claimPaymentRemarkCode1 | 2320 MIA20 | |
secondaryEditorView[].inpatientAdjudication.claimPaymentRemarkCode2 | 2320 MIA21 | |
secondaryEditorView[].inpatientAdjudication.claimPaymentRemarkCode3 | 2320 MIA22 | |
secondaryEditorView[].inpatientAdjudication.claimPaymentRemarkCode4 | 2320 MIA23 | |
secondaryEditorView[].inpatientAdjudication.ppsCapitalExceptionAmt | 2320 MIA24 | |
secondaryEditorView[].reimbursementRate | 2320 MOA01 | Medicare outpatient adjudication. Written when any is set. |
secondaryEditorView[].hcpcsPayableAmt | 2320 MOA02 | |
secondaryEditorView[].claimPaymentRemarkCode1 | 2320 MOA03 | |
secondaryEditorView[].claimPaymentRemarkCode2 | 2320 MOA04 | |
secondaryEditorView[].claimPaymentRemarkCode3 | 2320 MOA05 | |
secondaryEditorView[].claimPaymentRemarkCode4 | 2320 MOA06 | |
secondaryEditorView[].claimPaymentRemarkCode5 | 2320 MOA07 | |
secondaryEditorView[].endStageRenalDiseasePmtAmt | 2320 MOA08 | |
secondaryEditorView[].nonPayableProfessionalCompBilledAmt | 2320 MOA09 | |
secondaryEditorView[].otherSubscriber.entityType | 2330A NM1*IL NM102 | N4 needs city, state and zip all set. |
secondaryEditorView[].otherSubscriber.lastName | 2330A NM1*IL NM103 | |
secondaryEditorView[].otherSubscriber.firstName | 2330A NM1*IL NM104 | |
secondaryEditorView[].otherSubscriber.middleName | 2330A NM1*IL NM105 | |
secondaryEditorView[].otherSubscriber.suffix | 2330A NM1*IL NM107 | |
secondaryEditorView[].otherSubscriber.subscriberPrimaryIdent | 2330A NM1*IL NM109 | |
secondaryEditorView[].otherSubscriber.address1 | 2330A N301 | |
secondaryEditorView[].otherSubscriber.address2 | 2330A N302 | |
secondaryEditorView[].otherSubscriber.city | 2330A N401 | |
secondaryEditorView[].otherSubscriber.state | 2330A N402 | |
secondaryEditorView[].otherSubscriber.zip | 2330A N403 | |
secondaryEditorView[].otherSubscriber.ssn | 2330A REF*SY REF02 | |
secondaryEditorView[].payerEditorView.organizationName | 2330B NM1*PR NM103 | payerIdentifier is what each line's adjudications[].otherPayerPrimaryIdentifier must match. |
secondaryEditorView[].payerEditorView.payerIdentifier | 2330B NM1*PR NM109 | |
secondaryEditorView[].payerEditorView.address1 | 2330B N301 | |
secondaryEditorView[].payerEditorView.address2 | 2330B N302 | |
secondaryEditorView[].payerEditorView.city | 2330B N401 | |
secondaryEditorView[].payerEditorView.state | 2330B N402 | |
secondaryEditorView[].payerEditorView.zip | 2330B N403 | |
secondaryEditorView[].payerEditorView.adjudicationPaymentDate.dateQualifier | 2330B DTP*573 DTP01 | Filled in as 573. |
secondaryEditorView[].payerEditorView.adjudicationPaymentDate.dateValue | 2330B DTP*573 DTP03 | |
secondaryEditorView[].payerEditorView.additionalPayerIdentifier | 2330B REF*2U REF02 | |
secondaryEditorView[].payerEditorView.taxIdNumber | 2330B REF*EI REF02 | |
secondaryEditorView[].payerEditorView.claimOfficeNumber | 2330B REF*FY REF02 | |
secondaryEditorView[].payerEditorView.naicCode | 2330B REF*NF REF02 | |
secondaryEditorView[].payerEditorView.priorAuthNumber | 2330B REF*G1 REF02 | |
secondaryEditorView[].payerEditorView.referralNumber | 2330B REF*9F REF02 | |
secondaryEditorView[].payerEditorView.signalCode | 2330B REF*T4 REF02 | |
secondaryEditorView[].payerEditorView.origionalRefNumber | 2330B REF*F8 REF02 | |
secondaryEditorView[].attendingProvider | 2330C NM1*71, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as 71. |
secondaryEditorView[].operatingProvider | 2330D NM1*72, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as 72. |
secondaryEditorView[].otherOperatingProvider | 2330E NM1*ZZ, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as ZZ. |
secondaryEditorView[].serviceFacility.organizationName | 2330F NM1*77 NM103 | Written when organizationName is set. 2330F carries no address. |
secondaryEditorView[].serviceFacility.primaryIdentifier | 2330F NM1*77 NM109 | |
secondaryEditorView[].serviceFacility.secondaryIdentifiers[].qualifierCode | 2330F REF*G2 REF01 | Send G2. |
secondaryEditorView[].serviceFacility.secondaryIdentifiers[].refValue | 2330F REF*G2 REF02 | |
secondaryEditorView[].serviceFacility.secondaryIdentifiers[].otherRefValue | 2330F REF*G2 REF04 | |
secondaryEditorView[].renderingProvider | 2330G NM1*82, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as 82. |
secondaryEditorView[].referringProvider | 2330H NM1*DN, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as DN. |
secondaryEditorView[].billingProviderEditorView | 2330I NM1*85, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as 85. Its address and contacts are not sent. |
Service line (2400-2430)
Paths are relative to each entry in claims[].
