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on the encounter were 5 3 2013, indicating a one day service. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 17085 CC 40 Required for Same Day Transfer Reject Encounters submitted with TOB 11X and a patient status code of 02, 03, 05, 50, 51, 61, 62, 63, 65, 66, or 70; and the admission date is equal to the statement covers through date must contain Condition Code 40. Scenario: Wendy Wonder was admitted to Healthy Hospital on the morning of 2 21 2013 for a fall due to hallucinations. Healthy Hospital transferred Ms. Wonder to their inpatient psychiatric unit on the evening of 2 21 2013. Health Hospital submitted Ms. Wonder s claim to Wholeness Health using a patient status code of 65 (Discharged Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a Hospital) without providing the required Condition Code 40. Wholeness Health adjudicated the claim and submitted the encounter to the EDS. The EDPS rejected the encounter because inpatient hospital encounters populated with patient status code 65 must also contain Condition Code 40 to indicate that Ms. Wonder was admitted and discharged on the same date. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22280 Rev Code 277 Invalid for a HH Reject Home Health encounters cannot be submitted using revenue code 277(Medical surgical supplies oxygen (take home)). Scenario: Fawn Home submitted a claim to Hulu Health Care for provision of oxygen to Cletus Clapp, using revenue cod 0023 for the home health service and revenue code 277 for the supply service. Hulu Health Care adjudicated the claim and submitted the encounter to the EDS. Home Health received an MAO-002 report rejecting the encounter with edit 22280 because revenue code 277 is not a Medicare acceptable revenue code. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 18710 Missing Invalid POA Indicator Reject Encounter type requires that an indicator of Y or N for Present on Admission according to NUBC requirements, but the indicator is not populated or is inaccurate for the data provided in the encounter. Scenario: Miss Ames was admitted to Hope Hospital for a stroke and a cerebral infarction with complications on 3 26 2013. She was discharged on 4 5 2013. Hope Hospital submitted a claim to Mount Vios for Miss Ames hospital admission. Hope Hospital submitted an encounter to the EDS that did not include the required POA indicator of Y due to the diagnoses populated on the encounter. The EDS rejected the encounter with error code 18710. 837 Institutional Companion Guide Version 38.0 July 2016. 76 TABLE 18 EDIPPS EDITS PREVENTION AND RESOLUTION STRATEGIES PHASE III (CONTINUED) Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 21925 Swing Bed SNF Conditions Not Met Reject Encounter submitted with TOB 18X or 21X with Revenue Code 0022 and Occurrence Span Code 70 is not present or Occurrence Code 50 is not present for each submission of Revenue Code 0022. Scenario: Riverwalk Rehab, a Skilled Nursing Facility, submitted a claim to Haven Health Care for Mr. Benson s admission, following his transfer after a ten (10) day stay at Marco General Hospital. Haven Health submitted an encounter to the EDS using TOB 21X, Revenue Code 0022, and the required Occurrence Span Code of 70, which indicated Mr. Bensons inpatient hospital stay of three (3) days or greater. The EDS rejected the encounter with error code 21925 because it did not also include the Occurrence Code of 50, which is required for each service line submitted for Revenue Code 0022. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22405 Occurrence Code 55 DOD Required Reject When patient discharge status code is 20 (expired), 40 (expired at home), 41 (expired in a medical facility), or 42 (expired place unknown), submitter must ensure that Occurrence Code 55 and the date of death are present. Scenario: Gentle HealthCare submitted a final claim to Monument Medical Health Plan for Mr. G. Barnes, who expired on 9 15 2013. Monument Medical Health submitted and encounter to the EDS with a patient discharge status code of 41 in Loop 2300 CL103, but the Occurrence Code and Date of Death (occurrence code date) were not provided. The EDS rejected the encounter on the MAO-002 Report with error code 22405. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 17100 DOS Required for HH Encounter Reject Home Health encounters submitted with Revenue Codes 42X-44X and 55X-59X must contain dates of service for the revenue code line. Scenario: Tympany Home Health submitted an encounter to the EDS for physical therapy services (Revenue Code 42X) provided during a Home Health episode of care to Mrs. Waterman from 8 3 2013 through 8 31 2013. The encounter was rejected with error code 17100 because, although the dates of service were populated on the encounter header level, the revenue code line did not contain the physical therapy service dates. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 00175 Verteporfin Reject Encounters submitted with TOB 13X or 85X for Ocular Photodynamic Tomography with Verteporfin must contain the same dates of service for the combination of these services, with the appropriate ICD-9 and ICD- 10 diagnosis codes. Submitter must also ensure that the procedures are valid for the dates of service. Scenario: Dr. Cuff conducted an OPT with Verteporfin (J3396 and 67225) for Mr. Jay Bird as treatment for Mr. Bird s diagnosis of atrophic macular degeneration (362.51). The encounter was submitted to the EDS by Strideways Health and rejected because the diagnosis of 362.51 should not be identified for the service submitted on the encounter. 837 Institutional Companion Guide Version 38.0 July 2016. 77 TABLE 18 EDIPPS EDITS PREVENTION AND RESOLUTION STRATEGIES PHASE III (CONTINUED) Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 00750 Service(s) Not Covered Prior To 4 1 2013 Reject Encounters submitted for Ventricular Assist Devices (VADs) supplies accessories with procedure code Q0507, Q0508, or Q0509 must contain dates of service on or after 4 01 2013 Scenario: Dr. Zhivago s office submitted a claim to Healthy Heart Health Plan for a battery and battery charger provided to Mr. Joe Schmeaux following the attachment of his VAD on 2 3 | /kaggle/input/edi-db/Jul2016_CG_837I_5CR_081016.pdf | 5d1ff4d3761d8c9adb94936bf1b8ccf5 | 5d1ff4d3761d8c9adb94936bf1b8ccf5_22 |
procedure code Q0507, Q0508, or Q0509 must contain dates of service on or after 4 01 2013 Scenario: Dr. Zhivago s office submitted a claim to Healthy Heart Health Plan for a battery and battery charger provided to Mr. Joe Schmeaux following the attachment of his VAD on 2 3 2013. Healthy Heart submitted an encounter to the EDS using Q0507. The EDS rejected the encounter with error code 00750 because Q0507 was not an effective code for DOS prior to 4 1 2013. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22320 Missing ASC Procedure Code Informational The procedure codes present on TOB 83X encounter service lines cannot be located in the ASC Fee Schedule or ASC Drug Fee Schedule. Scenario: Flex Medical ASC submitted a TOB 83X encounter to the EDS with procedure code G0261 (prostate brachytherapy), which is not listed in the ASC Fee Schedule. The EDPS posted error 22320 because procedure code G0261 is not an acceptable procedure code in an ASC setting. TABLE 18 EDIPPS EDITS PREVENTION AND RESOLUTION STRATEGIES PHASE III (CONTINUED) Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22340 ESRD Diagnosis Code Missing Reject ERSD encounters (TOB 72X) must use the ESRD-related ICD-9 or ICD-10 diagnosis codes based on DOS (i.e., ICD-9 prior to 10 01 2015; ICD-10 on or after 10 01 2015). Scenario: On 10 15 2015, Health4U submitted an encounter to the EDS with bill type 72X for Feng Li s consultation with Dr. Jones on 9 1 2015 with ICD-10 diagnosis code N18.2 Chronic Kidney Disease, Stage 2 (Mild). The EDPS rejected the encounter because the DOS submitted on the encounter requires the use of ICD-9 diagnosis codes. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22355 Inpatient Service Line Error Reject EDPS will reject Institutional inpatient encounters (TOB 11X, 18X, 21X, and 41X) at the header level when any of the associated service lines have been rejected. MAOs must correct the service line errors and resubmit the encounter. Scenario: On 6 28 2015, Care Bear Health resubmitted an encounter to the EDS with bill type 21X and a billed amount of 240.00 on the Revenue Code 0022 service line. The EDS previously rejected the encounter and returned an MAO-002 Report containing error code 21979 Charges for Rev Code 0022 Must Be Zero because the Revenue Code service line billed amount and non-covered charge amounts must be either blank or equal to zero. The adjusted encounter received error code 22355 at the header level because it contained a reject error on the service line. 837 Institutional Companion Guide Version 38.0 July 2016. 78 TABLE 18 EDIPPS EDITS PREVENTION AND RESOLUTION STRATEGIES PHASE III (CONTINUED) Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22390 HIPPS Code Required for SNF HH Reject Encounters must contain HIPPS codes when submitted with TOB 18X or 21X and Revenue Code 0022 or TOB 32X and Revenue Code 0023. Note: This edit will post as a reject only for DOS on or after 7 1 2014. Scenario: Lamplight Home Health submitted an encounter to the EDS containing TOB 32X (Home Health Inpatient), Revenue Code 0023, and procedure code G0154(x2). The encounter did not contain a HIPPS code on the Revenue Code 0023 service line. The EDS returned the encounter with error code 22390, because all Home Health encounters must be submitted with appropriate HIPPS codes. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22395 HIPPS Code Conflicts with Revenue Code Reject Encounters must contain the appropriate HIPPS code for the service submitted. Revenue Code 0022 must contain appropriate SNF HIPPS codes. Revenue Code 0023 must contain appropriate HH HIPPS codes. Note: This edit will post as a reject only for DOS on or after 7 1 2014. Scenario: Pink Lady Nursing Care submitted a claim to Aurelia Health Plan for SNF services provided for Ms. Jamella Fantastic. Aurelia Health Plan submitted the encounter to the EDS with TOB 21X, Revenue Code 0022 and HIPPS code HAEK2. The EDS returned the encounter with error code 22395, because the HIPPS code populated on the encounter indicated a Home Health service instead of a Skilled Nursing Facility service. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22400 HP Qualifier Must Exist for HIPPS Code Reject Encounters submitted with TOB 18X or 21X and Revenue Code 0022 or TOB 32X and Revenue Code 0023 must contain a value of HP in the SV202-1 element for HIPPS codes. Note: This edit will post as a reject only for DOS on or after 7 1 2014. Scenario: Serenity Care Nursing submitted a claim to Universal Medical Health Plan for Mr. Bacchus two (2) week stay at their Skilled Nursing Facility. Universal Medical Health Plan submitted the encounter to the EDS with the appropriate HIPPS codes; however, the qualifier was populated with HC (procedure code qualifier). TABLE 18 EDIPPS EDITS PREVENTION AND RESOLUTION STRATEGIES PHASE III (CONTINUED) Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22410 Invalid Service(s) for TOB Reject Encounters submitted for Ventricular Assist Devices (VADs) supplies and accessories with procedure codes must only contain specific bill types (12X, 13X, 22X, 23X, 32X, 33X, 34X, 74X, or 85X). Note: TOB 33X is not applicable on or after 10 1 2013 Scenario: Dr. Pandora submitted a claim to Healthy Heart Health Plan for wound care and dressings provided after Mr. Jingleheimer s pacemaker insertion. The encounter was submitted to the EDS with TOB 14X. The encounter was rejected with error code 22410, because VAD supplies and accessories cannot be submitted with this bill type. 837 Institutional Companion Guide Version 38.0 July 2016. 79 TABLE 18 EDIPPS EDITS PREVENTION AND RESOLUTION STRATEGIES PHASE III (CONTINUED) Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22415 Revenue code 0274 Required Reject Encounters submitted for Ventricular Assist Devices (VADs) supplies accessories with procedure code Q0507, Q0508, or Q0509 must contain Revenue Code 0274 and the appropriate bill types (12X, 13X, 22X, 23X, 32X, 33X, 34X, 74X, or 85X). Scenario: Karma Health submitted an encounter to the EDS for VAD replacement leads using Revenue Code 0022. The encounter was rejected with error code 22415 because Revenue Code 0274 is | /kaggle/input/edi-db/Jul2016_CG_837I_5CR_081016.pdf | 5d1ff4d3761d8c9adb94936bf1b8ccf5 | 5d1ff4d3761d8c9adb94936bf1b8ccf5_23 |
must contain Revenue Code 0274 and the appropriate bill types (12X, 13X, 22X, 23X, 32X, 33X, 34X, 74X, or 85X). Scenario: Karma Health submitted an encounter to the EDS for VAD replacement leads using Revenue Code 0022. The encounter was rejected with error code 22415 because Revenue Code 0274 is the only appropriate code for submission of VAD supplies and accessories. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22420 TOB 33X Invalid for DOS Reject Encounters submitted with dates of service (DOS) on or after 10 01 2013 must not contain TOB 33X. Scenario: Strong s Home Care submitted an encounter with TOB 33X (Home Health Outpatient) to the EDS for Home Health services provided for Mr. V. Triumph from November 3, 2013 through 11 18 2013. The EDS rejected the encounter and returned an MAO-002 report with error code 22420, because TOB 33X was deactivated for all DOS on or after 10 1 2013. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 18500 Multiple CPT HCPCS for Same Service Informational Encounters cannot be submitted with multiple procedure codes to identify the same service procedure. Scenario: ProHealth submitted an encounter to the EDS with procedure code 15839 (labiaplasty) performed on Ms. Cross on 11 13 2013. The EDS returned an MAO-002 report to ProHealth with error code 18500 because ProHealth had already submitted another encounter for the same dates of service for Ms. Cross with procedure code 56620 (labiaplasty). Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 20500 Invalid DOS for Rev Code Billed Reject Encounter s Revenue Code service date must be within the range of the procedure service line DOS when submitting: a)TOB 71X, 75X, or 77X with a valid Revenue Code; b) Revenue Code 054X with TOBs 13X, 22X, 23X, 83X, or 85X; c) Revenue Codes 042X, 43X, 044X, or 047X with TOBs 12X, 13X, 22X, 23X, 74X, or 83X; d) Revenue Code 047X with TOB 34X; or e) Revenue Codes within the range of 0300-0319 with HCPCS Codes 78267, 78268,80002-89399, or G0000- G9999 and TOBs 13X, 14X, 23X, 72X, 83X, or 85X Scenario: Pink Acres Health Clinic submitted a claim to Way Out Health Plan for behavioral health services provided to Cookie Triton from 3 26 2013 through 4 12 2013. Way Out Health Plan submitted an encounter to the EDS with TOB 71X and Revenue Code 0900 with procedure service line DOS of 3 26 15 4 12 15 and Revenue Code service dates of 4 26 15 5 12 15. The EDS rejected the encounter because the Revenue Code service dates were not valid for the dates of the service provided. 837 Institutional Companion Guide Version 38.0 July 2016. 80 TABLE 18 EDIPPS EDITS PREVENTION AND RESOLUTION STRATEGIES PHASE III (CONTINUED) Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 21979 Charges for Rev Code 0022 Must Be Zero Reject For encounters submitted with TOB 18X or 21X and Revenue Code 0022, the billed amount (Loop 2400 SV203) and non- covered charge amount (Loop 2400 SV207) should equal zero when these fields are populated for the Revenue Code service line. Scenario: Mohair Nursing Camp submitted a claim to Fancy Free Health Plan for services provided to Curly Sue Skumptik. Fancy Free Health Plan submitted an encounter for the services to the EDS containing a billed amount of 240.00 on the Revenue Code 0022 service line. The EDS rejected the encounter and returned an MAO-002 Report containing error code 21979 because the Revenue Code service line billed amount and non-covered charge amounts must be either blank or equal to zero. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 98300 Exact Inpatient Duplicate Encounter Reject MAOs must submit replacement or void encounters when altering Inpatient encounters. The EDPS will reject Inpatient encounters submitted with bill types 11X, 18X, 21X, or 41X that contain duplicate header level (loop 2300) data elements for the HICN, DOS, TOB, and Billing Provider NPI of an existing accepted and stored encounter. Scenario: On 8 3 2015, A Fine MAO submitted an encounter for Mayank Deshpande s stay at Mercy Hospital from 6 15 2015 through 6 23 2015. On 8 10 2015, A Fine MAO resubmitted the same encounter as an original to the EDPS with altered procedure modifiers. The EDPS rejected the encounter submitted on 8 10 2015 because the header level (loop 2300) HICN, DOS, TOB, and Billing Provider NPI data values matched those of the previous encounter submitted on 8 3 2015. If the provider wishes to adjust the line level (loop 2400) elements, they must submit a replacement encounter or void the original encounter then resubmit. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 98315 Linked Chart Review Duplicate Reject Linked Chart Review encounters cannot be submitted where the HICN, Associated ICN, header DOS, diagnosis code(s) and TOB contain the exact same values as another Chart Review encounter already present within the EODS. Scenario: Sequoia Health Plan conducted an audit of Langhorne Hospital and discovered an encounter previously submitted to the EDS contained an unnecessary diagnosis code. On 4 01 2014, Sequoia Health Plan submitted a linked chart review encounter to the EDS containing the associated ICN of the original encounter to identify the unnecessary diagnosis code. On 5 01 2014 Sequoia Health Plan inadvertently submitted the exact same linked chart review encounter to the EDS. The EDS rejected the second submission of the linked chart review encounter because no changes were detected between the two (2) linked chart review encounters. 837 Institutional Companion Guide Version 38.0 July 2016. 81 TABLE 18 EDIPPS EDITS PREVENTION AND RESOLUTION STRATEGIES PHASE III (CONTINUED) Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 98320 Chart Review Duplicate Reject Unlinked Chart Review encounters cannot be submitted where the HICN, header DOS, diagnosis code(s) and TOB contain the exact same values as another Chart Review encounter already present within the EODS. Scenario: Ohio Health Plan conducted an audit of Cincinnati City Hospital and discovered an encounter not previously submitted to the EDS required an additional diagnosis code. On 3 15 2014, Ohio Health Plan submitted an unlinked chart review encounter to the EDS to include the additional | /kaggle/input/edi-db/Jul2016_CG_837I_5CR_081016.pdf | 5d1ff4d3761d8c9adb94936bf1b8ccf5 | 5d1ff4d3761d8c9adb94936bf1b8ccf5_24 |
present within the EODS. Scenario: Ohio Health Plan conducted an audit of Cincinnati City Hospital and discovered an encounter not previously submitted to the EDS required an additional diagnosis code. On 3 15 2014, Ohio Health Plan submitted an unlinked chart review encounter to the EDS to include the additional diagnosis code. On 6 01 2014, Ohio Health Plan submitted the same unlinked chart review encounter to the EDS due to a clerical error. The EDS rejected the second submission of the unlinked chart review encounter because the EDS detected no changes between the two (2) unlinked chart review encounters. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 00030 ICD-10 Dx Not Allowed Reject ICD-10 diagnosis and or procedure codes cannot be submitted for inpatient or home health encounters with Through DOS prior to 10 01 2015 or outpatient encounters with a From DOS prior to 10 1 2015. ICD-9 codes are required. Scenario: Arthur Home Health submitted an encounter (TOB 32X) for Elizabeth Door with DOS from 11 15 2014 through 11 20 2014 with a primary diagnosis code of C509.19 (Malignant Neoplasm of Unspecified Site). The EDS rejected the encounter because an ICD-10 diagnosis code was reported prior to the established transition date to ICD-10 codes. The encounter must be updated with ICD-9 diagnosis code 174.9 and resubmitted to the EDS. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 00035 ICD-9 Dx Not Allowed Reject ICD-9 diagnosis and or procedure codes cannot be submitted for inpatient or home health encounters with Through DOS on or after 10 01 2015 or outpatient encounters with a From DOS on or after to 10 1 2015. ICD- 10 codes are required. Scenario: Arthur Home Health submitted an encounter (TOB 32X) for Elizabeth Door with DOS from 12 03 2015 through 12 10 2015 with a primary diagnosis code of 174.9 (Malignant Neoplasm of Breast (Female) Unspecified Site). The EDS rejected the encounter because an ICD-9 diagnosis code was reported after the established transition date to ICD-10 codes. The encounter must be updated with ICD-10 diagnosis code C509.19 and resubmitted to the EDS. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 00775 Unable to Adjust Rejected Encounter Reject MAOs cannot submit a replacement encounter that links to a rejected encounter stored in the EODS. Scenario: Torchlight Healthcare submitted an encounter for services provided to James Miramar by Dr. Gavin, and received ICN 5555555555552. The EDPS rejected the encounter due to invalid beneficiary information. Dr. Gavin s staff identified the need to adjust the payment amount, and sent the corrected payment information to Torchlight Healthcare. Torchlight Healthcare submitted the replacement encounter, containing the corrected payment amount, to the EDPS prior to reconciling the MAO-002 report that identified the original encounter as a rejected encounter. The EDPS rejected the replacement encounter because the original encounter stored in the EODS with ICN 5555555555552 had been rejected. 837 Institutional Companion Guide Version 38.0 July 2016. 82 TABLE 18 EDIPPS EDITS PREVENTION AND RESOLUTION STRATEGIES PHASE III (CONTINUED) Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 00780 Adjustment Must Match Original Reject When submitting a replacement or void encounter, MAOs must match the ICN, HICN, Last Name, First Name, Payer ID, and TOB header data elements of an accepted encounter stored in the EODS. Note: The EDPS will validate the beneficiary s demographic data (HICN, Last Name, First Name) according to the Medicare Beneficiary Database (MBD), as well as validate the beneficiary s Billing Provider NPI prior to posting edit 00780 Scenario: Torchlight Healthcare submitted an encounter totaling 250 for services provided to Ciao Bella by Grammar City Hospital, and received ICN 5555555555557. Grammar City Hospital resubmitted the encounter to correct the payment amount to 205, to Torchlight Healthcare under a new Payer ID. Torchlight Healthcare submitted the replacement encounter to the EDPS with the corrected payment information and the patient s new Payer ID. The EDPS rejected the replacement encounter because the patient s Payer ID did not match that of the stored encounter in the EODS or the MBD. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 00785 Linked Encounter Not in EODS Reject The ICN referenced in a linked chart review must match the ICN of an accepted encounter stored in the EODS. Scenario: ABC Health Plan submitted an encounter for Janice Wei, and received ICN 1231234564569. As a result of a routine medical record review 6 months later, ABC Health Plan submitted a linked chart review encounter referencing ICN 1231234564568 to add a diagnosis code. The EDPS rejected the chart review encounter because there was not an existing, accepted encounter with ICN 1231234564568 stored in the EODS. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 00790 Linked Encounter is Voided Adjusted Reject The ICN referenced in a linked chart review must not match the ICN of a voided encounter stored in the EODS. Scenario: ABC Health Plan submitted an encounter for Emanuel Spice, and received ICN 1234567890123. ABC Health Plan discovered the encounter was submitted in error and submitted a void request to the EDS three months following the original submission. After a chart audit a year later, ABC Health Plan submitted a linked chart review encounter referencing ICN 1234567890123 to delete an incorrectly reported diagnosis code. The EDPS rejected the chart review encounter because the encounter stored in the EODS with ICN 1234567890123 was voided. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 00795 Linked Encounter is Rejected Reject The ICN referenced in a linked chart review must not match the ICN of a rejected encounter stored in the EODS. Scenario: ABC Health Plan submitted an encounter for Shaunna Brookstone, and received ICN 4561234561232. The EDPS rejected the encounter due to invalid beneficiary information populated on the encounter. As a result of a routine medical record review a year later, ABC Health Plan submitted a linked chart review encounter referencing ICN 4561234561232 to add diagnoses. The EDPS rejected the chart review encounter because the encounter stored in the EODS with ICN 4561234561232 was rejected. 837 Institutional Companion Guide Version 38.0 July 2016. 83 TABLE 18 EDIPPS EDITS PREVENTION AND RESOLUTION STRATEGIES PHASE III (CONTINUED) Edit Edit | /kaggle/input/edi-db/Jul2016_CG_837I_5CR_081016.pdf | 5d1ff4d3761d8c9adb94936bf1b8ccf5 | 5d1ff4d3761d8c9adb94936bf1b8ccf5_25 |
chart review encounter referencing ICN 4561234561232 to add diagnoses. The EDPS rejected the chart review encounter because the encounter stored in the EODS with ICN 4561234561232 was rejected. 837 Institutional Companion Guide Version 38.0 July 2016. 83 TABLE 18 EDIPPS EDITS PREVENTION AND RESOLUTION STRATEGIES PHASE III (CONTINUED) Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 03015 HCPCS Code Invalid for DOS Reject Prior to encounter submission, the submitter should verify that the procedure code is valid effective for the DOS populated on the encounter. Scenario: Oxford Hospital submits an encounter on 3 01 2013 for Chance Borny for a DOS 2 17 2013 which included HCPCS code G0290. The EDS will report error code 03015 with a reject status on the MAO-002 report because HCPCS code G0290 was terminated 12 31 2012. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 03022 Invalid CMG for IRF Encounter Reject TOB 11X Inpatient Rehabilitation Facility encounter service lines billed with Revenue Code 0024 must contain acceptable HIPPS codes. Scenario: Duane Max suffered a minor stroke and is recovering at Summer Rehab Facility. Summer Rehab submitted a TOB 11X encounter with a service line containing Revenue Code 0024 and HIPPS code 1BFLS. The EDPS posted edit 03022 since HIPPS code 1BFLS is invalid and A0101 (Stroke with Motor 51.05 w o comorbidities) should have been entered on the service line containing Revenue Code 0024, based on the HIPPS assessment performed. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 03102 Invalid Provider Type Specialty Informational The EDPS derives the Provider Specialty based on Provider s Address. Ensure the correct Provider Address is included on the encounter relevant to the services rendered. Scenario: Revive Center is an Independent Diagnostic Testing Center (provider specialty code 47) that contains a Mammography Screening Center (provider specialty code 45). Routine diagnostic tests were performed on Mr. Keene; however, the tests were billed under the location address for Provider Specialty code 45 rather than 47. The EDPS will post error code 03102 for this encounter due to the use of the wrong specialty code on the encounter. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 03165 Telehealth Facility Fee Not Allowed Reject Institutional Telehealth encounter service lines containing procedure code Q3014 (Telehealth Originating Site Facility Fee) must include revenue code 078X (telemedicine) and one (1) of the following bill types: 12X, 13X, 22X, 23X, 71X, 72X, 76X, 77X, or 85X. Scenario: Dr. Smith, working through Century Hospital, used the Telehealth option to follow-up with patient Saqib Murray. Dr. Smith submitted a Telehealth encounter service line with procedure code Q3014, revenue code 0780, and bill type 11X to the MAO, 4YourHealth. 4YourHealth submitted the encounter to the EDS. The EDPS rejected the service line because bill type 11X is not an accepted bill type for the Telehealth Originating Site Fee. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 20495 Revenue Code Is Non-Billable for TOB Reject Encounters with TOB 22X with certain revenue codes will receive this edit. Scenario: Skilled Nursing Facility Summit Peak submits a TOB 22X encounter incorrectly containing a service with revenue code 0944 Drug Rehabilitation. The EDS will report error code 20495 because revenue code 0944 is not permitted on TOB 22X encounters. 837 Institutional Companion Guide Version 38.0 July 2016. 84 TABLE 18 EDIPPS EDITS PREVENTION AND RESOLUTION STRATEGIES PHASE III (CONTINUED) Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22430 HCPCS Codes with Invalid TOB Reject Encounters with TOB 22X or 23X billed with the following HCPCS codes will receive this edit: G0446, G0442, G0443, G0444, and G0447. Scenario: Skilled Nursing Facility Summit Peak submits a TOB 22X encounter incorrectly containing a service with HCPCS code G0442 Annual Alcohol Misuse Screening 15 Minutes. The EDS will report error code 22430 because HCPCS code G0442 is not permitted on TOB 22X or 23X encounters. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 22375 Item Service Not Covered For RHC Reject All FQHC encounter service lines must contain only qualified FQHC services. Scenario: Top Care Health Plan submits a TOB 71X encounter incorrectly containing a service with revenue code 030X (Lab). The EDS will reject this encounter with error code 22375 because revenue code 030X is not permitted for submission in conjunction with TOB 71X. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 00800 Parent ICN Not Allowed for Original Reject An original, non-chart review encounter should not contain a a linked ICN. Scenario: Southwest Health Plan submitted an original, non-chart review encounter for Samuel Anderson. The original, non-chart review encounter contained a reference to ICN 4561234561233. The EDPS rejected the encounter because an original, non-chart review encounter should not contain an ICN. The original encounter should be resubmitted without the ICN. Edit Edit Description Edit Disposition Comprehensive Resolution Prevention 00805 Deleted Diagnosis Code Not Allowed Reject An unlinked chart review encounter should not be submitted with an indicator for deleting diagnosis code(s). OR A replacement chart review encounter for a previously accepted unlinked chart review encounter should not be submitted with an indicator for deleting diagnosis code(s). Scenario 1: Southwest Health Plan submitted an unlinked chart review encounter (i.e., a chart review encounter without an ICN reference). The original unlinked chart review contains the indicator for deleting a diagnosis code (REF01 EA REF02 8 ). The EDPS rejected the original, unlinked chart review encounter because no reference to an existing diagnosis code exists for deletion. Scenario 2: Southwest Health Plan submitted a replacement chart review encounter (frequency code 7 ) for a previously accepted unlinked chart review encounter (i.e., a chart review encounter without an ICN reference). The replacement chart review encounter includes an indicator for deleting a diagnosis code (REF01 EA REF 03 8 ). The EDPS rejected the replacement chart review encounter because EDPS does not allow deletion of a diagnosis from an unlinked chart review. To delete a diagnosis code from an unlinked chart review, the plan should void the existing unlinked chart review and resubmit without the diagnosis code. 837 Institutional Companion Guide Version 38.0 July 2016. 85 11.0 Submission of Default Data in a Limited Set of Circumstances MAOs and other entities may submit default | /kaggle/input/edi-db/Jul2016_CG_837I_5CR_081016.pdf | 5d1ff4d3761d8c9adb94936bf1b8ccf5 | 5d1ff4d3761d8c9adb94936bf1b8ccf5_26 |
a diagnosis code from an unlinked chart review, the plan should void the existing unlinked chart review and resubmit without the diagnosis code. 837 Institutional Companion Guide Version 38.0 July 2016. 85 11.0 Submission of Default Data in a Limited Set of Circumstances MAOs and other entities may submit default data in a limited set of circumstances, as identified and explained in Table 19. MAOs and other entities cannot submit default data for any circumstances other than those listed in the table below. CMS will use this interim approach for the submission of encounter data. In each circumstance where default information is submitted, MAOs and other entities are required to indicate in Loop 2300, NTE01 ADD, NTE02 the reason for the use of default information. If there are any questions regarding appropriate submission of default encounter data, MAOs and other entities should contact CMS for clarification. CMS will provide additional guidance concerning default data, as necessary. 11.1 Default Data Reason Codes (DDRC) Loop 2300, NTE02 allows for a maximum of 80 characters and one (1) iteration, which limits the submission of default data to one (1) message per encounter. In order to allow the population of multiple default data messages in the NTE02 field, CMS will use a three (3)-digit default data reason code (DDRC), which will map to the full default data message in the EDS. MAOs and other entities may submit multiple DDRCs with the appropriate three (3)-digit DDRC. Multiple DDRCs will be populated in a stringed sequence with no spaces or separators between each DDRC (i.e., 036040048). Table 19 provides the CMS approved situations for use of default data, the default data message, and the default data reason code. TABLE 19 DEFAULT DATA DEFAULT DATA DEFAULT DATA MESSAGE (NTE02) DEFAULT DATA REASON CODE Rejected Line Extraction REJECTED LINES CLAIM CHANGE DUE TO REJECTED LINE EXTRACTION 036 Medicaid Service Line Extraction MEDICAID CLAIM CHANGE DUE TO MEDICAID SERVICE LINE EXTRACTION 040 EDS Acceptable Anesthesia Modifier MODIFIER CLAIM CHANGE DUE TO EDS ACCEPTABLE ANESTHESIA MODIFIER 044 Default NPI for atypical providers NO NPI ON PROVIDER CLAIM 048 Default EIN for atypical providers NO EIN ON PROVIDER CLAIM 052 Chart Review Default Procedure Codes DEFAULT PROCEDURE CODES INCLUDED IN CHART REVIEW 056 True COB Default Adjudication Date DEFAULT TRUE COB PAYMENT ADJUDICATION DATE 060 Default NPIs should only be submitted to the EDS when the provider is considered atypical. An atypical provider is defined as an individual or business that bills for services rendered but does not meet the definition of a healthcare provider according to the NPI Final Rule 45 CFR 160.103 (e.g., non- emergency transportation providers, Meals on Wheels, personal care services, etc.). Default EIN should only be submitted to the EDS when the provider is considered atypical. 837 Institutional Companion Guide Version 38.0 July 2016. 86 12.0 Tier II Testing CMS developed the Tier II testing environment to ensure that MAOs and other entities have the opportunity to test a more inclusive sampling of their data. MAOs and other entities that have obtained end-to-end certification may submit Tier II testing data. CMS encourages MAOs and other entities to utilize the Tier II testing environment when they have questions or issues regarding edits received on EDFES Acknowledgement Reports or MAO-002 Encounter Data Processing Status reports; and when they have new submission scenarios that they wish to test prior to submitting to production. MAOs and other entities may submit chart review, replacement or void encounters to the Tier II testing environment only when the encounters are linked to previously submitted and accepted encounters in the Tier II testing environment. Encounter files submitted to the Tier II testing environment must comply with the TR3, CMS 5010 Edits Spreadsheets, and the CMS EDS Companion Guides, as well as the following requirements: Files must be identified using the Authorization Information Qualifier data element Additional Data Identification in the ISA segment (ISA01 03). Files must be identified using the Authorization Information data element to identify the Tier II indicator in the ISA segment (ISA02 8888888888). Files must be identified as Test in the ISA segment (ISA15 T). Submitters may send multiple Contract IDs per file Submitters may send multiple files for a Contract ID, as long as each file does not exceed 2,000 encounters per Contract ID If any Contract ID on a given file exceeds 2,000 encounters during the processing of the file, the entire file will be returned As with production encounter data, MAOs and other entities will receive the TA1, 999, and 277CA Acknowledgement Reports and the MAO-002 Reports. While not required, MAOs and other entities are strongly encouraged to correct errors identified on the reports and resubmit data. 837 Institutional Companion Guide Version 38.0 July 2016. 87 13.0 EDS Acronyms Table 20 below outlines a list of acronyms that are currently used in EDS documentation, materials, and reports distributed to MAOs and other entities. This list is not all-inclusive and should be considered a living document; as acronyms will be added, as required. TABLE 20 EDS ACRONYMS ACRONYM DEFINITION A N A ASC Ambulatory Surgery Center C N A CAH Critical Access Hospital CARC Claim Adjustment Reason Code CAS Claim Adjustment Segments CC Condition Code CCI Correct Coding Initiative CCN Claim Control Number CEM Common Edits and Enhancements Module CMG Case Mix Group CMS Centers for Medicare Medicaid Services CORF Comprehensive Outpatient Rehabilitation Facility CPO Care Plan Oversight CPT Current Procedural Terminology CRNA Certified Registered Nurse Anesthetist CSC Claim Status Code CSCC Claim Status Category Code CSSC Customer Service and Support Center D N A DCN Document Control Number DDRC Default Data Reason Code DME Durable Medical Equipment DMEPOS Durable Medical Equipment, Prosthetics, Orthotics, and Supplies DMERC Durable Medical Equipment Carrier DOB Date of Birth DOD Date of Death DOS Date(s) of Service E N A E M or E M Evaluation and Management EDDPPS Encounter Data DME Processing and Pricing Sub-System EDFES Encounter Data Front-End System EDI Electronic Data Interchange EDIPPS Encounter Data Institutional Processing and Pricing Sub-System EDPPPS Encounter Data Professional Processing and Pricing Sub-System EDPS Encounter Data Processing System EDR Encounter Data Record 837 Institutional Companion Guide Version 38.0 July | /kaggle/input/edi-db/Jul2016_CG_837I_5CR_081016.pdf | 5d1ff4d3761d8c9adb94936bf1b8ccf5 | 5d1ff4d3761d8c9adb94936bf1b8ccf5_27 |
Management EDDPPS Encounter Data DME Processing and Pricing Sub-System EDFES Encounter Data Front-End System EDI Electronic Data Interchange EDIPPS Encounter Data Institutional Processing and Pricing Sub-System EDPPPS Encounter Data Professional Processing and Pricing Sub-System EDPS Encounter Data Processing System EDR Encounter Data Record 837 Institutional Companion Guide Version 38.0 July 2016. 88 ACRONYM DEFINITION EDS Encounter Data System EIC Entity Identifier Code EODS Encounter Operational Data Store ESRD End Stage Renal Disease F N A FFS Fee-for-Service FQHC Federally Qualified Health Center FTP File Transfer Protocol FY Fiscal Year H N A HCPCS Healthcare Common Procedure Coding System HHA Home Health Agency HICN Health Information Claim Number HIPAA Health Insurance Portability and Accountability Act HIPPS Health Insurance Prospective Payment System I N A ICD-9CM ICD-10CM International Classification of Diseases, Clinical Modification (versions 9 and 10) ICN Interchange Control Number Internal Control Number IG Implementation Guide IPPS Inpatient Prospective Payment System IRF Inpatient Rehabilitation Facility M N A MAC Medicare Administrative Contractor MAO Medicare Advantage Organization MTP Multiple Technical Procedure MUE Medically Unlikely Edits N N A NCD National Coverage Determination NDC National Drug Codes NPI National Provider Identifier NCCI National Correct Coding Initiative NOC Not Otherwise Classified NPPES National Plan and Provider Enumeration System O N A OASIS Outcome and Assessment Information Set OBRA Omnibus Budget Reconciliation Act of 1993 OCE Outpatient Code Editor OIG Officer of Inspector General OPPS Outpatient Prospective Payment System P N A PACE Programs of All-Inclusive Care for the Elderly PHI Protected Health Information PIP Periodic Interim Payment 837 Institutional Companion Guide Version 38.0 July 2016. 89 ACRONYM DEFINITION POA Present on Admission POS Place of Service PPS Prospective Payment System R N A RAP Request for Anticipated Payment RHC Rural Health Clinic RNHCI Religious Nonmedical Health Care Institution RPCH Regional Primary Care Hospital S N A SME Subject Matter Expert SNF Skilled Nursing Facility SSA Social Security Administration T N A TARSC Technical Assistance Registration Service Center TCN Transaction Control Number TOB Type of Bill TOS Type of Service TPS Third Party Submitter V N A VC Value Code Z N A ZIP Code Zone Improvement Plan Code 837 Institutional Companion Guide Version 38.0 July 2016. 90 TABLE 21 - REVISION HISTORY VERSION DATE DESCRIPTION OF REVISION 2.1 9 9 2011 Baseline Version 3.0 11 16 2011 Release 2 4.0 12 9 2011 Release 3 5.0 12 20 2011 Release 4 6.0 3 8 2012 Release 5 7.0 5 9 2012 Release 6 8.0 6 22 2012 Release 7 9.0 8 31 2012 Release 8 10.0 9 26 2012 Release 9 11.0 11 2 2012 Release 10 12.0 11 26 2012 Release 11 13.0 12 21 2012 Release 12 14.0 1 21 2013 Release 13 15.0 2 26 2013 Release 14 16.0 3 20 2013 Release 15 17.0 4 15 2013 Release 16 18.0 5 20 2013 Release 17 19.0 6 24 2013 Release 18 20.0 7 25 2013 Release 19 21.0 9 26 2013 Release 20 22.0 10 25 2013 Release 21 23.0 11 22 2013 Release 22 24.0 12 27 2013 Release 23 25.0 1 20 2014 Release 24 26.0 2 21 2014 Release 25 27.0 3 18 2014 Release 26 28.0 4 28 2014 Release 27 837 Institutional Companion Guide Version 38.0 July 2016. 91 VERSION DATE DESCRIPTION OF REVISION 29.0 5 30 2014 Release 28 30.0 7 30 2014 Release 29 31.0 9 30 2014 Release 30 32.0 11 28 2014 Release 31 33.0 3 31 2015 Release 32 34.0 6 1 2015 Release 33 35.0 9 4 2015 Release 34 36.0 11 28 2015 Release 35 37.0 3 25 2016 Release 36 38.0 7 8 16 Section 3.1 Removed Limitations in Connectivity Table 38.0 7 8 16 Section 6.7, Table 10 Added new EDFES notification 38.0 7 8 16 Section 7.0, Table 11 Added new deactivated EDFES edit 38.0 7 8 16 Section 10.0, Table 14 Updated to include new edits (00800, 00805, and 22375). Updated disposition for error code 18730 to informational. 38.0 7 8 16 Section 10.0, Table 15 Updated to include new edits (00800,00805, 18730, and 22375). 38.0 7 8 16 Section 10.2.3, Table 17 Updated EDPPPS Edits Prevention and Resolution Strategies to include scenarios for new edits (00800, 00805 and 22375). | /kaggle/input/edi-db/Jul2016_CG_837I_5CR_081016.pdf | 5d1ff4d3761d8c9adb94936bf1b8ccf5 | 5d1ff4d3761d8c9adb94936bf1b8ccf5_28 |
Stedi maintains this guide based on public documentation from Health Partner Plans. Contact Health Partner Plans for official EDI specifications. To report any errors in this guide, please contact us. X12 837 Health Care Claim: Institutional (X223A3) X12 Release 5010 Revised May 24, 2023 Go to Stedi Network This X12 Transaction Set contains the format and establishes the data contents of the Health Care Claim Transaction Set (837) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to submit health care claim billing information, encounter information, or both, from providers of health care services to payers, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit health care claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and or payment of health care services within a specific health care insurance industry segment. For purposes of this standard, providers of health care products or services may include entities such as physicians, hospitals and other medical facilities or suppliers, dentists, and pharmacies, and entities providing medical information to meet regulatory requirements. The payer refers to a third party entity that pays claims or administers the insurance product or benefit or both. For example, a payer may be an insurance company, health maintenance organization (HMO), preferred provider organization (PPO), government agency (Medicare, Medicaid, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), etc.) or an entity such as a third party administrator (TPA) or third party organization (TPO) that may be contracted by one of those groups. A regulatory agency is an entity responsible, by law or rule, for administering and monitoring a statutory benefits program or a specific health care insurance industry segment. Delimiters Segment Element Component Repetition 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 1 579 View the latest version of this implementation guide as an interactive webpage https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional- x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX POWERED BY Build EDI implementation guides at stedi.com 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 2 579 Overview ISA - Interchange Control Header Max use 1 Required GS - Functional Group Header Max use 1 Required Heading ST 0050 Transaction Set Header Max use 1 Required BHT 0100 Beginning of Hierarchical Transaction Max use 1 Required Submitter Name Loop NM1 0200 Submitter Name Max use 1 Required PER 0450 Submitter EDI Contact Information Max use 2 Required Receiver Name Loop NM1 0200 Receiver Name Max use 1 Required Detail Billing Provider Hierarchical Level Loop HL 0010 Hierarchical Level Max use 1 Required PRV 0030 Billing Provider Specialty Information Max use 1 Optional CUR 0100 Foreign Currency Information Max use 1 Optional Billing Provider Name Loop NM1 0150 Billing Provider Name Max use 1 Required N3 0250 Billing Provider Address Max use 1 Required N4 0300 Billing Provider City, State, ZIP Code Max use 1 Required REF 0350 Billing Provider Tax Identification Max use 1 Required PER 0400 Billing Provider Contact Information Max use 2 Optional Pay-to Address Name Loop NM1 0150 Pay-to Address Name Max use 1 Required N3 0250 Pay-to Address - ADDRESS Max use 1 Required N4 0300 Pay-To Address City, State, ZIP Code Max use 1 Required Pay-To Plan Name Loop 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 3 579 NM1 0150 Pay-To Plan Name Max use 1 Required N3 0250 Pay-to Plan Address Max use 1 Required N4 0300 Pay-To Plan City, State, ZIP Code Max use 1 Required REF 0350 Pay-to Plan Secondary Identification Max use 1 Optional REF 0350 Pay-To Plan Tax Identification Number Max use 1 Required Subscriber Hierarchical Level Loop HL 0010 Hierarchical Level Max use 1 Required SBR 0050 Subscriber Information Max use 1 Required Subscriber Name Loop NM1 0150 Subscriber Name Max use 1 Required N3 0250 Subscriber Address Max use 1 Optional N4 0300 Subscriber City, State, ZIP Code Max use 1 Optional DMG 0320 Subscriber Demographic Information Max use 1 Optional REF 0350 Property and Casualty Claim Number Max use 1 Optional REF 0350 Subscriber Secondary Identification Max use 1 Optional Payer Name Loop NM1 0150 Payer Name Max use 1 Required N3 0250 Payer Address Max use 1 Optional N4 0300 Payer City, State, ZIP Code Max use 1 Optional REF 0350 Billing Provider Secondary Identification Max use 1 Optional REF 0350 Payer Secondary Identification Max use 3 Optional Claim Information Loop CLM 1300 Claim Information Max use 1 Required DTP 1350 Admission Date Hour Max use 1 Optional DTP 1350 Date - Repricer Received Date Max use 1 Optional DTP 1350 Discharge Hour Max use 1 Optional DTP 1350 Statement Dates Max use 1 Required CL1 1400 Institutional Claim Code Max use 1 Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 4 579 PWK 1550 Claim Supplemental Information Max use 10 Optional CN1 1600 Contract Information Max use 1 Optional AMT 1750 Patient Estimated Amount Due Max use 1 Optional REF 1800 Adjusted Repriced Claim Number Max use 1 Optional REF 1800 Auto Accident State Max use 1 Optional REF 1800 Claim Identifier For Transmission Intermediaries Max use 1 Optional REF 1800 Demonstration Project Identifier Max use 1 Optional REF 1800 Investigational Device Exemption Number Max use 5 Optional REF 1800 Medical Record Number Max use 1 Optional REF 1800 Payer Claim Control Number Max use 1 Optional REF 1800 Peer Review Organization (PRO) Approval Number Max use 1 Optional REF 1800 Prior Authorization Max use 1 Optional REF 1800 Referral Number Max use 1 Optional REF 1800 Repriced Claim Number Max use 1 Optional REF 1800 Service Authorization Exception Code Max use | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_0 |
Number Max use 1 Optional REF 1800 Peer Review Organization (PRO) Approval Number Max use 1 Optional REF 1800 Prior Authorization Max use 1 Optional REF 1800 Referral Number Max use 1 Optional REF 1800 Repriced Claim Number Max use 1 Optional REF 1800 Service Authorization Exception Code Max use 1 Optional K3 1850 File Information Max use 10 Optional NTE 1900 Billing Note Max use 1 Optional NTE 1900 Claim Note Max use 10 Optional CRC 2200 EPSDT Referral Max use 1 Optional HI 2310 Admitting Diagnosis Max use 1 Optional HI 2310 Condition Information Max use 2 Optional HI 2310 Diagnosis Related Group (DRG) Information Max use 1 Optional HI 2310 External Cause of Injury Max use 1 Optional HI 2310 Occurrence Information Max use 2 Optional HI 2310 Occurrence Span Information Max use 2 Optional HI 2310 Other Diagnosis Information Max use 2 Optional HI 2310 Other Procedure Information Max use 2 Optional HI 2310 Patient's Reason For Visit Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 5 579 HI 2310 Principal Diagnosis Max use 1 Required HI 2310 Principal Procedure Information Max use 1 Optional HI 2310 Treatment Code Information Max use 2 Optional HI 2310 Value Information Max use 2 Optional HCP 2410 Claim Pricing Repricing Information Max use 1 Optional Attending Provider Name Loop NM1 2500 Attending Provider Name Max use 1 Required PRV 2550 Attending Provider Specialty Information Max use 1 Optional REF 2710 Attending Provider Secondary Identification Max use 4 Optional Operating Physician Name Loop NM1 2500 Operating Physician Name Max use 1 Required REF 2710 Operating Physician Secondary Identification Max use 4 Optional Other Operating Physician Name Loop NM1 2500 Other Operating Physician Name Max use 1 Required REF 2710 Other Operating Physician Secondary Identification Max use 4 Optional Rendering Provider Name Loop NM1 2500 Rendering Provider Name Max use 1 Required REF 2710 Rendering Provider Secondary Identification Max use 4 Optional Service Facility Location Name Loop NM1 2500 Service Facility Location Name Max use 1 Required N3 2650 Service Facility Location Address Max use 1 Required N4 2700 Service Facility Location City, State, ZIP Code Max use 1 Required REF 2710 Service Facility Location Secondary Identification Max use 3 Optional Referring Provider Name Loop NM1 2500 Referring Provider Name Max use 1 Required REF 2710 Referring Provider Secondary Identification Max use 3 Optional Other Subscriber Information Loop 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 6 579 SBR 2900 Other Subscriber Information Max use 1 Required CAS 2950 Claim Level Adjustments Max use 5 Optional AMT 3000 Coordination of Benefits (COB) Payer Paid Amount Max use 1 Optional AMT 3000 Coordination of Benefits (COB) Total Non- Covered Amount Max use 1 Optional AMT 3000 Remaining Patient Liability Max use 1 Optional OI 3100 Other Insurance Coverage Information Max use 1 Required MIA 3150 Inpatient Adjudication Information Max use 1 Optional MOA 3200 Outpatient Adjudication Information Max use 1 Optional Other Subscriber Name Loop NM1 3250 Other Subscriber Name Max use 1 Required N3 3320 Other Subscriber Address Max use 1 Optional N4 3400 Other Subscriber City, State, ZIP Code Max use 1 Optional REF 3550 Other Subscriber Secondary Identification Max use 2 Optional Other Payer Name Loop NM1 3250 Other Payer Name Max use 1 Required N3 3320 Other Payer Address Max use 1 Optional N4 3400 Other Payer City, State, ZIP Code Max use 1 Optional DTP 3500 Claim Check or Remittance Date Max use 1 Optional REF 3550 Other Payer Claim Adjustment Indicator Max use 1 Optional REF 3550 Other Payer Claim Control Number Max use 1 Optional REF 3550 Other Payer Prior Authorization Number Max use 1 Optional REF 3550 Other Payer Referral Number Max use 1 Optional REF 3550 Other Payer Secondary Identifier Max use 2 Optional Other Payer Attending Provider Loop NM1 3250 Other Payer Attending Provider Max use 1 Required REF 3550 Other Payer Attending Provider Secondary Identification Max use 4 Required Other Payer Operating Physician Loop 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 7 579 NM1 3250 Other Payer Operating Physician Max use 1 Required REF 3550 Other Payer Operating Physician Secondary Identification Max use 4 Required Other Payer Other Operating Physician Loop NM1 3250 Other Payer Other Operating Physician Max use 1 Required REF 3550 Other Payer Other Operating Physician Secondary Identification Max use 4 Required Other Payer Service Facility Location Loop NM1 3250 Other Payer Service Facility Location Max use 1 Required REF 3550 Other Payer Service Facility Location Secondary Identification Max use 3 Required Other Payer Rendering Provider Name Loop NM1 3250 Other Payer Rendering Provider Name Max use 1 Required REF 3550 Other Payer Rendering Provider Secondary Identification Max use 4 Required Other Payer Referring Provider Loop NM1 3250 Other Payer Referring Provider Max use 1 Required REF 3550 Other Payer Referring Provider Secondary Identification Max use 3 Required Other Payer Billing Provider Loop NM1 3250 Other Payer Billing Provider Max use 1 Required REF 3550 Other Payer Billing Provider Secondary Identification Max use 2 Required Service Line Number Loop LX 3650 Service Line Number Max use 1 Required SV2 3750 Institutional Service Line Max use 1 Required PWK 4200 Line Supplemental Information Max use 10 Optional DTP 4550 Date - Service Date Max use 1 Optional REF 4700 Adjusted Repriced Line Item Reference Number Max use 1 Optional REF 4700 Line Item Control Number Max use 1 Optional REF 4700 Repriced Line Item Reference Number Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 8 579 AMT 4750 Facility Tax Amount Max use 1 Optional AMT 4750 Service Tax Amount Max use 1 Optional NTE 4850 Third Party Organization Notes Max use | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_1 |
AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 8 579 AMT 4750 Facility Tax Amount Max use 1 Optional AMT 4750 Service Tax Amount Max use 1 Optional NTE 4850 Third Party Organization Notes Max use 1 Optional HCP 4920 Line Pricing Repricing Information Max use 1 Optional Drug Identification Loop LIN 4930 Drug Identification Max use 1 Required CTP 4940 Drug Quantity Max use 1 Required REF 4950 Prescription or Compound Drug Association Number Max use 1 Optional Operating Physician Name Loop NM1 5000 Operating Physician Name Max use 1 Required REF 5250 Operating Physician Secondary Identification Max use 20 Optional Other Operating Physician Name Loop NM1 5000 Other Operating Physician Name Max use 1 Required REF 5250 Other Operating Physician Secondary Identification Max use 20 Optional Rendering Provider Name Loop NM1 5000 Rendering Provider Name Max use 1 Required REF 5250 Rendering Provider Secondary Identification Max use 20 Optional Referring Provider Name Loop NM1 5000 Referring Provider Name Max use 1 Required REF 5250 Referring Provider Secondary Identification Max use 20 Optional Line Adjudication Information Loop SVD 5400 Line Adjudication Information Max use 1 Required CAS 5450 Line Adjustment Max use 5 Optional DTP 5500 Line Check or Remittance Date Max use 1 Required AMT 5505 Remaining Patient Liability Max use 1 Optional Patient Hierarchical Level Loop HL 0010 Hierarchical Level Max use 1 Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 9 579 PAT 0070 Patient Information Max use 1 Required Patient Name Loop NM1 0150 Patient Name Max use 1 Required N3 0250 Patient Address Max use 1 Required N4 0300 Patient City, State, ZIP Code Max use 1 Required DMG 0320 Patient Demographic Information Max use 1 Required REF 0350 Property and Casualty Claim Number Max use 1 Optional REF 0350 Property and Casualty Patient Identifier Max use 1 Optional Claim Information Loop CLM 1300 Claim Information Max use 1 Required DTP 1350 Admission Date Hour Max use 1 Optional DTP 1350 Date - Repricer Received Date Max use 1 Optional DTP 1350 Discharge Hour Max use 1 Optional DTP 1350 Statement Dates Max use 1 Required CL1 1400 Institutional Claim Code Max use 1 Required PWK 1550 Claim Supplemental Information Max use 10 Optional CN1 1600 Contract Information Max use 1 Optional AMT 1750 Patient Estimated Amount Due Max use 1 Optional REF 1800 Adjusted Repriced Claim Number Max use 1 Optional REF 1800 Auto Accident State Max use 1 Optional REF 1800 Claim Identifier For Transmission Intermediaries Max use 1 Optional REF 1800 Demonstration Project Identifier Max use 1 Optional REF 1800 Investigational Device Exemption Number Max use 5 Optional REF 1800 Medical Record Number Max use 1 Optional REF 1800 Payer Claim Control Number Max use 1 Optional REF 1800 Peer Review Organization (PRO) Approval Number Max use 1 Optional REF 1800 Prior Authorization Max use 1 Optional REF 1800 Referral Number Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 10 579 REF 1800 Repriced Claim Number Max use 1 Optional REF 1800 Service Authorization Exception Code Max use 1 Optional K3 1850 File Information Max use 10 Optional NTE 1900 Billing Note Max use 1 Optional NTE 1900 Claim Note Max use 10 Optional CRC 2200 EPSDT Referral Max use 1 Optional HI 2310 Admitting Diagnosis Max use 1 Optional HI 2310 Condition Information Max use 2 Optional HI 2310 Diagnosis Related Group (DRG) Information Max use 1 Optional HI 2310 External Cause of Injury Max use 1 Optional HI 2310 Occurrence Information Max use 2 Optional HI 2310 Occurrence Span Information Max use 2 Optional HI 2310 Other Diagnosis Information Max use 2 Optional HI 2310 Other Procedure Information Max use 2 Optional HI 2310 Patient's Reason For Visit Max use 1 Optional HI 2310 Principal Diagnosis Max use 1 Required HI 2310 Principal Procedure Information Max use 1 Optional HI 2310 Treatment Code Information Max use 2 Optional HI 2310 Value Information Max use 2 Optional HCP 2410 Claim Pricing Repricing Information Max use 1 Optional Attending Provider Name Loop NM1 2500 Attending Provider Name Max use 1 Required PRV 2550 Attending Provider Specialty Information Max use 1 Optional REF 2710 Attending Provider Secondary Identification Max use 4 Optional Operating Physician Name Loop NM1 2500 Operating Physician Name Max use 1 Required REF 2710 Operating Physician Secondary Identification Max use 4 Optional Other Operating Physician Name Loop NM1 2500 Other Operating Physician Name Max use 1 Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 11 579 REF 2710 Other Operating Physician Secondary Identification Max use 4 Optional Rendering Provider Name Loop NM1 2500 Rendering Provider Name Max use 1 Required REF 2710 Rendering Provider Secondary Identification Max use 4 Optional Service Facility Location Name Loop NM1 2500 Service Facility Location Name Max use 1 Required N3 2650 Service Facility Location Address Max use 1 Required N4 2700 Service Facility Location City, State, ZIP Code Max use 1 Required REF 2710 Service Facility Location Secondary Identification Max use 3 Optional Referring Provider Name Loop NM1 2500 Referring Provider Name Max use 1 Required REF 2710 Referring Provider Secondary Identification Max use 3 Optional Other Subscriber Information Loop SBR 2900 Other Subscriber Information Max use 1 Required CAS 2950 Claim Level Adjustments Max use 5 Optional AMT 3000 Coordination of Benefits (COB) Payer Paid Amount Max use 1 Optional AMT 3000 Coordination of Benefits (COB) Total Non- Covered Amount Max use 1 Optional AMT 3000 Remaining Patient Liability Max use 1 Optional OI 3100 Other Insurance Coverage Information Max use 1 Required MIA 3150 Inpatient Adjudication Information Max use 1 Optional MOA 3200 Outpatient Adjudication Information Max use 1 Optional Other Subscriber Name Loop NM1 3250 Other Subscriber Name Max use | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_2 |
1 Optional AMT 3000 Remaining Patient Liability Max use 1 Optional OI 3100 Other Insurance Coverage Information Max use 1 Required MIA 3150 Inpatient Adjudication Information Max use 1 Optional MOA 3200 Outpatient Adjudication Information Max use 1 Optional Other Subscriber Name Loop NM1 3250 Other Subscriber Name Max use 1 Required N3 3320 Other Subscriber Address Max use 1 Optional N4 3400 Other Subscriber City, State, ZIP Code Max use 1 Optional REF 3550 Other Subscriber Secondary Identification Max use 2 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 12 579 Other Payer Name Loop NM1 3250 Other Payer Name Max use 1 Required N3 3320 Other Payer Address Max use 1 Optional N4 3400 Other Payer City, State, ZIP Code Max use 1 Optional DTP 3500 Claim Check or Remittance Date Max use 1 Optional REF 3550 Other Payer Claim Adjustment Indicator Max use 1 Optional REF 3550 Other Payer Claim Control Number Max use 1 Optional REF 3550 Other Payer Prior Authorization Number Max use 1 Optional REF 3550 Other Payer Referral Number Max use 1 Optional REF 3550 Other Payer Secondary Identifier Max use 2 Optional Other Payer Attending Provider Loop NM1 3250 Other Payer Attending Provider Max use 1 Required REF 3550 Other Payer Attending Provider Secondary Identification Max use 4 Required Other Payer Operating Physician Loop NM1 3250 Other Payer Operating Physician Max use 1 Required REF 3550 Other Payer Operating Physician Secondary Identification Max use 4 Required Other Payer Other Operating Physician Loop NM1 3250 Other Payer Other Operating Physician Max use 1 Required REF 3550 Other Payer Other Operating Physician Secondary Identification Max use 4 Required Other Payer Service Facility Location Loop NM1 3250 Other Payer Service Facility Location Max use 1 Required REF 3550 Other Payer Service Facility Location Secondary Identification Max use 3 Required Other Payer Rendering Provider Name Loop NM1 3250 Other Payer Rendering Provider Name Max use 1 Required REF 3550 Other Payer Rendering Provider Secondary Identification Max use 4 Required Other Payer Referring Provider Loop 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 13 579 NM1 3250 Other Payer Referring Provider Max use 1 Required REF 3550 Other Payer Referring Provider Secondary Identification Max use 3 Required Other Payer Billing Provider Loop NM1 3250 Other Payer Billing Provider Max use 1 Required REF 3550 Other Payer Billing Provider Secondary Identification Max use 2 Required Service Line Number Loop LX 3650 Service Line Number Max use 1 Required SV2 3750 Institutional Service Line Max use 1 Required PWK 4200 Line Supplemental Information Max use 10 Optional DTP 4550 Date - Service Date Max use 1 Optional REF 4700 Adjusted Repriced Line Item Reference Number Max use 1 Optional REF 4700 Line Item Control Number Max use 1 Optional REF 4700 Repriced Line Item Reference Number Max use 1 Optional AMT 4750 Facility Tax Amount Max use 1 Optional AMT 4750 Service Tax Amount Max use 1 Optional NTE 4850 Third Party Organization Notes Max use 1 Optional HCP 4920 Line Pricing Repricing Information Max use 1 Optional Drug Identification Loop LIN 4930 Drug Identification Max use 1 Required CTP 4940 Drug Quantity Max use 1 Required REF 4950 Prescription or Compound Drug Association Number Max use 1 Optional Operating Physician Name Loop NM1 5000 Operating Physician Name Max use 1 Required REF 5250 Operating Physician Secondary Identification Max use 20 Optional Other Operating Physician Name Loop NM1 5000 Other Operating Physician Name Max use 1 Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 14 579 REF 5250 Other Operating Physician Secondary Identification Max use 20 Optional Rendering Provider Name Loop NM1 5000 Rendering Provider Name Max use 1 Required REF 5250 Rendering Provider Secondary Identification Max use 20 Optional Referring Provider Name Loop NM1 5000 Referring Provider Name Max use 1 Required REF 5250 Referring Provider Secondary Identification Max use 20 Optional Line Adjudication Information Loop SVD 5400 Line Adjudication Information Max use 1 Required CAS 5450 Line Adjustment Max use 5 Optional DTP 5500 Line Check or Remittance Date Max use 1 Required AMT 5505 Remaining Patient Liability Max use 1 Optional SE 5550 Transaction Set Trailer Max use 1 Required GE - Functional Group Trailer Max use 1 Required IEA - Interchange Control Trailer Max use 1 Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 15 579 ISA Interchange Control Header To start and identify an interchange of zero or more functional groups and interchange- related control segments Example ISA 00 00 XX XXXXXXXXXXXXXX X XX XXXXXXXXXXXXXXX 250131 2345 00501 00000000 0 X X Max use 1 Required ISA-01 I01 Authorization Information Qualifier Identifier (ID) Required Code identifying the type of information in the Authorization Information 00 No Authorization Information Present (No Meaningful Information in I02) ISA-02 I02 Authorization Information Min 10 Max 10 String (AN) Required Information used for additional identification or authorization of the interchange sender or the data in the interchange; the type of information is set by the Authorization Information Qualifier (I01) ISA-03 I03 Security Information Qualifier Identifier (ID) Required Code identifying the type of information in the Security Information 00 No Security Information Present (No Meaningful Information in I04) ISA-04 I04 Security Information Min 10 Max 10 String (AN) Required This is used for identifying the security information about the interchange sender or the data in the interchange; the type of information is set by the Security Information Qualifier (I03) ISA-05 I05 Interchange ID Qualifier Min 2 Max 2 Identifier (ID) Required Code indicating the system method of code structure used to designate the sender or receiver ID element being qualified Codes ISA-06 I06 Interchange Sender ID Min 15 Max 15 String (AN) Required 1 30 25, 11:52 AM Health | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_3 |
ISA-05 I05 Interchange ID Qualifier Min 2 Max 2 Identifier (ID) Required Code indicating the system method of code structure used to designate the sender or receiver ID element being qualified Codes ISA-06 I06 Interchange Sender ID Min 15 Max 15 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 16 579 Identification code published by the sender for other parties to use as the receiver ID to route data to them; the sender always codes this value in the sender ID element ISA-07 I05 Interchange ID Qualifier Min 2 Max 2 Identifier (ID) Required Code indicating the system method of code structure used to designate the sender or receiver ID element being qualified Codes ISA-08 I07 Interchange Receiver ID Min 15 Max 15 String (AN) Required Identification code published by the receiver of the data; When sending, it is used by the sender as their sending ID, thus other parties sending to them will use this as a receiving ID to route data to them ISA-09 I08 Interchange Date YYMMDD format Date (DT) Required Date of the interchange ISA-10 I09 Interchange Time HHMM format Time (TM) Required Time of the interchange ISA-11 I65 Repetition Separator Min 1 Max 1 String (AN) Required Type is not applicable; the repetition separator is a delimiter and not a data element; this field provides the delimiter used to separate repeated occurrences of a simple data element or a composite data structure; this value must be different than the data element separator, component element separator, and the segment terminator Repetition Separator ISA-12 I11 Interchange Control Version Number Identifier (ID) Required Code specifying the version number of the interchange control segments 00501 Standards Approved for Publication by ASC X12 Procedures Review Board through October 2003 ISA-13 I12 Interchange Control Number Min 9 Max 9 Numeric (N0) Required A control number assigned by the interchange sender ISA-14 I13 Acknowledgment Requested Min 1 Max 1 Identifier (ID) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 17 579 Code indicating sender's request for an interchange acknowledgment 0 No Interchange Acknowledgment Requested 1 Interchange Acknowledgment Requested (TA1) ISA-15 I14 Interchange Usage Indicator Min 1 Max 1 Identifier (ID) Required Code indicating whether data enclosed by this interchange envelope is test, production or information I Information P Production Data T Test Data ISA-16 I15 Component Element Separator Min 1 Max 1 String (AN) Required Type is not applicable; the component element separator is a delimiter and not a data element; this field provides the delimiter used to separate component data elements within a composite data structure; this value must be different than the data element separator and the segment terminator Component Element Separator 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 18 579 GS Functional Group Header To indicate the beginning of a functional group and to provide control information Example GS HC XXXXXXX XXXX 20250131 0038 00000000 X 00501 0X223A3 Max use 1 Required GS-01 479 Functional Identifier Code Identifier (ID) Required Code identifying a group of application related transaction sets HC Health Care Claim (837) GS-02 142 Application Sender's Code Min 2 Max 15 String (AN) Required Code identifying party sending transmission; codes agreed to by trading partners GS-03 124 Application Receiver's Code Min 2 Max 15 String (AN) Required Code identifying party receiving transmission; codes agreed to by trading partners GS-04 373 Date CCYYMMDD format Date (DT) Required Date expressed as CCYYMMDD where CC represents the first two digits of the calendar year GS-05 337 Time HHMM, HHMMSS, HHMMSSD, or HHMMSSDD format Time (TM) Required Time expressed in 24-hour clock time as follows: HHMM, or HHMMSS, or HHMMSSD, or HHMMSSDD, where H hours (00-23), M minutes (00-59), S integer seconds (00-59) and DD decimal seconds; decimal seconds are expressed as follows: D tenths (0-9) and DD hundredths (00-99) GS-06 28 Group Control Number Min 1 Max 9 Numeric (N0) Required Assigned number originated and maintained by the sender GS-07 455 Responsible Agency Code Min 1 Max 2 Identifier (ID) Required Code identifying the issuer of the standard; this code is used in conjunction with Data Element 480 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 19 579 T Transportation Data Coordinating Committee (TDCC) X Accredited Standards Committee X12 GS-08 480 Version Release Industry Identifier Code String (AN) Required Code indicating the version, release, subrelease, and industry identifier of the EDI standard being used, including the GS and GE segments; if code in DE455 in GS segment is X, then in DE 480 positions 1-3 are the version number; positions 4-6 are the release and subrelease, level of the version; and positions 7-12 are the industry or trade association identifiers (optionally assigned by user); if code in DE455 in GS segment is T, then other formats are allowed 005010X223A3 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 20 579 Heading ST 0050 Heading ST Transaction Set Header To indicate the start of a transaction set and to assign a control number Example ST 837 0001 005010X223A3 Max use 1 Required ST-01 143 Transaction Set Identifier Code Identifier (ID) Required Code uniquely identifying a Transaction Set The transaction set identifier (ST01) is used by the translation routines of the interchange partners to select the appropriate transaction set definition (e.g., 810 selects the Invoice Transaction Set). 837 Health Care Claim ST-02 329 Transaction Set Control Number Min 4 Max 9 Numeric (N) Required Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set Usage notes The Transaction Set Control Number in ST02 and SE02 must be identical. The number must | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_4 |
329 Transaction Set Control Number Min 4 Max 9 Numeric (N) Required Identifying control number that must be unique within the transaction set functional group assigned by the originator for a transaction set Usage notes The Transaction Set Control Number in ST02 and SE02 must be identical. The number must be unique within a specific interchange (ISA-IEA), but can repeat in other interchanges. ST-03 1705 Version, Release, or Industry Identifier String (AN) Required Reference assigned to identify Implementation Convention The implementation convention reference (ST03) is used by the translation routines of the interchange partners to select the appropriate implementation convention to match the transaction set definition. When used, this implementation convention reference takes precedence over the implementation reference specified in the GS08. Usage notes This element must be populated with the guide identifier named in Section 1.2. This field contains the same value as GS08. Some translator products strip off the ISA and GS segments prior to application (ST-SE) processing. Providing the information from the GS08 at this level will ensure that the appropriate application mapping is used at translation time. 005010X223A3 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 21 579 BHT 0100 Heading BHT Beginning of Hierarchical Transaction To define the business hierarchical structure of the transaction set and identify the business application purpose and reference data, i.e., number, date, and time Usage notes The second example denotes the case where the entire transaction set contains ENCOUNTERS. Example BHT 0019 00 XXXX 20250131 0823 RP Max use 1 Required BHT-01 1005 Hierarchical Structure Code Identifier (ID) Required Code indicating the hierarchical application structure of a transaction set that utilizes the HL segment to define the structure of the transaction set 0019 Information Source, Subscriber, Dependent BHT-02 353 Transaction Set Purpose Code Identifier (ID) Required Code identifying purpose of transaction set Usage notes BHT02 is intended to convey the electronic transmission status of the 837 batch contained in this ST-SE envelope. The terms "original" and "reissue" refer to the electronic transmission status of the 837 batch, not the billing status. 00 Original Original transmissions are transmissions which have never been sent to the receiver. BHT-03 127 Originator Application Transaction Identifier String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier BHT03 is the number assigned by the originator to identify the transaction within the originator's business application system. Usage notes The inventory file number of the transmission assigned by the submitter's system. This number operates as a batch control number. This field is limited to 30 characters. BHT-04 373 Transaction Set Creation Date CCYYMMDD format Date (DT) Required Date expressed as CCYYMMDD where CC represents the first two digits of the calendar 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 22 579 year BHT04 is the date the transaction was created within the business application system. Usage notes This is the date that the original submitter created the claim file from their business application system. BHT-05 337 Transaction Set Creation Time Time (TM) Required HHMM, HHMMSS, HHMMSSD, or HHMMSSDD format Time expressed in 24-hour clock time as follows: HHMM, or HHMMSS, or HHMMSSD, or HHMMSSDD, where H hours (00-23), M minutes (00-59), S integer seconds (00-59) and DD decimal seconds; decimal seconds are expressed as follows: D tenths (0-9) and DD hundredths (00-99) BHT05 is the time the transaction was created within the business application system. Usage notes This is the time that the original submitter created the claim file from their business application system. BHT-06 640 Claim Identifier Identifier (ID) Required Code specifying the type of transaction 31 Subrogation Demand The subrogation demand code is only for use by state Medicaid agencies performing post payment recovery claiming with willing trading partners. NOTE: At the time of this writing, Subrogation Demand is not a HIPAA mandated use of the 837 transaction. CH Chargeable Use CH when the transaction contains only fee for service claims or claims with at least one chargeable line item. If it is not clear whether a transaction contains claims or capitated encounters, or if the transaction contains a mix of claims and capitated encounters, use CH. RP Reporting Use RP when the entire ST-SE envelope contains only capitated encounters. Use RP when the transaction is being sent to an entity (usually not a payer or a normal provider payer transmission intermediary) for purposes other than adjudication of a claim. Such an entity could be a state health data agency which is using the 837 for health data reporting purposes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 23 579 1000A Submitter Name Loop Max 1 Required Variants (all may be used) Receiver Name Loop NM1 0200 Heading Submitter Name Loop NM1 Submitter Name To supply the full name of an individual or organizational entity Usage notes The submitter is the entity responsible for the creation and formatting of this transaction. Example NM1 41 2 EMDEON XXXXX XX 46 133052274 Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 41 Submitter NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 2 Non-Person Entity NM1-03 1035 Submitter Last or Organization Name String (AN) Required Individual last name or organizational name EMDEON NM1-04 1036 Submitter First Name Min 1 Max 35 String (AN) Optional Individual first name NM1-05 1037 Submitter Middle Name or Initial Min 1 Max 25 String (AN) Optional Individual middle name or initial NM1-08 66 Identification Code Qualifier Identifier (ID) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 24 579 Code designating the system method of code structure used | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_5 |