| JSON field | 837 | Notes |
|---|---|---|
serviceLinesEditorView[].lineNumber | 2400 LX01 | |
serviceLinesEditorView[].revenueCode | 2400 SV201 | |
serviceLinesEditorView[].procedureCodeQualifier | 2400 SV202-1 | |
serviceLinesEditorView[].procedureCode | 2400 SV202-2 | |
serviceLinesEditorView[].modifier1 | 2400 SV202-3 | |
serviceLinesEditorView[].modifier2 | 2400 SV202-4 | |
serviceLinesEditorView[].modifier3 | 2400 SV202-5 | |
serviceLinesEditorView[].modifier4 | 2400 SV202-6 | |
serviceLinesEditorView[].procedureDescription | 2400 SV202-7 | |
serviceLinesEditorView[].lineChargeAmount | 2400 SV203 | |
serviceLinesEditorView[].serviceUnitMeasurementCode | 2400 SV204 | |
serviceLinesEditorView[].serviceUnitCount | 2400 SV205 | |
serviceLinesEditorView[].nonCoveredChargeAmount | 2400 SV207 | |
serviceLinesEditorView[].supplementalInfos[].reportTypeCode | 2400 PWK01 | Up to 10. PWK05 is AC when the transmission code is BM, EL, EM, FX or FT. |
serviceLinesEditorView[].supplementalInfos[].transmissionCode | 2400 PWK02 | |
serviceLinesEditorView[].supplementalInfos[].attachmentControlNumber1 | 2400 PWK06 | |
serviceLinesEditorView[].dateService.dateQualifier | 2400 DTP*472 DTP01 | A dateValue with a hyphen (20260801-20260805) is sent as a range, RD8. Filled in as 472. |
serviceLinesEditorView[].dateService.dateValue | 2400 DTP*472 DTP03 | Send 20300101-20300105. |
serviceLinesEditorView[].dateService.periodFormat | 2400 DTP*472 DTP02 | Filled in as RD8. |
serviceLinesEditorView[].refLineItemControlNumber | 2400 REF*6R (reference) | Your line id; it comes back on the 835. |
serviceLinesEditorView[].refRepricedLineItemRefNumber | 2400 REF*9B (reference) | |
serviceLinesEditorView[].refAdjRepricedLineItemRefNumber | 2400 REF*9D (reference) | |
serviceLinesEditorView[].salesTaxAmount.monetaryAmt | 2400 AMT*GT AMT02 | The service tax amount. AMT01 is always GT. |
serviceLinesEditorView[].postageClaimedAmt.monetaryAmt | 2400 AMT*N8 AMT02 | The facility tax amount. AMT01 is always N8. |
serviceLinesEditorView[].thirdPartyNote.referenceCode | 2400 NTE*TPO NTE01 | Written when noteText is set. Send TPO. |
serviceLinesEditorView[].thirdPartyNote.noteText | 2400 NTE*TPO NTE02 | |
serviceLinesEditorView[].repricing.pricingMethodology | 2400 HCP01 | Written when pricingMethodology and repricedAllowedAmt are set. |
serviceLinesEditorView[].repricing.repricedAllowedAmt | 2400 HCP02 | |
serviceLinesEditorView[].repricing.repriceSavingsAmt | 2400 HCP03 | |
serviceLinesEditorView[].repricing.repricingOrgIdent | 2400 HCP04 | |
serviceLinesEditorView[].repricing.rate | 2400 HCP05 | |
serviceLinesEditorView[].repricing.groupCode | 2400 HCP06 | |
serviceLinesEditorView[].repricing.patientGroupAmt | 2400 HCP07 | |
serviceLinesEditorView[].repricing.productIdQualifier | 2400 HCP09 | |
serviceLinesEditorView[].repricing.repricedApprHcpcsCode | 2400 HCP10 | |
serviceLinesEditorView[].repricing.measurementCode | 2400 HCP11 | |
serviceLinesEditorView[].repricing.serviceUnitCount | 2400 HCP12 | |
serviceLinesEditorView[].repricing.rejectReasonCode | 2400 HCP13 | |
serviceLinesEditorView[].repricing.complianceCode | 2400 HCP14 | |
serviceLinesEditorView[].repricing.exceptionCode | 2400 HCP15 | |
serviceLinesEditorView[].drugIdentification.productServiceIdQualifier | 2410 LIN02 | Written when productServiceIdQualifier and nationalDrugCode are set. |
serviceLinesEditorView[].drugIdentification.nationalDrugCode | 2410 LIN03 | |
serviceLinesEditorView[].drugIdentification.drugQuanity | 2410 CTP04 | |
serviceLinesEditorView[].drugIdentification.drugQtyUnitOfMeasure | 2410 CTP05 | |
serviceLinesEditorView[].drugIdentification.prescriptionCompoundDrugNumber.qualifierCode | 2410 REF*XZ REF01 | Send XZ. |
serviceLinesEditorView[].drugIdentification.prescriptionCompoundDrugNumber.refValue | 2410 REF*XZ REF02 | |
serviceLinesEditorView[].operatingProvider | 2420A NM1*72, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as 72. |
serviceLinesEditorView[].otherOperatingProvider | 2420B NM1*ZZ, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as ZZ. |
serviceLinesEditorView[].renderingProvider | 2420C NM1*82, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as 82. |
serviceLinesEditorView[].referringProvider | 2420D NM1*DN, REF (provider) | Written when nm1Data.lastName is set. entityCode is filled in as DN. |
serviceLinesEditorView[].adjudications[].otherPayerPrimaryIdentifier | 2430 SVD01 | One per payer that adjudicated the line. Written only when otherPayerPrimaryIdentifier is set, and it must match that payer's secondaryEditorView[].payerEditorView.payerIdentifier. |
serviceLinesEditorView[].adjudications[].serviceLinePaidAmt | 2430 SVD02 | |
serviceLinesEditorView[].adjudications[].productServiceIdQualifier | 2430 SVD03-1 | |
serviceLinesEditorView[].adjudications[].procedureCode | 2430 SVD03-2 | |
serviceLinesEditorView[].adjudications[].modifier1 | 2430 SVD03-3 | |
serviceLinesEditorView[].adjudications[].modifier2 | 2430 SVD03-4 | |
serviceLinesEditorView[].adjudications[].modifier3 | 2430 SVD03-5 | |
serviceLinesEditorView[].adjudications[].modifier4 | 2430 SVD03-6 | |
serviceLinesEditorView[].adjudications[].procedureDescription | 2430 SVD03-7 | |
serviceLinesEditorView[].adjudications[].serviceLineRevenueCode | 2430 SVD04 | |
serviceLinesEditorView[].adjudications[].paidServiceUnitCount | 2430 SVD05 | |
serviceLinesEditorView[].adjudications[].bundledLineNumber | 2430 SVD06 | |
serviceLinesEditorView[].adjudications[].lineAdjustments[] | 2430 CAS (adjustment) | One entry per group code. |
serviceLinesEditorView[].adjudications[].dateClaimPaid | 2430 DTP*573 (date) | |
serviceLinesEditorView[].adjudications[].amountOwed.amountQualCode | 2430 AMT*EAF AMT01 | Filled in as EAF. |
serviceLinesEditorView[].adjudications[].amountOwed.monetaryAmt | 2430 AMT*EAF AMT02 |
Not sent
These fields are accepted but do not appear in the 837P. Most belong to institutional or dental claims, which share the same model.