Individual middle name or initial NM1-08 66 Identification Code Qualifier Identifier (ID) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 24 579 Code designating the system method of code structure used for Identification Code (67) 46 Electronic Transmitter Identification Number (ETIN) Established by trading partner agreement NM1-09 67 Submitter Identifier String (AN) Required Code identifying a party or other code 133052274 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 25 579 PER 0450 Heading Submitter Name Loop PER Submitter EDI Contact Information To identify a person or office to whom administrative communications should be directed Usage notes When the communication number represents a telephone number in the United States and other countries using the North American Dialing Plan (for voice, data, fax, etc.), the communication number must always include the area code and phone number using the format AAABBBCCCC where AAA is the area code, BBB is the telephone number prefix, and CCCC is the telephone number. Therefore, the following telephone number (555) 555-1234 would be represented as 5555551234. Do not submit long distance access numbers, such as "1", in the telephone number. Telephone extensions, when applicable, must be submitted in the next element immediately following the telephone number. When submitting telephone extensions, only submit the numeric extension. Do not include data that indicates an extension, such as "ext" or "x-". The contact information in this segment identifies the person in the submitter organization who deals with data transmission issues. If data transmission problems arise, this is the person to contact in the submitter organization. There are 2 repetitions of the PER segment to allow for six possible combinations of communication numbers including extensions. Example PER IC EMDEON CUSTOMER SOLUTIONS TE 8008456592 E M XXXXX EM XXXX If either Communication Number Qualifier (PER-05) or Communication Number (PER-06) is present, then the other is required If either Communication Number Qualifier (PER-07) or Communication Number (PER-08) is present, then the other is required Max use 2 Required PER-01 366 Contact Function Code Identifier (ID) Required Code identifying the major duty or responsibility of the person or group named IC Information Contact PER-02 93 Submitter Contact Name String (AN) Optional Free-form name EMDEON CUSTOMER SOLUTIONS PER-03 365 Communication Number Qualifier Identifier (ID) Required Code identifying the type of communication number TE Telephone PER-04 364 Communication Number String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 26 579 1000A Submitter Name Loop end Complete communications number including country or area code when applicable 8008456592 PER-05 365 Communication Number Qualifier Identifier (ID) Optional Code identifying the type of communication number EM Electronic Mail EX Telephone Extension FX Facsimile TE Telephone PER-06 364 Communication Number Min 1 Max 256 String (AN) Optional Complete communications number including country or area code when applicable PER-07 365 Communication Number Qualifier Identifier (ID) Optional Code identifying the type of communication number EM Electronic Mail EX Telephone Extension FX Facsimile TE Telephone PER-08 364 Communication Number Min 1 Max 256 String (AN) Optional Complete communications number including country or area code when applicable 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 27 579 1000B Receiver Name Loop Max 1 Required Variants (all may be used) Submitter Name Loop NM1 0200 Heading Receiver Name Loop NM1 Receiver Name To supply the full name of an individual or organizational entity Example NM1 40 2 XX 46 801420001 Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 40 Receiver NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 2 Non-Person Entity NM1-03 1035 Receiver Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-08 66 Identification Code Qualifier Identifier (ID) Required Code designating the system method of code structure used for Identification Code (67) 46 Electronic Transmitter Identification Number (ETIN) NM1-09 67 Receiver Primary Identifier String (AN) Required Code identifying a party or other code 801420001 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 28 579 1000B Receiver Name Loop end Heading end 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 29 579 Detail 2000A Billing Provider Hierarchical Level Loop Max 1 Required HL 0010 Detail Billing Provider Hierarchical Level Loop HL Hierarchical Level To identify dependencies among and the content of hierarchically related groups of data segments Example HL 1 20 1 Max use 1 Required HL-01 628 Hierarchical ID Number Min 1 Max 12 String (AN) Required A unique number assigned by the sender to identify a particular data segment in a hierarchical structure HL01 shall contain a unique alphanumeric number for each occurrence of the HL segment in the transaction set. For example, HL01 could be used to indicate the number of occurrences of the HL segment, in which case the value of HL01 would be "1" for the initial HL segment and would be incremented by one in each subsequent HL segment within the transaction. HL-03 735 Hierarchical Level Code Identifier (ID) Required Code defining the characteristic of a level in a hierarchical structure HL03 indicates the context of the series of segments following the current HL segment up to the next occurrence of an HL segment in the transaction. For example, HL03 is used to indicate that subsequent segments in the HL loop form a logical grouping of data referring to shipment, order, or item-level information. 20 Information Source HL-04 736 Hierarchical Child Code Identifier (ID) Optional Code indicating if there are hierarchical child | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_6 |
HL segment in the transaction. For example, HL03 is used to indicate that subsequent segments in the HL loop form a logical grouping of data referring to shipment, order, or item-level information. 20 Information Source HL-04 736 Hierarchical Child Code Identifier (ID) Optional Code indicating if there are hierarchical child data segments subordinate to the level being described HL04 indicates whether or not there are subordinate (or child) HL segments related to the current HL segment. 1 Additional Subordinate HL Data Segment in This Hierarchical Structure. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 30 579 PRV 0030 Detail Billing Provider Hierarchical Level Loop PRV Billing Provider Specialty Information To specify the identifying characteristics of a provider Usage notes Required when the payer's adjudication is known to be impacted by the provider taxonomy code. If not required by this implementation guide, do not send. Example PRV BI PXC XX Max use 1 Optional PRV-01 1221 Provider Code Identifier (ID) Required Code identifying the type of provider BI Billing PRV-02 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification PXC Health Care Provider Taxonomy Code PRV-03 127 Provider Taxonomy Code Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 31 579 CUR 0100 Detail Billing Provider Hierarchical Level Loop CUR Foreign Currency Information To specify the currency (dollars, pounds, francs, etc.) used in a transaction Usage notes Required when the amounts represented in this transaction are currencies other than the United States dollar. If not required by this implementation guide, do not send. It is REQUIRED that all amounts reported within the transaction are of the currency named in this segment. If this segment is not used, then it is required that all amounts in this transaction be expressed in US dollars. Example CUR 85 XXX Max use 1 Optional CUR-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 85 Billing Provider CUR-02 100 Currency Code Min 3 Max 3 Identifier (ID) Required Code (Standard ISO) for country in whose currency the charges are specified Usage notes The submitter must use the Currency Code, not the Country Code, for this element. For example the Currency Code CAD Canadian dollars would be valid, while CA Canada would be invalid. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 32 579 2010AA Billing Provider Name Loop Max 1 Required Variants (all may be used) Pay-to Address Name Loop Pay-To Plan Name Loop NM1 0150 Detail Billing Provider Hierarchical Level Loop Billing Provider Name Loop NM1 Billing Provider Name To supply the full name of an individual or organizational entity Usage notes Beginning on the NPI compliance date: When the Billing Provider is an organization health care provider, the organization health care provider's NPI or its subpart's NPI is reported in NM109. When a health care provider organization has determined that it needs to enumerate its subparts, it will report the NPI of a subpart as the Billing Provider. The subpart reported as the Billing Provider MUST always represent the most detailed level of enumeration as determined by the organization health care provider and MUST be the same identifier sent to any trading partner. For additional explanation, see section 1.10.3 Organization Health Care Provider Subpart Presentation. Prior to the NPI compliance date, proprietary identifiers necessary for the receiver to identify the Billing Provider entity are to be reported in the REF segment of Loop ID- 2010BB. The Taxpayer Identifying Number (TIN) of the Billing Provider to be used for 1099 purposes must be reported in the REF segment of this loop. When the individual or the organization is not a health care provider and, thus, not eligible to receive an NPI (For example, personal care services, carpenters, etc), the Billing Provider should be the legal entity. However, willing trading partners may agree upon varying definitions. Proprietary identifiers necessary for the receiver to identify the entity are to be reported in the Loop ID-2010BB REF, Billing Provider Secondary Identification segment. The TIN to be used for 1099 purposes must be reported in the REF (Tax Identification Number) segment of this loop. Example NM1 85 2 X XX XXXX If either Identification Code Qualifier (NM1-08) or Billing Provider Identifier (NM1-09) is present, then the other is required Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 85 Billing Provider NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 33 579 2 Non-Person Entity NM1-03 1035 Billing Provider Organizational Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Medicare and Medicaid Services National Provider Identifier NM1-09 67 Billing Provider Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code Usage notes Use appropriate NPI number. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 34 579 N3 0250 Detail Billing Provider Hierarchical Level Loop Billing Provider Name Loop N3 Billing Provider Address To specify the location of the named party Usage notes The Billing Provider Address must be a street address. Post Office Box or Lock Box addresses are to be sent in the Pay-To Address Loop (Loop ID-2010AB), if necessary. | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_7 |
Hierarchical Level Loop Billing Provider Name Loop N3 Billing Provider Address To specify the location of the named party Usage notes The Billing Provider Address must be a street address. Post Office Box or Lock Box addresses are to be sent in the Pay-To Address Loop (Loop ID-2010AB), if necessary. Example N3 XX XXXXX Max use 1 Required N3-01 166 Billing Provider Address Line Min 1 Max 55 String (AN) Required Address information N3-02 166 Billing Provider Address Line Min 1 Max 55 String (AN) Optional Address information 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 35 579 N4 0300 Detail Billing Provider Hierarchical Level Loop Billing Provider Name Loop N4 Billing Provider City, State, ZIP Code To specify the geographic place of the named party Usage notes Include city, 2-character state code and 9-digit ZIP code. Example N4 XXXXXX XX XXXXXXXX XX Only one of Billing Provider State or Province Code (N4-02) or Country Subdivision Code (N4-07) may be present If Country Subdivision Code (N4-07) is present, then Country Code (N4-04) is required Max use 1 Required N4-01 19 Billing Provider City Name Min 2 Max 30 String (AN) Required Free-form text for city name A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. N4-02 156 Billing Provider State or Province Code Min 2 Max 2 Identifier (ID) Optional Code (Standard State Province) as defined by appropriate government agency N402 is required only if city name (N401) is in the U.S. or Canada. N4-03 116 Billing Provider Postal Zone or ZIP Code Min 3 Max 15 Identifier (ID) Optional Code defining international postal zone code excluding punctuation and blanks (zip code for United States) Usage notes When reporting the ZIP code for U.S. addresses, the full nine digit ZIP code must be provided. N4-04 26 Country Code Min 2 Max 3 Identifier (ID) Optional Code identifying the country Usage notes Use the alpha-2 country codes from Part 1 of ISO 3166. N4-07 1715 Country Subdivision Code Min 1 Max 3 Identifier (ID) Optional Code identifying the country subdivision 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 36 579 Usage notes Use the country subdivision codes from Part 2 of ISO 3166. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 37 579 REF 0350 Detail Billing Provider Hierarchical Level Loop Billing Provider Name Loop REF Billing Provider Tax Identification To specify identifying information Usage notes This is the tax identification number (TIN) of the entity to be paid for the submitted services. Example REF EI XX Max use 1 Required REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification EI Employer's Identification Number The Employer's Identification Number must be a string of exactly nine numbers with no separators. For example, "001122333" would be valid, while sending "001-12-2333" or "00-1122333" would be invalid. REF-02 127 Billing Provider Tax Identification Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 38 579 PER 0400 Detail Billing Provider Hierarchical Level Loop Billing Provider Name Loop PER Billing Provider Contact Information To identify a person or office to whom administrative communications should be directed Usage notes Required when this information is different than that contained in the Loop ID-1000A - Submitter PER segment. If not required by this implementation guide, do not send.; When the communication number represents a telephone number in the United States and other countries using the North American Dialing Plan (for voice, data, fax, etc.), the communication number must always include the area code and phone number using the format AAABBBCCCC where AAA is the area code, BBB is the telephone number prefix, and CCCC is the telephone number. Therefore, the following telephone number (555) 555-1234 would be represented as 5555551234. Do not submit long distance access numbers, such as "1", in the telephone number. Telephone extensions, when applicable, must be submitted in the next element immediately following the telephone number. When submitting telephone extensions, only submit the numeric extension. Do not include data that indicates an extension, such as "ext" or "x-". There are 2 repetitions of the PER segment to allow for six possible combinations of communication numbers including extensions. Example PER IC XXXX TE XX EM XXX TE XXXXX If either Communication Number Qualifier (PER-05) or Communication Number (PER-06) is present, then the other is required If either Communication Number Qualifier (PER-07) or Communication Number (PER-08) is present, then the other is required Max use 2 Optional PER-01 366 Contact Function Code Identifier (ID) Required Code identifying the major duty or responsibility of the person or group named IC Information Contact PER-02 93 Billing Provider Contact Name Min 1 Max 60 String (AN) Optional Free-form name PER-03 365 Communication Number Qualifier Identifier (ID) Required Code identifying the type of communication number EM Electronic Mail FX Facsimile TE Telephone PER-04 364 Communication Number Min 1 Max 256 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 39 579 2010AA Billing Provider Name Loop end Complete communications number including country or area code when applicable PER-05 365 Communication Number Qualifier Identifier (ID) Optional Code identifying the type of communication number EM Electronic Mail EX Telephone Extension FX Facsimile TE Telephone PER-06 364 Communication Number Min 1 Max 256 String (AN) Optional Complete communications number including country or area code when applicable PER-07 365 Communication Number Qualifier Identifier (ID) Optional Code identifying the type of communication number EM Electronic Mail EX Telephone Extension FX Facsimile TE | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_8 |
Extension FX Facsimile TE Telephone PER-06 364 Communication Number Min 1 Max 256 String (AN) Optional Complete communications number including country or area code when applicable PER-07 365 Communication Number Qualifier Identifier (ID) Optional Code identifying the type of communication number EM Electronic Mail EX Telephone Extension FX Facsimile TE Telephone PER-08 364 Communication Number Min 1 Max 256 String (AN) Optional Complete communications number including country or area code when applicable 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 40 579 2010AB Pay-to Address Name Loop Max 1 Optional Variants (all may be used) Billing Provider Name Loop Pay-To Plan Name Loop NM1 0150 Detail Billing Provider Hierarchical Level Loop Pay-to Address Name Loop NM1 Pay-to Address Name To supply the full name of an individual or organizational entity Usage notes Required when the address for payment is different than that of the Billing Provider. If not required by this implementation guide, do not send.; The purpose of Loop ID-2010AB has changed from previous versions. Loop ID-2010AB only contains address information when different from the Billing Provider Address. There are no applicable identifiers for Pay-To Address information. Example NM1 87 2 Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 87 Pay-to Provider NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 2 Non-Person Entity 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 41 579 N3 0250 Detail Billing Provider Hierarchical Level Loop Pay-to Address Name Loop N3 Pay-to Address - ADDRESS To specify the location of the named party Example N3 X XXXX Max use 1 Required N3-01 166 Pay-To Address Line Min 1 Max 55 String (AN) Required Address information N3-02 166 Pay-To Address Line Min 1 Max 55 String (AN) Optional Address information 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 42 579 N4 0300 Detail Billing Provider Hierarchical Level Loop Pay-to Address Name Loop N4 Pay-To Address City, State, ZIP Code To specify the geographic place of the named party Usage notes Include city, 2-character state code and 9-digit ZIP code. Example N4 XXXXXXX XX XXXXXXX XX Only one of Pay-to Address State Code (N4-02) or Country Subdivision Code (N4-07) may be present If Country Subdivision Code (N4-07) is present, then Country Code (N4-04) is required Max use 1 Required N4-01 19 Pay-to Address City Name Min 2 Max 30 String (AN) Required Free-form text for city name A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. N4-02 156 Pay-to Address State Code Min 2 Max 2 Identifier (ID) Optional Code (Standard State Province) as defined by appropriate government agency N402 is required only if city name (N401) is in the U.S. or Canada. N4-03 116 Pay-to Address Postal Zone or ZIP Code Min 3 Max 15 Identifier (ID) Optional Code defining international postal zone code excluding punctuation and blanks (zip code for United States) N4-04 26 Country Code Min 2 Max 3 Identifier (ID) Optional Code identifying the country Usage notes Use the alpha-2 country codes from Part 1 of ISO 3166. N4-07 1715 Country Subdivision Code Min 1 Max 3 Identifier (ID) Optional Code identifying the country subdivision Usage notes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 43 579 2010AB Pay-to Address Name Loop end Use the country subdivision codes from Part 2 of ISO 3166. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 44 579 2010AC Pay-To Plan Name Loop Max 1 Optional Variants (all may be used) Billing Provider Name Loop Pay-to Address Name Loop NM1 0150 Detail Billing Provider Hierarchical Level Loop Pay-To Plan Name Loop NM1 Pay-To Plan Name To supply the full name of an individual or organizational entity Usage notes Required when willing trading partners agree to use this implementation for their subrogation payment requests. This loop may only be used when BHT06 31. Example NM1 PE 2 XXXX PI XXXXXX Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual PE Payee PE is used to indicate the subrogated payee. NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 2 Non-Person Entity NM1-03 1035 Pay-To Plan Organizational Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-08 66 Identification Code Qualifier Identifier (ID) Required Code designating the system method of code structure used for Identification Code (67) Usage notes Use code value "PI" when reporting Payor Identification. Use code value "XV" when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID). 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 45 579 Prior to the mandated implementation date for Health Plan Identifier, willing trading partners may agree to: Follow a dual use approach in which both the HPID or OEID and the Payor Identification are sent. Send XV qualifier in NM108 with HPID or OEID in NM109 and the Payor Identification, that would have been sent using qualifier PI, in the corresponding REF segment using qualifier 2U (Payer Identification Number). OR Follow an early implementation approach in which the HPID or OEID is sent in NM109. PI Payor Identification XV Centers for Medicare and Medicaid Services PlanID NM1-09 67 Pay-To Plan Primary Identifier Min 2 Max 80 String (AN) Required Code identifying a party or other code 1 30 25, 11:52 AM | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_9 |
an early implementation approach in which the HPID or OEID is sent in NM109. PI Payor Identification XV Centers for Medicare and Medicaid Services PlanID NM1-09 67 Pay-To Plan Primary Identifier Min 2 Max 80 String (AN) Required Code identifying a party or other code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 46 579 N3 0250 Detail Billing Provider Hierarchical Level Loop Pay-To Plan Name Loop N3 Pay-to Plan Address To specify the location of the named party Example N3 XXXXX XXXXXX Max use 1 Required N3-01 166 Pay-To Plan Address Line Min 1 Max 55 String (AN) Required Address information N3-02 166 Pay-To Plan Address Line Min 1 Max 55 String (AN) Optional Address information 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 47 579 N4 0300 Detail Billing Provider Hierarchical Level Loop Pay-To Plan Name Loop N4 Pay-To Plan City, State, ZIP Code To specify the geographic place of the named party Example N4 XXX XX XXXX XX Only one of Pay-To Plan State or Province Code (N4-02) or Country Subdivision Code (N4-07) may be present If Country Subdivision Code (N4-07) is present, then Country Code (N4-04) is required Max use 1 Required N4-01 19 Pay-To Plan City Name Min 2 Max 30 String (AN) Required Free-form text for city name A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. N4-02 156 Pay-To Plan State or Province Code Min 2 Max 2 Identifier (ID) Optional Code (Standard State Province) as defined by appropriate government agency N402 is required only if city name (N401) is in the U.S. or Canada. N4-03 116 Pay-To Plan Postal Zone or ZIP Code Min 3 Max 15 Identifier (ID) Optional Code defining international postal zone code excluding punctuation and blanks (zip code for United States) N4-04 26 Country Code Min 2 Max 3 Identifier (ID) Optional Code identifying the country Usage notes Use the alpha-2 country codes from Part 1 of ISO 3166. N4-07 1715 Country Subdivision Code Min 1 Max 3 Identifier (ID) Optional Code identifying the country subdivision Usage notes Use the country subdivision codes from Part 2 of ISO 3166. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 48 579 REF 0350 Detail Billing Provider Hierarchical Level Loop Pay-To Plan Name Loop REF Pay-to Plan Secondary Identification To specify identifying information Usage notes Required when an additional identification number to that provided in the NM109 of this loop is necessary to identify the entity. If not required by this implementation guide, do not send. Example REF FY XXXXX Variants (all may be used) REF Pay-To Plan Tax Identification Number Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 2U Payer Identification Number This code is only allowed when the qualifier XV is reported in NM108 of this loop. FY Claim Office Number NF National Association of Insurance Commissioners (NAIC) Code REF-02 127 Pay-to Plan Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 49 579 2010AC Pay-To Plan Name Loop end REF 0350 Detail Billing Provider Hierarchical Level Loop Pay-To Plan Name Loop REF Pay-To Plan Tax Identification Number To specify identifying information Example REF EI XXXXX Variants (all may be used) REF Pay-to Plan Secondary Identification Max use 1 Required REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification EI Employer's Identification Number The Employer's Identification Number must be a string of exactly nine numbers with no separators. For example, "001122333" would be valid, while sending "001-12-2333" or "00-1122333" would be invalid. REF-02 127 Pay-To Plan Tax Identification Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 50 579 2000B Subscriber Hierarchical Level Loop Max 1 Required HL 0010 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop HL Hierarchical Level To identify dependencies among and the content of hierarchically related groups of data segments Example HL 2 1 22 1 Max use 1 Required HL-01 628 Hierarchical ID Number Min 1 Max 12 String (AN) Required A unique number assigned by the sender to identify a particular data segment in a hierarchical structure HL01 shall contain a unique alphanumeric number for each occurrence of the HL segment in the transaction set. For example, HL01 could be used to indicate the number of occurrences of the HL segment, in which case the value of HL01 would be "1" for the initial HL segment and would be incremented by one in each subsequent HL segment within the transaction. HL-02 734 Hierarchical Parent ID Number Min 1 Max 12 String (AN) Required Identification number of the next higher hierarchical data segment that the data segment being described is subordinate to HL02 identifies the hierarchical ID number of the HL segment to which the current HL segment is subordinate. HL-03 735 Hierarchical Level Code Identifier (ID) Required Code defining the characteristic of a level in a hierarchical structure HL03 indicates the context of the series of segments following the current HL segment up to the next occurrence of an HL segment in the transaction. For example, HL03 is used to indicate that subsequent segments in the HL loop form a logical grouping of data referring to shipment, order, or item-level information. 22 Subscriber HL-04 736 Hierarchical Child Code Identifier (ID) Optional Code indicating if | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_10 |