| JSON field | Why |
|---|---|
accountNumber | Replaced by the account your credentials resolve to. |
claimType | Set institutional for this page's 837I. Sets GS08 and ST03 when envelop.gs08 is empty. |
envelop.isa09 | ISA09/ISA10 are the time ClaimRev builds the file. |
envelop.isa10 | ISA09/ISA10 are the time ClaimRev builds the file. |
envelop.isa11 | Taken from envelop.separators. |
envelop.isa12 | Always 00501. |
envelop.isa16 | Taken from envelop.separators. |
envelop.separators | Sets the delimiters ClaimRev writes with; *, ~, : and ^ when omitted. |
claimId | Yours to use; not part of the 837. |
sharpRcmClaimId | Internal. |
claimStatusId | Internal. |
claimText | Internal. |
claimErrors | Output only. |
receiverViewModel | The receiver (1000B) comes from envelop.receiverName / receiverName. |
submitterEditViewModel | Required, but the submitter (1000A) comes from submitterName, submitterId, submitterContactName and submitterPhone. |
*.qualifierCodeHint | Editor hints. |
*.refValueHint | Editor hints. |
*.otherRefValueHint | Editor hints. |
*.nm1Data.taxonomyCode | Written only for the billing (2000A PRV) and attending (2310A PRV) providers. |
billingProviderEditorView.secondaryIdentifiers[].otherRefValue | Not sent for the billing provider. |
payToAddressView.entityCode | Always 87. |
subscriberEditorView.contact1 | The 837I has no subscriber contact. |
patientEditorView.contact | The 837I has no patient contact. |
payerEditerView.priorAuthNumber | Use claimEditorView.refPriorAuthorization. |
payerEditerView.referralNumber | Use claimEditorView.refReferralNumber. |
payerEditerView.signalCode | Other payers (2330B) only. |
payerEditerView.origionalRefNumber | Use claimEditorView.refOriginalReference. |
payerEditerView.additionalPayerIdentifier | Other payers (2330B) only. |
payerEditerView.adjudicationPaymentDate | Other payers (2330B) only. |
payerEditerView.predeterminationOfBenefits | Dental (837D) only. |
claimEditorView.patientSignatureCode | Professional (837P) only. |
claimEditorView.relatedCausesCode1 | Professional (837P) only. |
claimEditorView.relatedCausesCode2 | Professional (837P) only. |
claimEditorView.accidentState | Professional (837P) only. |
claimEditorView.accidentCountry | Professional (837P) only. |
claimEditorView.specialProgramIndicator | Professional (837P) only. |
claimEditorView.claimSubmissionReasonCode | Dental (837D) only. |
claimEditorView.dateOnSetOfCurrentIllness | Professional (837P) only. |
claimEditorView.dateLastXRay | Professional (837P) only. |
claimEditorView.dateInitialTreatment | Professional (837P) only. |
claimEditorView.dateHearingVisionRx | Professional (837P) only. |
claimEditorView.dateStartAssumedRelinqished | Professional (837P) only. |
claimEditorView.dateEndAssumedRelinqished | Professional (837P) only. |
claimEditorView.dateLastSeen | Professional (837P) only. |
claimEditorView.dateDisability | Professional (837P) only. |
claimEditorView.dateDisabilityStart | Professional (837P) only. |
claimEditorView.dateDisabilityEnd | Professional (837P) only. |
claimEditorView.dateAcuteManifestation | Professional (837P) only. |
claimEditorView.dateLastWorked | Professional (837P) only. |
claimEditorView.datePropertyCasualty | Professional (837P) only. |
claimEditorView.dateAccident | Professional (837P) only. |
claimEditorView.dateAuthorizedReturnWork | Professional (837P) only. |
claimEditorView.dateLastMenstrual | Professional (837P) only. |
claimEditorView.appliancePlacement | Dental (837D) only. |
claimEditorView.service | Dates of service are per line (serviceLinesEditorView[].dateService); the statement period is dateStatementDate. |
claimEditorView.refPredeterminationOfBenefitsIdent | Dental (837D) only. |
claimEditorView.refSpecialPayment | Professional (837P) only. |
claimEditorView.refClinicalLabImprovement | Professional (837P) only. |
claimEditorView.refFacilityIdNumber | Professional (837P) only. |