the next occurrence of an HL segment in the transaction. For example, HL03 is used to indicate that subsequent segments in the HL loop form a logical grouping of data referring to shipment, order, or item-level information. 22 Subscriber HL-04 736 Hierarchical Child Code Identifier (ID) Optional Code indicating if there are hierarchical child data segments subordinate to the level being described HL04 indicates whether or not there are subordinate (or child) HL segments related to the current HL segment. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 51 579 0 No Subordinate HL Segment in This Hierarchical Structure. 1 Additional Subordinate HL Data Segment in This Hierarchical Structure. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 52 579 SBR 0050 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop SBR Subscriber Information To record information specific to the primary insured and the insurance carrier for that insured Example SBR C 18 X XXXXXX OF Max use 1 Required SBR-01 1138 Payer Responsibility Sequence Number Code Identifier (ID) Required Code identifying the insurance carrier's level of responsibility for a payment of a claim Usage notes Within a given claim, the various values for the Payer Responsibility Sequence Number Code (other than value "U") may occur no more than once. A Payer Responsibility Four B Payer Responsibility Five C Payer Responsibility Six D Payer Responsibility Seven E Payer Responsibility Eight F Payer Responsibility Nine G Payer Responsibility Ten H Payer Responsibility Eleven P Primary S Secondary T Tertiary U Unknown This code may only be used in payer to payer COB claims when the original payer determined the presence of this coverage from eligibility files received from this payer or when the original claim did not provide the responsibility sequence for this payer. SBR-02 1069 Individual Relationship Code Identifier (ID) Optional Code indicating the relationship between two individuals or entities SBR02 specifies the relationship to the person insured. 18 Self SBR-03 127 Subscriber Group or Policy Number Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier SBR03 is policy or group number. Usage notes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 53 579 This is not the number uniquely identifying the subscriber. The unique subscriber number is submitted in Loop ID-2010BA-NM109. SBR-04 93 Subscriber Group Name Min 1 Max 60 String (AN) Optional Free-form name SBR04 is plan name. SBR-09 1032 Claim Filing Indicator Code Identifier (ID) Required Code identifying type of claim 11 Other Non-Federal Programs 12 Preferred Provider Organization (PPO) 13 Point of Service (POS) 14 Exclusive Provider Organization (EPO) 15 Indemnity Insurance 16 Health Maintenance Organization (HMO) Medicare Risk 17 Dental Maintenance Organization AM Automobile Medical BL Blue Cross Blue Shield CH Champus CI Commercial Insurance Co. DS Disability FI Federal Employees Program HM Health Maintenance Organization LM Liability Medical MA Medicare Part A MB Medicare Part B MC Medicaid OF Other Federal Program Use code OF when submitting Medicare Part D claims. TV Title V VA Veterans Affairs Plan WC Workers' Compensation Health Claim ZZ Mutually Defined Use Code ZZ when Type of Insurance is not known. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 54 579 2010BA Subscriber Name Loop Max 1 Required Variants (all may be used) Payer Name Loop NM1 0150 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Subscriber Name Loop NM1 Subscriber Name To supply the full name of an individual or organizational entity Usage notes In worker's compensation or other property and casualty claims, the "subscriber" may be a non-person entity (for example, the employer). However, this varies by state. Example NM1 IL 2 XXXXX XXXXXX XXXXX XXXXXX II XXX If either Identification Code Qualifier (NM1-08) or Subscriber Primary Identifier (NM1-09) is present, then the other is required Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual IL Insured or Subscriber NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 Person 2 Non-Person Entity NM1-03 1035 Subscriber Last Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-04 1036 Subscriber First Name Min 1 Max 35 String (AN) Optional Individual first name NM1-05 1037 Subscriber Middle Name or Initial Min 1 Max 25 String (AN) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 55 579 Individual middle name or initial NM1-07 1039 Subscriber Name Suffix Min 1 Max 10 String (AN) Optional Suffix to individual name Usage notes Examples: I, II, III, IV, Jr, Sr This data element is used only to indicate generation or patronymic. NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) II Standard Unique Health Identifier for each Individual in the United States Required if the HIPAA Individual Patient Identifier is mandated use. If not required, use value MI' instead. MI Member Identification Number The code MI is intended to be the subscriber's identification number as assigned by the payer. (For example, Insured's ID, Subscriber's ID, Health Insurance Claim Number (HIC), etc.) MI is also intended to be used in claims submitted to the Indian Health Service Contract Health Services (IHS CHS) Fiscal Intermediary for the purpose of reporting the Tribe Residency Code (Tribe County State). In the event that a Social Security Number (SSN) is also available on an IHS CHS claim, put the SSN in REF02. When sending the Social Security Number as the Member ID, it must | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_11 |
(IHS CHS) Fiscal Intermediary for the purpose of reporting the Tribe Residency Code (Tribe County State). In the event that a Social Security Number (SSN) is also available on an IHS CHS claim, put the SSN in REF02. When sending the Social Security Number as the Member ID, it must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid. NM1-09 67 Subscriber Primary Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 56 579 N3 0250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Subscriber Name Loop N3 Subscriber Address To specify the location of the named party Usage notes Required when the patient is the subscriber or considered to be the subscriber. If not required by this implementation guide, do not send. Example N3 XXX XXXX Max use 1 Optional N3-01 166 Subscriber Address Line Min 1 Max 55 String (AN) Required Address information N3-02 166 Subscriber Address Line Min 1 Max 55 String (AN) Optional Address information 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 57 579 N4 0300 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Subscriber Name Loop N4 Subscriber City, State, ZIP Code To specify the geographic place of the named party Usage notes Required when the patient is the subscriber or considered to be the subscriber. If not required by this implementation guide, do not send. Example N4 XXX XX XXXXX XX Only one of Subscriber State Code (N4-02) or Country Subdivision Code (N4-07) may be present If Country Subdivision Code (N4-07) is present, then Country Code (N4-04) is required Max use 1 Optional N4-01 19 Subscriber City Name Min 2 Max 30 String (AN) Required Free-form text for city name A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. N4-02 156 Subscriber State Code Min 2 Max 2 Identifier (ID) Optional Code (Standard State Province) as defined by appropriate government agency N402 is required only if city name (N401) is in the U.S. or Canada. N4-03 116 Subscriber Postal Zone or ZIP Code Min 3 Max 15 Identifier (ID) Optional Code defining international postal zone code excluding punctuation and blanks (zip code for United States) N4-04 26 Country Code Min 2 Max 3 Identifier (ID) Optional Code identifying the country Usage notes Use the alpha-2 country codes from Part 1 of ISO 3166. N4-07 1715 Country Subdivision Code Min 1 Max 3 Identifier (ID) Optional Code identifying the country subdivision Usage notes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 58 579 Use the country subdivision codes from Part 2 of ISO 3166. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 59 579 DMG 0320 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Subscriber Name Loop DMG Subscriber Demographic Information To supply demographic information Usage notes Required when the patient is the subscriber or considered to be the subscriber. If not required by this implementation guide, do not send. Example DMG D8 XXX M Max use 1 Optional DMG-01 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format D8 Date Expressed in Format CCYYMMDD DMG-02 1251 Subscriber Birth Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times DMG02 is the date of birth. DMG-03 1068 Subscriber Gender Code Identifier (ID) Required Code indicating the sex of the individual F Female M Male U Unknown 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 60 579 REF 0350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Subscriber Name Loop REF Property and Casualty Claim Number To specify identifying information Usage notes This is a property and casualty payer-assigned claim number. Providers receive this number from the property and casualty payer during eligibility determinations or some other communication with that payer. See Section 1.4.2, Property and Casualty, for additional information about property and casualty claims.; This segment is not a HIPAA requirement as of this writing. Required when the services included in this claim are to be considered as part of a property and casualty claim. If not required by this implementation guide, do not send. Example REF Y4 XXXX Variants (all may be used) REF Subscriber Secondary Identification Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification Y4 Agency Claim Number REF-02 127 Property Casualty Claim Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 61 579 2010BA Subscriber Name Loop end REF 0350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Subscriber Name Loop REF Subscriber Secondary Identification To specify identifying information Usage notes Required when an additional identification number to that provided in NM109 of this loop is necessary for the claim processor to identify the entity. If not required by this implementation guide, do not send. Example REF SY XXXXXX Variants (all may be used) REF Property and Casualty Claim Number Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification SY Social Security Number The Social Security Number must be a string of exactly nine | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_12 |
do not send. Example REF SY XXXXXX Variants (all may be used) REF Property and Casualty Claim Number Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification SY Social Security Number The Social Security Number must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid. REF-02 127 Subscriber Supplemental Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 62 579 2010BB Payer Name Loop Max 1 Required Variants (all may be used) Subscriber Name Loop NM1 0150 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Payer Name Loop NM1 Payer Name To supply the full name of an individual or organizational entity Usage notes This is the destination payer. For the purposes of this implementation the term payer is synonymous with several other terms, such as, repricer and third party administrator. Example NM1 PR 2 XXX XV XXXXX Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual PR Payer NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 2 Non-Person Entity NM1-03 1035 Payer Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-08 66 Identification Code Qualifier Identifier (ID) Required Code designating the system method of code structure used for Identification Code (67) Usage notes Use code value "PI" when reporting Payor Identification. Use code value "XV" when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID). Prior to the mandated implementation date for Health Plan Identifier, willing trading partners may agree to: Follow a dual use approach in which both the HPID or OEID and the Payor Identification are sent. Send XV qualifier in NM108 with HPID or OEID in NM109 and the Payor 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 63 579 Identification, that would have been sent using qualifier PI, in the corresponding REF segment using qualifier 2U (Payer Identification Number). OR Follow an early implementation approach in which the HPID or OEID is sent in NM109. PI Payor Identification XV Centers for Medicare and Medicaid Services PlanID NM1-09 67 Payer Identifier Min 2 Max 80 String (AN) Required Code identifying a party or other code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 64 579 N3 0250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Payer Name Loop N3 Payer Address To specify the location of the named party Usage notes Required when the payer address is available and the submitter intends for the claim to be printed on paper at the next EDI location (for example, a clearinghouse). If not required by this implementation guide, do not send. Example N3 XXXXXX XXXXXX Max use 1 Optional N3-01 166 Payer Address Line Min 1 Max 55 String (AN) Required Address information N3-02 166 Payer Address Line Min 1 Max 55 String (AN) Optional Address information 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 65 579 N4 0300 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Payer Name Loop N4 Payer City, State, ZIP Code To specify the geographic place of the named party Usage notes Required when the payer address is available and the submitter intends for the claim to be printed on paper at the next EDI location (for example, a clearinghouse). If not required by this implementation guide, do not send. Example N4 XXX XX XXX XXX Only one of Payer State Code (N4-02) or Country Subdivision Code (N4-07) may be present If Country Subdivision Code (N4-07) is present, then Country Code (N4-04) is required Max use 1 Optional N4-01 19 Payer City Name Min 2 Max 30 String (AN) Required Free-form text for city name A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. N4-02 156 Payer State Code Min 2 Max 2 Identifier (ID) Optional Code (Standard State Province) as defined by appropriate government agency N402 is required only if city name (N401) is in the U.S. or Canada. N4-03 116 Payer Postal Zone or ZIP Code Min 3 Max 15 Identifier (ID) Optional Code defining international postal zone code excluding punctuation and blanks (zip code for United States) N4-04 26 Country Code Min 2 Max 3 Identifier (ID) Optional Code identifying the country Usage notes Use the alpha-2 country codes from Part 1 of ISO 3166. N4-07 1715 Country Subdivision Code Min 1 Max 3 Identifier (ID) Optional Code identifying the country subdivision Usage notes Use the country subdivision codes from Part 2 of ISO 3166. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 66 579 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 67 579 REF 0350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Payer Name Loop REF Billing Provider Secondary Identification To specify identifying information Usage notes Required prior to the mandated NPI Implementation Date when an additional identification number is necessary for the receiver to identify the provider. OR Required on or after the mandated NPI Implementation Date when NM109 in Loop 2010AA is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_13 |
is necessary for the receiver to identify the provider. OR Required on or after the mandated NPI Implementation Date when NM109 in Loop 2010AA is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send. Example REF LU XXXX Variants (all may be used) REF Payer Secondary Identification Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification G2 Provider Commercial Number This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim. This is to be used by all payers including: Medicare, Medicaid, Blue Cross, etc. LU Location Number REF-02 127 Billing Provider Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 68 579 2010BB Payer Name Loop end REF 0350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Payer Name Loop REF Payer Secondary Identification To specify identifying information Usage notes Required when an additional identification number to that provided in the NM109 of this loop is necessary to identify the entity. If not required by this implementation guide, do not send. Example REF NF XXXXX Variants (all may be used) REF Billing Provider Secondary Identification Max use 3 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 2U Payer Identification Number This code is only allowed when the qualifier XV is reported in NM108 of this loop. EI Employer's Identification Number The Employer's Identification Number must be a string of exactly nine numbers with no separators. For example, "001122333" would be valid, while sending "001-12-2333" or "00-1122333" would be invalid. FY Claim Office Number NF National Association of Insurance Commissioners (NAIC) Code REF-02 127 Payer Additional Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 69 579 2300 Claim Information Loop Max 100 Optional CLM 1300 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop CLM Claim Information To specify basic data about the claim Usage notes The developers of this implementation guide recommend that trading partners limit the size of the transaction (ST-SE envelope) to a maximum of 5000 CLM segments. There is no recommended limit to the number of ST-SE transactions within a GS-GE or ISA- IEA. Willing trading partners can agree to set limits higher. For purposes of this documentation, the claim detail information is presented only in the dependent level. Specific claim detail information can be given in either the subscriber or the dependent hierarchical level. Because of this, the claim information is said to "float." Claim information is positioned in the same hierarchical level that describes its owner-participant, either the subscriber or the dependent. In other words, the claim information, Loop ID-2300, is placed following Loop ID-2010BB in the Subscriber Hierarchical Level (HL) when patient information is sent in Loop ID-2010BA of the Subscriber HL. Claim information is placed in the Patient HL when the patient information is sent in Loop ID-2010CA of the Patient HL. When the patient is the subscriber or is considered to be the subscriber, Loop ID-2000C and Loop ID-2010CA are not sent. See Subscriber Patient HL Segment explanation in section 1.4.3.2.2.1 for details. Example CLM XXXXX 00000000000000 X A X B N I 8 Max use 1 Required CLM-01 1028 Patient Control Number Min 1 Max 38 String (AN) Required Identifier used to track a claim from creation by the health care provider through payment Usage notes The number that the submitter transmits in this position is echoed back to the submitter in the 835 and other transactions. This permits the submitter to use the value in this field as a key in the submitter's system to match the claim to the payment information returned in the 835 transaction. The two recommended identifiers are either the Patient Account Number or the Claim Number in the billing submitter's patient management system. The developers of this implementation guide strongly recommend that submitters use unique numbers for this field for each individual claim. When Loop ID-2010AC is present, CLM01 represents the subrogated Medicaid agency's claim number (ICN DCN) from their original 835 CLP07 - Payer Claim Control Number. See Section 1.4.1.4 of the front matter for a description of post payment recovery claims for subrogated Medicaid agencies. The maximum number of characters to be supported for this field is 20'. Characters beyond the maximum are not required to be stored nor returned by any 837-receiving system. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 70 579 CLM-02 782 Total Claim Charge Amount Min 1 Max 15 Decimal number (R) Required Monetary amount CLM02 is the total amount of all submitted charges of service segments for this claim. Usage notes The Total Claim Charge Amount must be greater than or equal to zero. The total claim charge amount must balance to the sum of all service line charge amounts reported in the Institutional Service Line (SV2) segments for this claim. CLM-05 C023 Health Care Service Location Information To provide information that identifies the place of service or the type of bill related to the location at which a health care service was rendered Max use 1 Required C023-01 1331 Facility Type Code Min 1 Max 2 String (AN) Required Code identifying where services were, or may be, performed; the first and second positions of the Uniform Bill Type Code for Institutional Services or the Place of Service Codes for Professional or Dental Services. | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_14 |
Max use 1 Required C023-01 1331 Facility Type Code Min 1 Max 2 String (AN) Required Code identifying where services were, or may be, performed; the first and second positions of the Uniform Bill Type Code for Institutional Services or the Place of Service Codes for Professional or Dental Services. C023-02 1332 Facility Code Qualifier Identifier (ID) Required Code identifying the type of facility referenced C023-02 qualifies C023-01 and C023-03. A Uniform Billing Claim Form Bill Type C023-03 1325 Claim Frequency Code Min 1 Max 1 Identifier (ID) Required Code specifying the frequency of the claim; this is the third position of the Uniform Billing Claim Form Bill Type CLM-07 1359 Assignment or Plan Participation Code Identifier (ID) Required Code indicating whether the provider accepts assignment Usage notes Within this element the context of the word assignment is related to the relationship between the provider and the payer. This is NOT the field for reporting whether the patient has or has not assigned benefits to the provider. The benefit assignment indicator is in CLM08. A Assigned Required when the provider accepts assignment and or has a participation agreement with the destination payer. OR Required when the provider does not accept assignment and or have a participation agreement, but is advising the payer to adjudicate this specific claim under participating provider benefits as allowed under certain plans. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 71 579 B Assignment Accepted on Clinical Lab Services Only Required when the provider accepts assignment for Clinical Lab Services only. C Not Assigned Required when neither codes A' nor B' apply. CLM-08 1073 Benefits Assignment Certification Indicator Identifier (ID) Required Code indicating a Yes or No condition or response CLM08 is assignment of benefits indicator. A "Y" value indicates insured or authorized person authorizes benefits to be assigned to the provider; an "N" value indicates benefits have not been assigned to the provider. Usage notes This element answers the question whether or not the insured has authorized the plan to remit payment directly to the provider. N No W Not Applicable Use code W' when the patient refuses to assign benefits. Y Yes CLM-09 1363 Release of Information Code Identifier (ID) Required Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations Usage notes The Release of Information response is limited to the information carried in this claim. I Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes Required when the provider has not collected a signature AND state or federal laws do not require a signature be collected. Y Yes, Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim Required when the provider has collected a signature. OR Required when state or federal laws require a signature be collected. CLM-20 1514 Delay Reason Code Identifier (ID) Optional Code indicating the reason why a request was delayed 1 Proof of Eligibility Unknown or Unavailable 2 Litigation 3 Authorization Delays 4 Delay in Certifying Provider 5 Delay in Supplying Billing Forms 6 Delay in Delivery of Custom-made Appliances 7 Third Party Processing Delay 8 Delay in Eligibility Determination 9 Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation Rules 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 72 579 10 Administration Delay in the Prior Approval Process 11 Other 15 Natural Disaster 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 73 579 DTP 1350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop DTP Admission Date Hour To specify any or all of a date, a time, or a time period Usage notes Required on inpatient claims. If not required by this implementation guide, do not send. Example DTP 435 DT X Variants (all may be used) DTP Date - Repricer Received Date DTP Discharge Hour DTP Statement Dates Max use 1 Optional DTP-01 374 Date Time Qualifier Identifier (ID) Required Code specifying type of date or time, or both date and time 435 Admission DTP-02 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. Usage notes Selection of the appropriate qualifier is designated by the NUBC Billing Manual. D8 Date Expressed in Format CCYYMMDD DT Date and Time Expressed in Format CCYYMMDDHHMM DTP-03 1251 Admission Date and Hour Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 74 579 DTP 1350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop DTP Date - Repricer Received Date To specify any or all of a date, a time, or a time period Usage notes Required when a repricer is passing the claim onto the payer. If not required by this implementation guide, do not send. Example DTP 050 D8 XXX Variants (all may be used) DTP Admission Date Hour DTP Discharge Hour DTP Statement Dates Max use 1 Optional DTP-01 374 Date Time Qualifier Identifier (ID) Required Code specifying type of date or time, or both date and time 050 Received DTP-02 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. D8 Date Expressed in Format CCYYMMDD DTP-03 1251 Repricer Received Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_15 |
format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. D8 Date Expressed in Format CCYYMMDD DTP-03 1251 Repricer Received Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 75 579 DTP 1350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop DTP Discharge Hour To specify any or all of a date, a time, or a time period Usage notes Required on all final inpatient claims. If not required by this implementation guide, do not send. Example DTP 096 TM XXXXXX Variants (all may be used) DTP Admission Date Hour DTP Date - Repricer Received Date DTP Statement Dates Max use 1 Optional DTP-01 374 Date Time Qualifier Identifier (ID) Required Code specifying type of date or time, or both date and time 096 Discharge DTP-02 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. TM Time Expressed in Format HHMM DTP-03 1251 Discharge Time Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 76 579 DTP 1350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop DTP Statement Dates To specify any or all of a date, a time, or a time period Example DTP 434 RD8 X Variants (all may be used) DTP Admission Date Hour DTP Date - Repricer Received Date DTP Discharge Hour Max use 1 Required DTP-01 374 Date Time Qualifier Identifier (ID) Required Code specifying type of date or time, or both date and time 434 Statement DTP-02 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD Use RD8 to indicate the from and through date of the statement. When the statement is for a single date of service, the from and through date are the same. DTP-03 1251 Statement From and To Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 77 579 CL1 1400 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop CL1 Institutional Claim Code To supply information specific to hospital claims Example CL1 X X XX Max use 1 Required CL1-01 1315 Admission Type Code Min 1 Max 1 Identifier (ID) Required Code indicating the priority of this admission CL1-02 1314 Admission Source Code Min 1 Max 1 Identifier (ID) Optional Code indicating the source of this admission CL1-03 1352 Patient Status Code Min 1 Max 2 Identifier (ID) Required Code indicating patient status as of the "statement covers through date" 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 78 579 PWK 1550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop PWK Claim Supplemental Information To identify the type or transmission or both of paperwork or supporting information Usage notes Required when there is a paper attachment following this claim. OR Required when attachments are sent electronically (PWK02 EL) but are transmitted in another functional group (for example, 275) rather than by paper. PWK06 is then used to identify the attached electronic documentation. The number in PWK06 is carried in the TRN of the electronic attachment. OR Required when the provider deems it necessary to identify additional information that is being held at the provider's office and is available upon request by the payer (or appropriate entity), but the information is not being submitted with the claim. Use the value of "AA" in PWK02 to convey this specific use of the PWK segment. If not required by this implementation guide, do not send. Example PWK A4 FT AC XXXXXX If either Identification Code Qualifier (PWK-05) or Attachment Control Number (PWK-06) is present, then the other is required Max use 10 Optional PWK-01 755 Attachment Report Type Code Identifier (ID) Required Code indicating the title or contents of a document, report or supporting item 03 Report Justifying Treatment Beyond Utilization Guidelines 04 Drugs Administered 05 Treatment Diagnosis 06 Initial Assessment 07 Functional Goals 08 Plan of Treatment 09 Progress Report 10 Continued Treatment 11 Chemical Analysis 13 Certified Test Report 15 Justification for Admission 21 Recovery Plan A3 Allergies Sensitivities Document A4 Autopsy Report AM Ambulance Certification AS Admission Summary B2 Prescription B3 Physician Order B4 Referral Form BR Benchmark Testing Results BS Baseline BT Blanket Test Results CB Chiropractic Justification 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 79 579 CK Consent Form(s) CT Certification D2 Drug Profile Document DA Dental Models DB Durable Medical Equipment Prescription DG Diagnostic Report DJ Discharge Monitoring Report DS Discharge Summary EB Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payor) HC Health Certificate HR Health Clinic Records I5 Immunization Record IR State School Immunization Records LA Laboratory Results M1 Medical Record Attachment MT Models NN Nursing Notes OB Operative Note OC Oxygen Content Averaging Report OD Orders and Treatments Document OE Objective Physical Examination (including vital signs) Document OX Oxygen Therapy Certification OZ Support Data for Claim P4 Pathology Report | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_16 |
IR State School Immunization Records LA Laboratory Results M1 Medical Record Attachment MT Models NN Nursing Notes OB Operative Note OC Oxygen Content Averaging Report OD Orders and Treatments Document OE Objective Physical Examination (including vital signs) Document OX Oxygen Therapy Certification OZ Support Data for Claim P4 Pathology Report P5 Patient Medical History Document PE Parenteral or Enteral Certification PN Physical Therapy Notes PO Prosthetics or Orthotic Certification PQ Paramedical Results PY Physician's Report PZ Physical Therapy Certification RB Radiology Films RR Radiology Reports RT Report of Tests and Analysis Report RX Renewable Oxygen Content Averaging Report SG Symptoms Document V5 Death Notification XP Photographs PWK-02 756 Attachment Transmission Code Identifier (ID) Required Code defining timing, transmission method or format by which reports are to be sent AA Available on Request at Provider Site This means that the additional information is not being sent with the claim at this time. Instead, it is available to the payer (or appropriate entity) at their request. BM By Mail EL Electronically Only Indicates that the attachment is being transmitted in a separate X12 functional group. EM E-Mail FT File Transfer 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 80 579 Required when the actual attachment is maintained by an attachment warehouse or similar vendor. FX By Fax PWK-05 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) PWK05 and PWK06 may be used to identify the addressee by a code number. AC Attachment Control Number PWK-06 67 Attachment Control Number Min 2 Max 80 String (AN) Optional Code identifying a party or other code Usage notes PWK06 is used to identify the attached electronic documentation. The number in PWK06 is carried in the TRN of the electronic attachment. For the purpose of this implementation, the maximum field length is 50. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 81 579 CN1 1600 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop CN1 Contract Information To specify basic data about the contract or contract line item Usage notes Required when the submitter is contractually obligated to supply this information on post-adjudicated claims. If not required by this implementation guide, do not send. The developers of this implementation guide note that the CN1 segment is for use only for post-adjudicated claims, which do not meet the definition of a health care claim under HIPAA. Consequently, at the time of this writing, the CN1 segment is for non- HIPAA use only. Example CN1 03 0000000000 0 XXXXXX 00000 X Max use 1 Optional CN1-01 1166 Contract Type Code Identifier (ID) Required Code identifying a contract type 01 Diagnosis Related Group (DRG) 02 Per Diem 03 Variable Per Diem 04 Flat 05 Capitated 06 Percent 09 Other CN1-02 782 Contract Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CN102 is the contract amount. CN1-03 332 Contract Percentage Min 1 Max 6 Decimal number (R) Optional Percent given in decimal format (e.g., 0.0 through 100.0 represents 0 through 100 ) CN103 is the allowance or charge percent. CN1-04 127 Contract Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier CN104 is the contract code. CN1-05 338 Terms Discount Percentage Min 1 Max 6 Decimal number (R) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 82 579 Terms discount percentage, expressed as a percent, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date CN1-06 799 Contract Version Identifier Min 1 Max 30 String (AN) Optional Revision level of a particular format, program, technique or algorithm CN106 is an additional identifying number for the contract. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 83 579 AMT 1750 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop AMT Patient Estimated Amount Due To indicate the total monetary amount Usage notes Required when the Patient Responsibility Amount is applicable to this claim. If not required by this implementation guide, do not send. Example AMT F3 000000000000000 Max use 1 Optional AMT-01 522 Amount Qualifier Code Identifier (ID) Required Code to qualify amount F3 Patient Responsibility - Estimated AMT-02 782 Patient Responsibility Amount Min 1 Max 15 Decimal number (R) Required Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 84 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Adjusted Repriced Claim Number To specify identifying information Usage notes Required when this information is deemed necessary by the repricer. The segment is not completed by providers. The information is completed by repricers only. If not required by this implementation guide, do not send. This information is specific to the destination payer reported in Loop ID-2010BB. Example REF 9C X Variants (all may be used) REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 9C Adjusted Repriced Claim Reference Number REF-02 127 Adjusted Repriced Claim Reference Number String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_17 |
Reference Identification 9C Adjusted Repriced Claim Reference Number REF-02 127 Adjusted Repriced Claim Reference Number String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 85 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Auto Accident State To specify identifying information Usage notes Required when the services reported on this claim are related to an auto accident and the accident occurred in a country or location that has a state, province, or sub- country code named in code source 22. If not required by this implementation guide, do not send. Example REF LU XX Variants (all may be used) REF Adjusted Repriced Claim Number REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification LU Location Number REF-02 127 Auto Accident State or Province Code Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes Values in this field must be valid codes found in code source 22. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 86 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Claim Identifier For Transmission Intermediaries To specify identifying information Usage notes Required when this information is deemed necessary by transmission intermediaries (Automated Clearinghouses, and others) who need to attach their own unique claim number. If not required by this implementation guide, do not send. Although this REF is supplied for transmission intermediaries to attach their own unique claim number to a claim, 837-recipients are not required under HIPAA to return this number in any HIPAA transaction. Trading partners may voluntarily agree to this interaction if they wish. Example REF D9 XXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification Usage notes Number assigned by clearinghouse, van, etc. D9 Claim Number REF-02 127 Value Added Network Trace Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 87 579 The value carried in this element is limited to a maximum of 20 positions. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 88 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Demonstration Project Identifier To specify identifying information Usage notes Required when it is necessary to identify claims which are atypical in ways such as content, purpose, and or payment, as could be the case for a demonstration or other special project, or a clinical trial. If not required by this implementation guide, do not send. Example REF P4 XXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification P4 Project Code REF-02 127 Demonstration Project Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 89 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Investigational Device Exemption Number To specify identifying information Usage notes Required when claim involves a Food and Drug Administration (FDA) assigned investigational device exemption (IDE) number. When more than one IDE applies, they must be split into separate claims. If not required by this implementation guide, do not send. Example REF LX XXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 5 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification LX Qualified Products List REF-02 127 Investigational Device Exemption Identifier String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 90 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Medical Record Number To specify identifying information Usage notes Required when | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_18 |
Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 90 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Medical Record Number To specify identifying information Usage notes Required when the provider needs to identify for future inquiries, the actual medical record of the patient identified in either Loop ID-2010BA or Loop ID-2010CA for this episode of care. If not required by this implementation guide, do not send. Example REF EA XXXXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification EA Medical Record Identification Number REF-02 127 Medical Record Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 91 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Payer Claim Control Number To specify identifying information Usage notes Required when CLM05-3 (Claim Frequency Code) indicates this claim is a replacement or void to a previously adjudicated claim. If not required by this implementation guide, do not send. This information is specific to the destination payer reported in Loop ID-2010BB. Example REF F8 XXXXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification F8 Original Reference Number REF-02 127 Payer Claim Control Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 92 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Peer Review Organization (PRO) Approval Number To specify identifying information Usage notes Required when an external Peer Review Organization assigns an Approval Number to services deemed medically necessary by that organization. If not required by this implementation guide, do not send. Example REF G4 XX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification G4 Peer Review Organization (PRO) Approval Number REF-02 127 Peer Review Authorization Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 93 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Prior Authorization To specify identifying information Usage notes Generally, preauthorization numbers are assigned by the payer or UMO to authorize a service prior to its being performed. The UMO (Utilization Management Organization) is generally the entity empowered to make a decision regarding the outcome of a health services review or the owner of information. The prior authorization number carried in this REF is specific to the destination payer reported in the Loop ID-2010BB. If other payers have similar numbers for this claim, report that information in the Loop ID-2330 loop REF which holds that payer's information. Numbers at this position apply to the entire claim unless they are overridden in the REF segment in Loop ID-2400. A reference identification is considered to be overridden if the value in REF01 is the same in both the Loop ID-2300 REF segment and the Loop ID-2400 REF segment. In that case, the Loop ID-2400 REF applies only to that specific line. Required when an authorization number is assigned by the payer or UMO AND the services on this claim were preauthorized. If not required by this implementation guide, do not send. Example REF G1 XXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification G1 Prior Authorization Number REF-02 127 Prior Authorization Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 94 579 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 95 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Referral Number To specify identifying information Usage notes Required | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_19 |
11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 95 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Referral Number To specify identifying information Usage notes Required when a referral number is assigned by the payer or Utilization Management Organization (UMO) AND a referral is involved. If not required by this implementation guide, do not send. Numbers at this position apply to the entire claim unless they are overridden in the REF segment in Loop ID-2400. A reference identification is considered to be overridden if the value in REF01 is the same in both the Loop ID-2300 REF segment and the Loop ID-2400 REF segment. In that case, the Loop ID-2400 REF applies only to that specific line. Example REF 9F XXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 9F Referral Number REF-02 127 Referral Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 96 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Repriced Claim Number To specify identifying information Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. Required when this information is deemed necessary by the repricer. The segment is not completed by providers. The information is completed by repricers only. If not required by this implementation guide, do not send. Example REF 9A XXXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 9A Repriced Claim Reference Number REF-02 127 Repriced Claim Reference Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 97 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop REF Service Authorization Exception Code To specify identifying information Usage notes Required when mandated by government law or regulation to obtain authorization for specific service(s) but, for the reasons listed in REF02, the service was performed without obtaining the authorization. If not required by this implementation guide, do not send. Example REF 4N X Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 4N Special Payment Reference Number REF-02 127 Service Authorization Exception Code Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes Allowable values for this element are: 1 Immediate Urgent Care 2 Services Rendered in a Retroactive Period 3 Emergency Care 4 Client has Temporary Medicaid 5 Request from County for Second Opinion to Determine if Recipient Can Work 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 98 579 6 Request for Override Pending 7 Special Handling 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 99 579 K3 1850 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop K3 File Information To transmit a fixed-format record or matrix contents Usage notes Required when ALL of the following conditions are met: A regulatory agency concludes it must use the K3 to meet an emergency legislative requirement; The administering regulatory agency or other state organization has completed each one of the following steps: contacted the X12N workgroup, requested a review of the K3 data requirement to ensure there is not an existing method within the implementation guide to meet this requirement X12N determines that there is no method to meet the requirement. If not required by this implementation guide, do not send. At the time of publication of this implementation, K3 segments have no specific use. The K3 segment is expected to be used only when necessary to meet the unexpected data requirement of a legislative authority. Before this segment can be used: The X12N Health Care Claim workgroup must conclude there is no other available option in the implementation guide to meet the emergency legislative requirement. The requestor must submit a proposal for approval accompanied by the relevant business documentation to the X12N Health Care Claim workgroup chairs and receive approval for the request. Upon review of the request, X12N will issue an approval or denial decision to the requesting entity. Approved usage(s) of the K3 segment will be reviewed by the X12N Health Care Claim workgroup to develop a permanent change to include the business case in future | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_20 |
receive approval for the request. Upon review of the request, X12N will issue an approval or denial decision to the requesting entity. Approved usage(s) of the K3 segment will be reviewed by the X12N Health Care Claim workgroup to develop a permanent change to include the business case in future transaction implementations. Only when all of the requirements above have been met, may the regulatory agency require the temporary use of the K3 segment. X12N will submit the necessary data maintenance and refer the request to the appropriate data content committee(s). Example K3 XXXXXX Max use 10 Optional K3-01 449 Fixed Format Information Min 1 Max 80 String (AN) Required Data in fixed format agreed upon by sender and receiver 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 100 579 NTE 1900 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop NTE Billing Note To transmit information in a free-form format, if necessary, for comment or special instruction Usage notes Required when in the judgment of the provider, the information is needed to substantiate the medical treatment and is not supported elsewhere within the claim data set. If not required by this implementation guide, do not send. Example NTE ADD XX Variants (all may be used) NTE Claim Note Max use 1 Optional NTE-01 363 Note Reference Code Identifier (ID) Required Code identifying the functional area or purpose for which the note applies ADD Additional Information NTE-02 352 Billing Note Text Min 1 Max 80 String (AN) Required A free-form description to clarify the related data elements and their content 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 101 579 NTE 1900 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop NTE Claim Note To transmit information in a free-form format, if necessary, for comment or special instruction Usage notes Required when in the judgment of the provider, the information is needed to substantiate the medical treatment and is not supported elsewhere within the claim data set. OR Required when in the judgment of the provider, narrative information from the forms "Home Health Certification and Plan of Treatment" or "Medical Update and Patient Information" is needed to substantiate home health services. If not required by this implementation guide, do not send. The developers of this implementation guide discourage using narrative information within the 837. Trading partners who use narrative information with claims are strongly encouraged to codify that information within the X12 environment.; Example NTE RLH XXXXX Variants (all may be used) NTE Billing Note Max use 10 Optional NTE-01 363 Note Reference Code Identifier (ID) Required Code identifying the functional area or purpose for which the note applies ALG Allergies DCP Goals, Rehabilitation Potential, or Discharge Plans DGN Diagnosis Description DME Durable Medical Equipment (DME) and Supplies MED Medications NTR Nutritional Requirements ODT Orders for Disciplines and Treatments RHB Functional Limitations, Reason Homebound, or Both RLH Reasons Patient Leaves Home RNH Times and Reasons Patient Not at Home SET Unusual Home, Social Environment, or Both SFM Safety Measures SPT Supplementary Plan of Treatment UPI Updated Information NTE-02 352 Claim Note Text Min 1 Max 80 String (AN) Required A free-form description to clarify the related data elements and their content 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 102 579 CRC 2200 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop CRC EPSDT Referral To supply information on conditions Usage notes Required on Early Periodic Screening, Diagnosis, and Treatment (EPSDT) claims when the screening service is being billed in this claim. If not required by this implementation guide, do not send. Example CRC ZZ Y AV XX XX Max use 1 Optional CRC-01 1136 Code Qualifier Identifier (ID) Required Specifies the situation or category to which the code applies CRC01 qualifies CRC03 through CRC07. ZZ Mutually Defined EPSDT Screening referral information. CRC-02 1073 Certification Condition Code Applies Indicator Identifier (ID) Required Code indicating a Yes or No condition or response CRC02 is a Certification Condition Code applies indicator. A "Y" value indicates the condition codes in CRC03 through CRC07 apply; an "N" value indicates the condition codes in CRC03 through CRC07 do not apply. Usage notes The response answers the question: Was an EPSDT referral given to the patient? N No If no, then choose "NU" in CRC03 indicating no referral given. Y Yes CRC-03 1321 Condition Indicator Identifier (ID) Required Code indicating a condition Usage notes The codes for CRC03 also can be used for CRC04 through CRC05. AV Available - Not Used Patient refused referral. NU Not Used This conditioner indicator must be used when the submitter answers "N" in CRC02. S2 Under Treatment Patient is currently under treatment for referred diagnostic or corrective health problem. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 103 579 ST New Services Requested Patient is referred to another provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals). OR Patient is scheduled for another appointment with screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals).; CRC-04 1321 Condition Indicator Min 2 Max 3 Identifier (ID) Optional Code indicating a condition Usage notes Use the codes listed in CRC03. CRC-05 1321 Condition Indicator Min 2 Max 3 Identifier (ID) Optional Code indicating a condition Usage notes Use the codes listed in CRC03. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 104 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_21 |