claimEditorView.refMedicareVersionCode | Professional (837P) only. |
claimEditorView.refMammographyCertNumber | Professional (837P) only. |
claimEditorView.note.referenceCode | Always ADD for note. |
claimEditorView.ambulanceTransport | Professional (837P) only. |
claimEditorView.spinalManipulation | Professional (837P) only. |
claimEditorView.ambulanceCerts | Professional (837P) only. |
claimEditorView.visionCerts | Professional (837P) only. |
claimEditorView.homeBound | Professional (837P) only. |
claimEditorView.epsdt.codeCategory | Always ZZ. |
claimEditorView.diagnosisCodes[].diagnosisOrder | Order 1 is the principal diagnosis; the rest are sorted by it. |
claimEditorView.diagnosisCodes[].procedureDate | Not used for diagnoses. |
claimEditorView.diagnosisCodes[].monitaryAmount | Not used for diagnoses. |
claimEditorView.admittingDiagnosisCode.diagnosisOrder | Not used. |
claimEditorView.admittingDiagnosisCode.presentOnAdmission | Not used for the admitting diagnosis. |
claimEditorView.admittingDiagnosisCode.procedureDate | Not used. |
claimEditorView.admittingDiagnosisCode.monitaryAmount | Not used. |
claimEditorView.reasonForVisitDiagnosisCodes[].diagnosisOrder | Sets the order of the composites. |
claimEditorView.reasonForVisitDiagnosisCodes[].presentOnAdmission | Not used for reason for visit. |
claimEditorView.reasonForVisitDiagnosisCodes[].procedureDate | Not used. |
claimEditorView.reasonForVisitDiagnosisCodes[].monitaryAmount | Not used. |
claimEditorView.externalCauseInjDiagnosisCodes[].diagnosisOrder | Sets the order of the composites. |
claimEditorView.externalCauseInjDiagnosisCodes[].procedureDate | Not used. |
claimEditorView.externalCauseInjDiagnosisCodes[].monitaryAmount | Not used. |
claimEditorView.principalProcedureCode.diagnosisOrder | Not used. |
claimEditorView.principalProcedureCode.presentOnAdmission | Not used for procedures. |
claimEditorView.principalProcedureCode.monitaryAmount | Not used. |
claimEditorView.otherPrincipalProcedureCodes[].diagnosisOrder | Sets the order of the composites. |
claimEditorView.otherPrincipalProcedureCodes[].presentOnAdmission | Not used for procedures. |
claimEditorView.otherPrincipalProcedureCodes[].monitaryAmount | Not used. |
claimEditorView.occurrenceSpanCodes[].diagnosisOrder | Sets the order of the composites. |
claimEditorView.occurrenceSpanCodes[].presentOnAdmission | Not used. |
claimEditorView.occurrenceSpanCodes[].monitaryAmount | Not used. |
claimEditorView.occurrenceCodes[].diagnosisOrder | Sets the order of the composites. |
claimEditorView.occurrenceCodes[].presentOnAdmission | Not used. |
claimEditorView.occurrenceCodes[].monitaryAmount | Not used. |
claimEditorView.valueInformation[].diagnosisOrder | Sets the order of the composites. |
claimEditorView.valueInformation[].presentOnAdmission | Not used. |
claimEditorView.valueInformation[].procedureDate | Not used. |
claimEditorView.anesthesaProcedureCode | Professional (837P) only. |
claimEditorView.anesthesaIndustryCode | Professional (837P) only. |
claimEditorView.repricing.productIdQualifier | Line-level only (HCP09). |
claimEditorView.repricing.repricedApprHcpcsCode | Line-level only (HCP10). |
claimEditorView.repricing.measurementCode | Line-level only (HCP11). |
claimEditorView.repricing.serviceUnitCount | Line-level only (HCP12). |
claimEditorView.primaryCareProvider | Professional (837P) only. |
claimEditorView.supervisingProvider | Professional (837P) only. |
claimEditorView.assistantSurgeon | Dental (837D) only. |
claimEditorView.ambulancePickupLocation | Professional (837P) only. |
claimEditorView.ambulanceDropOffLocation | Professional (837P) only. |
claimEditorView.orthoTotalMonthsTreatment | Dental (837D) only. |
claimEditorView.toothStatuses | Dental (837D) only. |
secondaryEditorView[].otherSubscriber.insuranceTypeCode | Not used in 2320 SBR. |
secondaryEditorView[].otherSubscriber.dateOfDeath | Not part of 2330A. |
secondaryEditorView[].otherSubscriber.measurementCode | Not part of 2330A. |
secondaryEditorView[].otherSubscriber.weight | Not part of 2330A. |
secondaryEditorView[].otherSubscriber.pregnancyIndicator | Not part of 2330A. |
secondaryEditorView[].otherSubscriber.birthDay | Not part of 2330A. |
secondaryEditorView[].otherSubscriber.gender | Not part of 2330A. |
secondaryEditorView[].otherSubscriber.casualtyClaimNumber | Not part of 2330A. |
secondaryEditorView[].otherSubscriber.contact1 | Not part of 2330A. |
secondaryEditorView[].patientSignatureCode | Professional (837P) only. |
secondaryEditorView[].payerEditorView.providerCommericalNumber | A billing-provider id (2010BB); not valid for another payer (2330B). |
secondaryEditorView[].payerEditorView.locationNumber | A billing-provider id (2010BB); not valid for another payer (2330B). |
secondaryEditorView[].payerEditorView.predeterminationOfBenefits | Dental (837D) only. |
secondaryEditorView[].payerEditorView.adjudicationPaymentDate.periodFormat | Always D8. |
secondaryEditorView[].serviceFacility.address1 | 2330F carries the name and ids only. |
secondaryEditorView[].serviceFacility.address2 | 2330F carries the name and ids only. |
secondaryEditorView[].serviceFacility.city | 2330F carries the name and ids only. |
secondaryEditorView[].serviceFacility.state | 2330F carries the name and ids only. |
secondaryEditorView[].serviceFacility.zip | 2330F carries the name and ids only. |
secondaryEditorView[].primaryCareProvider | Professional (837P) only. |
secondaryEditorView[].supervisingProvider | Professional (837P) only. |
secondaryEditorView[].assistantSurgeon | Dental (837D) only. |
secondaryEditorView[].billingProviderEditorView.address1 | 2330I carries the name and ids only. |
secondaryEditorView[].billingProviderEditorView.address2 | 2330I carries the name and ids only. |
secondaryEditorView[].billingProviderEditorView.city | 2330I carries the name and ids only. |
secondaryEditorView[].billingProviderEditorView.state | 2330I carries the name and ids only. |
secondaryEditorView[].billingProviderEditorView.zip | 2330I carries the name and ids only. |
secondaryEditorView[].billingProviderEditorView.contact1 | 2330I carries the name and ids only. |
secondaryEditorView[].billingProviderEditorView.contact2 | 2330I carries the name and ids only. |
serviceLinesEditorView[].placeOfService | Professional (837P) only. |
serviceLinesEditorView[].oralCavityDesignationCode1 | Dental (837D) only. |
serviceLinesEditorView[].oralCavityDesignationCode2 | Dental (837D) only. |
serviceLinesEditorView[].oralCavityDesignationCode3 | Dental (837D) only. |
serviceLinesEditorView[].oralCavityDesignationCode4 | Dental (837D) only. |
serviceLinesEditorView[].oralCavityDesignationCode5 | Dental (837D) only. |
serviceLinesEditorView[].prosthesisCrownInlayCode | Dental (837D) only. |
serviceLinesEditorView[].procedureCount | Dental (837D) only. |
serviceLinesEditorView[].pointer1 | Professional (837P) only. |
serviceLinesEditorView[].pointer2 | Professional (837P) only. |
serviceLinesEditorView[].pointer3 | Professional (837P) only. |
serviceLinesEditorView[].pointer4 | Professional (837P) only. |
serviceLinesEditorView[].emergencyIndicator | Professional (837P) only. |
serviceLinesEditorView[].epsdtIndicator | Professional (837P) only. |
serviceLinesEditorView[].familyIndicator | Professional (837P) only. |
serviceLinesEditorView[].coPayStatusCode | Professional (837P) only. |
serviceLinesEditorView[].dmeService | Professional (837P) only. |
serviceLinesEditorView[].teethInformation | Dental (837D) only. |
serviceLinesEditorView[].dmeCertOfMedicalNecessityIndicator | Professional (837P) only. |
serviceLinesEditorView[].ambulanceTransport | Professional (837P) only. |
serviceLinesEditorView[].durableMedicalEquipmentCert | Professional (837P) only. |
serviceLinesEditorView[].ambulanceCerts | Professional (837P) only. |
serviceLinesEditorView[].hospiceIndicator | Professional (837P) only. |
serviceLinesEditorView[].dmeCondition | Professional (837P) only. |
serviceLinesEditorView[].datePrescription | Professional (837P) only. |
serviceLinesEditorView[].dateCertificationRevisionRecert | Professional (837P) only. |
serviceLinesEditorView[].dateBeginTherapy | Professional (837P) only. |
serviceLinesEditorView[].dateLastCertification | Professional (837P) only. |
serviceLinesEditorView[].dateLastSeen | Professional (837P) only. |
serviceLinesEditorView[].dateRecentHemoglobin | Professional (837P) only. |
serviceLinesEditorView[].dateRecentSerumCreatine | Professional (837P) only. |
serviceLinesEditorView[].dateShipped | Professional (837P) only. |
serviceLinesEditorView[].dateLastXRay | Professional (837P) only. |
serviceLinesEditorView[].dateInitialTreatment | Professional (837P) only. |
serviceLinesEditorView[].dateEstimatedPriorPlacement | Dental (837D) only. |
serviceLinesEditorView[].datePriorPlacement | Dental (837D) only. |
serviceLinesEditorView[].dateAppliancePlacement | Dental (837D) only. |
serviceLinesEditorView[].dateApplianceReplacement | Dental (837D) only. |
serviceLinesEditorView[].dateTreatmentStart | Dental (837D) only. |
serviceLinesEditorView[].dateTreatmentEnd | Dental (837D) only. |
serviceLinesEditorView[].ambulancePatientCount | Professional (837P) only. |
serviceLinesEditorView[].obstretricAnesthesiaAddUnits | Professional (837P) only. |
serviceLinesEditorView[].testResults | Professional (837P) only. |
serviceLinesEditorView[].contractInfo | Not used at line level in 837I. |
serviceLinesEditorView[].refPriorAuthorization | Not used at line level in 837I. |
serviceLinesEditorView[].refPredeterminationOfBenefitsIdent | Dental (837D) only. |
serviceLinesEditorView[].refRepricedClaimRefNumber | Not used at line level. |
serviceLinesEditorView[].refAdjRepricedClaimRefNumber | Not used at line level. |
serviceLinesEditorView[].refMammographyCertNumber | Professional (837P) only. |
serviceLinesEditorView[].refCliaNumber | Professional (837P) only. |
serviceLinesEditorView[].refCliaNumberFacilityIdent | Professional (837P) only. |
serviceLinesEditorView[].refImmunizationBatchNumber | Professional (837P) only. |
serviceLinesEditorView[].refReferralNumber | Not used at line level in 837I. |
serviceLinesEditorView[].salesTaxAmount.amountQualCode | Always GT. |
serviceLinesEditorView[].postageClaimedAmt.amountQualCode | Always N8. |
serviceLinesEditorView[].serviceTaxAmount | Use salesTaxAmount, written as AMT*GT. |
serviceLinesEditorView[].miscTaxes | Use postageClaimedAmt, written as AMT*N8. |
claimEditorView.patientPaidAmount.qualifierCode | Always F3. |
serviceLinesEditorView[].fileInformations | Not used at line level in 837I. |
serviceLinesEditorView[].lineNote | Professional (837P) only. |
serviceLinesEditorView[].purchasedServiceInfo | Professional (837P) only. |
serviceLinesEditorView[].drugIdentification.prescriptionCompoundDrugNumber.otherRefValue | Not sent. |
serviceLinesEditorView[].purchasedServiceProvider | Professional (837P) only. |
serviceLinesEditorView[].assistantSurgeon | Dental (837D) only. |
serviceLinesEditorView[].serviceFacility | Not used at line level in 837I. |
serviceLinesEditorView[].supervisingProvider | Professional (837P) only. |
serviceLinesEditorView[].orderingProvider | Professional (837P) only. |
serviceLinesEditorView[].primaryCareProvider | Professional (837P) only. |
serviceLinesEditorView[].ambulancePickupLocation | Professional (837P) only. |
serviceLinesEditorView[].ambulanceDropOffLocation | Professional (837P) only. |
serviceLinesEditorView[].formIdent | Professional (837P) only. |
serviceLinesEditorView[].adjudications[].modifier5 | SVD03 carries four modifiers. |
serviceLinesEditorView[].adjudications[].dateClaimPaid.periodFormat | Always D8. |