indicating a condition Usage notes Use the codes listed in CRC03. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 104 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Admitting Diagnosis To supply information related to the delivery of health care Usage notes Required when claim involves an inpatient admission. If not required by this implementation guide, do not send.; Do not transmit the decimal point for ICD codes. The decimal point is implied. Example HI BJ XXX Variants (all may be used) HI Condition Information HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 1 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABJ International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BJ International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis C022-02 1271 Admitting Diagnosis Code Min 1 Max 30 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 105 579 Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 106 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Condition Information To supply information related to the delivery of health care Usage notes Required when there is a Condition Code that applies to this claim. If not required by this implementation guide, do not send. Example HI BG X BG XXX BG XX BG X BG X BG XXXXXX BG XXXX X BG X BG XXXXXX BG XXX BG XXXX BG XXX Variants (all may be used) HI Admitting Diagnosis HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 2 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-02 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 107 579 Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-03 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-04 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 108 579 Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_22 |
specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-05 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-06 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 109 579 Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-07 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-08 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-09 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 110 579 Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-10 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-11 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 111 579 C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-12 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_23 |
beginning value in a range of codes. HI-12 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 112 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Diagnosis Related Group (DRG) Information To supply information related to the delivery of health care Usage notes Required when an inpatient hospital is under DRG contract with a payer and the contract requires the provider to identify the DRG to the payer. If not required by this implementation guide, do not send. Example HI DR XX Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 1 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. DR Diagnosis Related Group (DRG) C022-02 1271 Diagnosis Related Group (DRG) Code String (AN) Required Min 1 Max 30 Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 113 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI External Cause of Injury To supply information related to the delivery of health care Usage notes Required when an external Cause of Injury is needed to describe an injury, poisoning, or adverse effect. If not required by this implementation guide, do not send. Do not transmit the decimal point for ICD codes. The decimal point is implied. In order to fully describe an injury using ICD-10-CM, it will be necessary to report a series of 3 external cause of injury codes. Example HI BN XXXXX W ABN XXXXXX N BN XXX Y BN XXXX W ABN XXXXXX N BN XXXX N BN XXXXX Y BN XXXX W ABN XX U BN XXX Y ABN XXX W ABN XX Y Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI Diagnosis Related Group (DRG) Information HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 1 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 114 579 the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-02 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_24 |
Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 115 579 OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-03 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 116 579 BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-04 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 117 579 ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_25 |
"U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-05 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 118 579 This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-06 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 119 579 If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-07 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 120 579 The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_26 |
Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-08 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 121 579 OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-09 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 122 579 BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-10 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 123 579 ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_27 |
qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 123 579 ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-11 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 124 579 This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-12 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 125 579 If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_28 |
C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 126 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Occurrence Information To supply information related to the delivery of health care Usage notes Required when there is a Occurrence Code that applies to this claim. If not required by this implementation guide, do not send. Example HI BH XXXXX D8 XXX BH XXXXXX D8 XXXXXX BH XXXX D 8 XXXXX BH XX D8 XXXX BH XXX D8 XXXXX BH XXX D8 X XXXXX BH XX D8 XXX BH XXXXXX D8 XXXX BH X D8 XX X BH XX D8 XXXXX BH XX D8 XXXXX BH XXXXXX D8 XXXX XX Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 2 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BH Occurrence C022-02 1271 Occurrence Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 127 579 C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-02 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence code and the preceding HI data elements have been used to report other occurrence codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BH Occurrence C022-02 1271 Occurrence Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-03 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 128 579 Required when it is necessary to report an additional occurrence code and the preceding HI data elements have been used to report other occurrence codes. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BH Occurrence C022-02 1271 Occurrence Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-04 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence code and the preceding HI data elements have been used to report other occurrence codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BH Occurrence C022-02 1271 Occurrence Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 129 579 If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-05 C022 Health Care | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_29 |
and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-05 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence code and the preceding HI data elements have been used to report other occurrence codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BH Occurrence C022-02 1271 Occurrence Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-06 C022 Health Care Code Information Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 130 579 To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence code and the preceding HI data elements have been used to report other occurrence codes. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BH Occurrence C022-02 1271 Occurrence Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-07 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence code and the preceding HI data elements have been used to report other occurrence codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BH Occurrence C022-02 1271 Occurrence Code Min 1 Max 30 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 131 579 Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-08 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence code and the preceding HI data elements have been used to report other occurrence codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BH Occurrence C022-02 1271 Occurrence Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 132 579 Expression of a date, a time, or range of dates, times or dates and times HI-09 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence code and the preceding HI data elements have been used to report other occurrence codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BH Occurrence C022-02 1271 Occurrence Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_30 |
from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-10 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence code and the preceding HI data elements have been used to report other occurrence codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 133 579 BH Occurrence C022-02 1271 Occurrence Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-11 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence code and the preceding HI data elements have been used to report other occurrence codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BH Occurrence C022-02 1271 Occurrence Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 134 579 C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-12 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence code and the preceding HI data elements have been used to report other occurrence codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BH Occurrence C022-02 1271 Occurrence Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 135 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Occurrence Span Information To supply information related to the delivery of health care Usage notes Required when there is an Occurrence Span Code that applies to this claim. If not required by this implementation guide, do not send. Example HI BI XXXXXX RD8 XX BI XXXXXX RD8 XX BI XXXXX RD 8 XXXX BI XXX RD8 XXXXXX BI XXXXXX RD8 XXXX BI X X RD8 XXX BI XXXXX RD8 XXXXX BI XXXX RD8 XXXX B I XXXXX RD8 XXXXXX BI XX RD8 X BI XXXX RD8 XXXX B I XXXXXX RD8 XXXXX Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 2 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BI Occurrence Span C022-02 1271 Occurrence Span Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 136 579 C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_31 |
a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 136 579 C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-02 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence span code and the preceding HI data elements have been used to report other occurrence span codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BI Occurrence Span C022-02 1271 Occurrence Span Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-03 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 137 579 Required when it is necessary to report an additional occurrence span code and the preceding HI data elements have been used to report other occurrence span codes. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BI Occurrence Span C022-02 1271 Occurrence Span Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-04 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence span code and the preceding HI data elements have been used to report other occurrence span codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BI Occurrence Span C022-02 1271 Occurrence Span Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 138 579 If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-05 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence span code and the preceding HI data elements have been used to report other occurrence span codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BI Occurrence Span C022-02 1271 Occurrence Span Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-06 C022 Health Care Code Information Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 139 579 To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence span code and the preceding HI data elements have been used to report other occurrence span codes. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_32 |
dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence span code and the preceding HI data elements have been used to report other occurrence span codes. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BI Occurrence Span C022-02 1271 Occurrence Span Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-07 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence span code and the preceding HI data elements have been used to report other occurrence span codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BI Occurrence Span C022-02 1271 Occurrence Span Code Min 1 Max 30 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 140 579 Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-08 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence span code and the preceding HI data elements have been used to report other occurrence span codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BI Occurrence Span C022-02 1271 Occurrence Span Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 141 579 Expression of a date, a time, or range of dates, times or dates and times HI-09 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence span code and the preceding HI data elements have been used to report other occurrence span codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BI Occurrence Span C022-02 1271 Occurrence Span Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-10 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence span code and the preceding HI data elements have been used to report other occurrence span codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 142 579 BI Occurrence Span C022-02 1271 Occurrence Span Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_33 |
indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-11 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence span code and the preceding HI data elements have been used to report other occurrence span codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BI Occurrence Span C022-02 1271 Occurrence Span Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 143 579 C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-12 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence span code and the preceding HI data elements have been used to report other occurrence span codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BI Occurrence Span C022-02 1271 Occurrence Span Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD C022-04 1251 Occurrence Span Code Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 144 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Other Diagnosis Information To supply information related to the delivery of health care Usage notes Do not transmit the decimal point for ICD codes. The decimal point is implied. Required when other condition(s) coexist or develop(s) subsequently during the patient's treatment. If not required by this implementation guide, do not send. Example HI BF XXXX W ABF XXX N BF XXXXXX N BF XXXXXX Y BF XXXX U BF XXXXX W BF XX U BF XXXXX N ABF XXXX U ABF XXXXXX W BF XX W ABF XXX N Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 2 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 145 579 BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-02 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional diagnosis and the preceding HI data elements have been used to report other diagnoses. If not required by this implementation guide, do | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_34 |
C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional diagnosis and the preceding HI data elements have been used to report other diagnoses. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 146 579 C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-03 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional diagnosis and the preceding HI data elements have been used to report other diagnoses. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 147 579 If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-04 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional diagnosis and the preceding HI data elements have been used to report other diagnoses. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 148 579 Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_35 |
that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-05 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional diagnosis and the preceding HI data elements have been used to report other diagnoses. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 149 579 an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-06 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional diagnosis and the preceding HI data elements have been used to report other diagnoses. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 150 579 C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-07 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional diagnosis and the preceding HI data elements have been used to report other diagnoses. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_36 |
Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 151 579 N No U Unknown W Not Applicable Y Yes HI-08 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional diagnosis and the preceding HI data elements have been used to report other diagnoses. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 152 579 Y Yes HI-09 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional diagnosis and the preceding HI data elements have been used to report other diagnoses. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-10 C022 Health Care Code Information 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 153 579 To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional diagnosis and the preceding HI data elements have been used to report other diagnoses. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_37 |
pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-11 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 154 579 Required when it is necessary to report an additional diagnosis and the preceding HI data elements have been used to report other diagnoses. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-12 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional diagnosis and the preceding HI data elements have been used to report other diagnoses. If not required by this implementation guide, do not send. Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 155 579 C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modification (ICD-10-CM) Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BF International Classification of Diseases Clinical Modification (ICD-9-CM) Diagnosis C022-02 1271 Other Diagnosis Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 156 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Other Procedure Information To supply information related to the delivery of health care Usage notes Required on inpatient claims when additional procedures must be reported. If not required by this implementation guide, do not send. Do not transmit the decimal point for ICD codes. The decimal point is implied. Example HI BQ XXXX D8 XXX BQ XXXXXX D8 XXXX BBQ XXXXX D 8 XXXXX BQ XXXX D8 XXXXXX BQ XX D8 XXXX BBQ XXX D 8 XXX BQ XX D8 XXXXX BQ XX D8 XXXX BBQ XXXXXX D 8 XX BQ XXXXX D8 X BBQ XXXXX D8 XXXXXX BBQ X D8 X XXXXX | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_38 |
D8 XXX BQ XXXXXX D8 XXXX BBQ XXXXX D 8 XXXXX BQ XXXX D8 XXXXXX BQ XX D8 XXXX BBQ XXX D 8 XXX BQ XX D8 XXXXX BQ XX D8 XXXX BBQ XXXXXX D 8 XX BQ XXXXX D8 X BBQ XXXXX D8 XXXXXX BBQ X D8 X XXXXX Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 2 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 157 579 OR For claims which are not covered under HIPAA. BQ International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes C022-02 1271 Procedure Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Procedure Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-02 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional procedure and the preceding HI data elements have been used to report other procedures. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BQ International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes C022-02 1271 Procedure Code Min 1 Max 30 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 158 579 Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Procedure Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-03 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional procedure and the preceding HI data elements have been used to report other procedures. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BQ International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes C022-02 1271 Procedure Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 159 579 Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Procedure Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-04 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional procedure and the preceding HI data elements have been used to report other procedures. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_39 |
amounts and quantities Usage notes Required when it is necessary to report an additional procedure and the preceding HI data elements have been used to report other procedures. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BQ International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes C022-02 1271 Procedure Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Procedure Date Min 1 Max 35 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 160 579 Expression of a date, a time, or range of dates, times or dates and times HI-05 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional procedure and the preceding HI data elements have been used to report other procedures. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BQ International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes C022-02 1271 Procedure Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Procedure Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-06 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 161 579 Required when it is necessary to report an additional procedure and the preceding HI data elements have been used to report other procedures. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BQ International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes C022-02 1271 Procedure Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Procedure Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-07 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional procedure and the preceding HI data elements have been used to report other procedures. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 162 579 Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_40 |
HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BQ International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes C022-02 1271 Procedure Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Procedure Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-08 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional procedure and the preceding HI data elements have been used to report other procedures. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 163 579 OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BQ International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes C022-02 1271 Procedure Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Procedure Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-09 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional procedure and the preceding HI data elements have been used to report other procedures. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BQ International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 164 579 C022-02 1271 Procedure Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Procedure Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-10 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional procedure and the preceding HI data elements have been used to report other procedures. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BQ International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes C022-02 1271 Procedure Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 165 579 Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_41 |
30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 165 579 Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Procedure Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times HI-11 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional procedure and the preceding HI data elements have been used to report other procedures. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BQ International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes C022-02 1271 Procedure Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Procedure Date Min 1 Max 35 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 166 579 Expression of a date, a time, or range of dates, times or dates and times HI-12 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional procedure and the preceding HI data elements have been used to report other procedures. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BQ International Classification of Diseases Clinical Modification (ICD-9-CM) Other Procedure Codes C022-02 1271 Procedure Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Procedure Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 167 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Patient's Reason For Visit To supply information related to the delivery of health care Usage notes Required when claim involves outpatient visits. If not required by this implementation guide, do not send. Do not transmit the decimal point for ICD codes. The decimal point is implied. Example HI PR XXXX PR XXX APR XXXX Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 1 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 168 579 APR International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. PR International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit C022-02 1271 Patient Reason For Visit Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-02 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional Patient's | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_42 |
Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-02 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional Patient's Reason for Visit must be sent and the preceding HI data elements have been used to report other patient's reason for visit. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. APR International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. PR International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit C022-02 1271 Patient Reason For Visit Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 169 579 HI-03 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional Patient's Reason for Visit must be sent and the preceding HI data elements have been used to report other patient's reason for visit. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. APR International Classification of Diseases Clinical Modification (ICD-10-CM) Patient's Reason for Visit This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. PR International Classification of Diseases Clinical Modification (ICD-9-CM) Patient's Reason for Visit C022-02 1271 Patient Reason For Visit Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 170 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Principal Diagnosis To supply information related to the delivery of health care Usage notes Do not transmit the decimal point for ICD codes. The decimal point is implied. Example HI BK XX N Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 1 Required HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABK International Classification of Diseases Clinical Modification (ICD-10-CM) Principal Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BK International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Diagnosis C022-02 1271 Principal Diagnosis Code Min 1 Max 30 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 171 579 Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 172 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Principal Procedure Information To supply information related to the delivery of health care Usage notes Required on inpatient claims when a procedure was performed. If not required by this implementation guide, do not send. Do not transmit the decimal point for ICD codes. The decimal point is implied. Example HI CAH XXXXX D8 | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_43 |
To supply information related to the delivery of health care Usage notes Required on inpatient claims when a procedure was performed. If not required by this implementation guide, do not send. Do not transmit the decimal point for ICD codes. The decimal point is implied. Example HI CAH XXXXX D8 X Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Treatment Code Information HI Value Information Max use 1 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 173 579 BBR International Classification of Diseases Clinical Modification (ICD-10-PCS) Principal Procedure Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-PCS as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BR International Classification of Diseases Clinical Modification (ICD-9-CM) Principal Procedure Codes CAH Advanced Billing Concepts (ABC) Codes C022-02 1271 Principal Procedure Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Principal Procedure Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 174 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Treatment Code Information To supply information related to the delivery of health care Usage notes Required when Home Health Agencies need to report Plan of Treatment information under various payer contracts. If not required by this implementation guide, do not send. Example HI TC XXX TC XXX TC X TC XXXX TC XXXXXX TC XXX T C XXXXX TC XXXXX TC X TC XXXXXX TC XX TC XXXXXX Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Value Information Max use 2 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-02 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 175 579 Usage notes Required when it is necessary to report an additional treatment code and the preceding HI data elements have been used to report other treatment codes. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-03 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional treatment code and the preceding HI data elements have been used to report other treatment codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-04 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional treatment code and the preceding HI data elements have been used to report other treatment codes. If not required by this implementation guide, do not send. Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 176 579 C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_44 |
- Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 176 579 C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-05 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional treatment code and the preceding HI data elements have been used to report other treatment codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-06 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional treatment code and the preceding HI data elements have been used to report other treatment codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 177 579 TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-07 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional treatment code and the preceding HI data elements have been used to report other treatment codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-08 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional treatment code and the preceding HI data elements have been used to report other treatment codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 178 579 If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-09 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional treatment code and the preceding HI data elements have been used to report other treatment codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-10 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional treatment code and the preceding HI data elements have been used to report other treatment codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-11 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 179 579 Required when it is necessary to report an additional treatment code and the preceding HI data elements have been used to report other treatment codes. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-12 C022 Health Care Code Information To send health | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_45 |
and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-12 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional treatment code and the preceding HI data elements have been used to report other treatment codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 180 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Value Information To supply information related to the delivery of health care Usage notes Required when there is a Value Code that applies to this claim. If not required by this implementation guide, do not send. Example HI BE XXX 000000000 BE XXX 0 BE XXXXXX 0 B E XXX 0000 BE X 0000000000 BE XX 000 BE XXX X 00000000000000 BE XXXXX 000000000000 BE XXX XX 0000000 BE XXX 0000000000000 BE XXX 0000 0000 BE XXXX 00000000 Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information Max use 2 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BE Value C022-02 1271 Value Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 181 579 C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount HI-02 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional value code and the preceding HI data elements have been used to report other value codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BE Value C022-02 1271 Value Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount HI-03 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional value code and the preceding HI data elements have been used to report other value codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BE Value C022-02 1271 Value Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 182 579 If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount HI-04 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional value code and the preceding HI data elements have been used to report other value codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BE Value C022-02 1271 Value Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount HI-05 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional value code and the preceding HI data elements have been used to report other value codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BE Value 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 183 579 C022-02 1271 Value Code Min 1 | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_46 |
identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BE Value 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 183 579 C022-02 1271 Value Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount HI-06 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional value code and the preceding HI data elements have been used to report other value codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BE Value C022-02 1271 Value Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount HI-07 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional value code and the preceding HI data elements have been used to report other value codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 184 579 BE Value C022-02 1271 Value Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount HI-08 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional value code and the preceding HI data elements have been used to report other value codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BE Value C022-02 1271 Value Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount HI-09 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional value code and the preceding HI data elements have been used to report other value codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 185 579 Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BE Value C022-02 1271 Value Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount HI-10 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional value code and the preceding HI data elements have been used to report other value codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BE Value C022-02 1271 Value Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount HI-11 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional value code and the preceding HI data elements have been used to report other value codes. If not required by this implementation guide, do not send. Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 186 579 C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BE Value C022-02 1271 Value Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount HI-12 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_47 |
value in a range of codes. C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount HI-12 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional value code and the preceding HI data elements have been used to report other value codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BE Value C022-02 1271 Value Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-05 782 Value Code Amount Min 1 Max 15 Decimal number (R) Required Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 187 579 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 188 579 HCP 2410 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HCP Claim Pricing Repricing Information To specify pricing or repricing information about a health care claim or line item Usage notes Required when this information is deemed necessary by the repricer. The segment is not completed by providers. The information is completed by repricers only. If not required by this implementation guide, do not send. This information is specific to the destination payer reported in Loop ID-2010BB. For capitated encounters, pricing or repricing information usually is not applicable and is provided to qualify other information within the claim. Example HCP 04 0000000000 00000 XXXXXX 000 XXXXX 00 XXXX X DA 000 T4 4 3 If either Unit or Basis for Measurement Code (HCP-11) or Repriced Approved Service Unit Count (HCP-12) is present, then the other is required Max use 1 Optional HCP-01 1473 Pricing Methodology Identifier (ID) Required Code specifying pricing methodology at which the claim or line item has been priced or repriced Usage notes Specific code use is determined by Trading Partner Agreement due to the variances in contracting policies in the industry. 00 Zero Pricing (Not Covered Under Contract) 01 Priced as Billed at 100 02 Priced at the Standard Fee Schedule 03 Priced at a Contractual Percentage 04 Bundled Pricing 05 Peer Review Pricing 06 Per Diem Pricing 07 Flat Rate Pricing 08 Combination Pricing 09 Maternity Pricing 10 Other Pricing 11 Lower of Cost 12 Ratio of Cost 13 Cost Reimbursed 14 Adjustment Pricing HCP-02 782 Repriced Allowed Amount Min 1 Max 15 Decimal number (R) Required Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 189 579 HCP02 is the allowed amount. HCP-03 782 Repriced Saving Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount HCP03 is the savings amount. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. HCP-04 127 Repricing Organization Identifier Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier HCP04 is the repricing organization identification number. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. HCP-05 118 Repricing Per Diem or Flat Rate Amount Decimal number (R) Optional Min 1 Max 9 Rate expressed in the standard monetary denomination for the currency specified HCP05 is the pricing rate associated with per diem or flat rate repricing. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. HCP-06 127 Repriced Approved DRG Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier HCP06 is the approved DRG code. HCP06, HCP07, HCP08, HCP10, and HCP12 are fields that will contain different values from the original submitted values. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. HCP-07 782 Repriced Approved Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount HCP07 is the approved DRG amount. Usage notes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 190 579 This information is specific to the destination payer reported in Loop ID-2010BB. HCP-08 234 Repriced Approved Revenue Code Min 1 Max 48 String (AN) Optional Identifying number for a product or service HCP08 is the approved revenue code. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. HCP-11 355 Unit or Basis for Measurement Code Identifier (ID) Optional Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken DA Days UN Unit HCP-12 380 Repriced Approved Service Unit Count Decimal number (R) Optional Min 1 Max 15 Numeric value of quantity HCP12 is the approved service units or inpatient days. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. HCP-13 901 Reject Reason Code Identifier (ID) Optional Code assigned by issuer to identify reason for rejection HCP13 is the rejection message returned from the third party organization. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. T1 Cannot Identify Provider as TPO (Third Party Organization) Participant T2 Cannot Identify Payer as TPO (Third Party Organization) Participant T3 Cannot Identify Insured as TPO (Third Party Organization) Participant T4 Payer Name or Identifier Missing T5 Certification Information Missing T6 Claim does not contain enough information for re-pricing | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_48 |
ID-2010BB. T1 Cannot Identify Provider as TPO (Third Party Organization) Participant T2 Cannot Identify Payer as TPO (Third Party Organization) Participant T3 Cannot Identify Insured as TPO (Third Party Organization) Participant T4 Payer Name or Identifier Missing T5 Certification Information Missing T6 Claim does not contain enough information for re-pricing HCP-14 1526 Policy Compliance Code Identifier (ID) Optional Code specifying policy compliance Usage notes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 191 579 This information is specific to the destination payer reported in Loop ID-2010BB. 1 Procedure Followed (Compliance) 2 Not Followed - Call Not Made (Non-Compliance Call Not Made) 3 Not Medically Necessary (Non-Compliance Non-Medically Necessary) 4 Not Followed Other (Non-Compliance Other) 5 Emergency Admit to Non-Network Hospital HCP-15 1527 Exception Code Identifier (ID) Optional Code specifying the exception reason for consideration of out-of-network health care services HCP15 is the exception reason generated by a third party organization. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. 1 Non-Network Professional Provider in Network Hospital 2 Emergency Care 3 Services or Specialist not in Network 4 Out-of-Service Area 5 State Mandates 6 Other 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 192 579 2310A Attending Provider Name Loop Max 1 Optional Variants (all may be used) Operating Physician Name Loop Other Operating Physician Name Loop Rendering Provider Name Loop Service Facility Location Name Loop Referring Provider Name Loop NM1 2500 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Attending Provider Name Loop NM1 Attending Provider Name To supply the full name of an individual or organizational entity Usage notes Required when the claim contains any services other than non-scheduled transportation claims. If not required by this implementation guide, do not send. The Attending Provider is the individual who has overall responsibility for the patient's medical care and treatment reported in this claim. Example NM1 71 1 XXXX XXX XX X XX XXXXX If either Identification Code Qualifier (NM1-08) or Attending Provider Primary Identifier (NM1-09) is present, then the other is required Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 71 Attending Physician When used, the term physician is any type of provider filling this role. NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 Person NM1-03 1035 Attending Provider Last Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-04 1036 Attending Provider First Name Min 1 Max 35 String (AN) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 193 579 Individual first name NM1-05 1037 Attending Provider Middle Name or Initial Min 1 Max 25 String (AN) Optional Individual middle name or initial NM1-07 1039 Attending Provider Name Suffix Min 1 Max 10 String (AN) Optional Suffix to individual name NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Medicare and Medicaid Services National Provider Identifier NM1-09 67 Attending Provider Primary Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code Usage notes Use appropriate NPI number. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 194 579 PRV 2550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Attending Provider Name Loop PRV Attending Provider Specialty Information To specify the identifying characteristics of a provider Usage notes Required when adjudication of the destination payer, or any subsequent payer listed on this claim, is known to be impacted by the attending provider taxonomy code. If not required by this implementation guide, do not send. Example PRV AT PXC XXXXX Max use 1 Optional PRV-01 1221 Provider Code Identifier (ID) Required Code identifying the type of provider AT Attending PRV-02 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification PXC Health Care Provider Taxonomy Code PRV-03 127 Provider Taxonomy Code Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 195 579 2310A Attending Provider Name Loop end REF 2710 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Attending Provider Name Loop REF Attending Provider Secondary Identification To specify identifying information Usage notes Required prior to the mandated HIPAA National Provider Identifier (NPI) implementation date when an identification number other than the NPI is necessary for the receiver to identify the provider. OR Required on or after the mandated NPI Implementation Date when NM109 in this loop is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send. Example REF G2 XXXXXX Max use 4 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification G2 Provider Commercial Number This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim. This is to be used by all payers including: Medicare, Medicaid, Blue Cross, etc. REF-02 127 Attending Provider Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes Health partners provider identification number (5 digits). 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_49 |
String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes Health partners provider identification number (5 digits). 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 196 579 2310B Operating Physician Name Loop Max 1 Optional Variants (all may be used) Attending Provider Name Loop Other Operating Physician Name Loop Rendering Provider Name Loop Service Facility Location Name Loop Referring Provider Name Loop NM1 2500 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Operating Physician Name Loop NM1 Operating Physician Name To supply the full name of an individual or organizational entity Usage notes Required when a surgical procedure code is listed on this claim. If not required by this implementation guide, do not send. The Operating Physician is the individual with primary responsibility for performing the surgical procedure(s). Information in Loop ID-2310 applies to the entire claim unless overridden on a service line by the presence of Loop ID-2420 with the same value in NM101. Example NM1 72 1 X X XX XXXXXX XX XXXX If either Identification Code Qualifier (NM1-08) or Operating Physician Primary Identifier (NM1-09) is present, then the other is required Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 72 Operating Physician NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 Person NM1-03 1035 Operating Physician Last Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-04 1036 Operating Physician First Name Min 1 Max 35 String (AN) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 197 579 Individual first name NM1-05 1037 Operating Physician Middle Name or Initial String (AN) Optional Min 1 Max 25 Individual middle name or initial NM1-07 1039 Operating Physician Name Suffix Min 1 Max 10 String (AN) Optional Suffix to individual name NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Medicare and Medicaid Services National Provider Identifier NM1-09 67 Operating Physician Primary Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code Usage notes Use appropriate NPI number. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 198 579 2310B Operating Physician Name Loop end REF 2710 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Operating Physician Name Loop REF Operating Physician Secondary Identification To specify identifying information Usage notes Required prior to the mandated HIPAA National Provider Identifier (NPI) implementation date when an identification number other than the NPI is necessary for the receiver to identify the provider. OR Required on or after the mandated NPI Implementation Date when NM109 in this loop is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send. Example REF G2 XXX Max use 4 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim. This is to be used by all payers including: Medicare, Medicaid, Blue Cross, etc. LU Location Number REF-02 127 Operating Physician Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 199 579 2310C Other Operating Physician Name Loop Max 1 Optional Variants (all may be used) Attending Provider Name Loop Operating Physician Name Loop Rendering Provider Name Loop Service Facility Location Name Loop Referring Provider Name Loop NM1 2500 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Operating Physician Name Loop NM1 Other Operating Physician Name To supply the full name of an individual or organizational entity Usage notes Required when another Operating Physician is involved. If not required by the implementation guide, do not send. The Other Operating Physician is the individual performing a secondary surgical procedure or assisting the Operating Physician. This Other Operating Physician segment can only be used when Operating Physician information (Loop ID-2310B) is also sent on this claim. Information in Loop ID-2310 applies to the entire claim unless overridden on a service line by the presence of Loop ID-2420 with the same value in NM101. Example NM1 ZZ 1 X XXXXX XXX XXXXX XX XXXXXXX If either Identification Code Qualifier (NM1-08) or Other Operating Physician Identifier (NM1-09) is present, then the other is required Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual ZZ Mutually Defined ZZ is used to indicate Other Operating Physician. NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 Person NM1-03 1035 Other Operating Physician Last Name Min 1 Max 60 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 200 579 Individual last name or organizational name NM1-04 1036 Other Operating Physician First Name Min 1 Max 35 String (AN) Optional Individual first name NM1-05 1037 Other Operating Physician Middle Name or Initial String (AN) Optional Min 1 Max 25 Individual middle name or initial | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_50 |
view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 200 579 Individual last name or organizational name NM1-04 1036 Other Operating Physician First Name Min 1 Max 35 String (AN) Optional Individual first name NM1-05 1037 Other Operating Physician Middle Name or Initial String (AN) Optional Min 1 Max 25 Individual middle name or initial NM1-07 1039 Other Operating Physician Name Suffix Min 1 Max 10 String (AN) Optional Suffix to individual name NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Medicare and Medicaid Services National Provider Identifier NM1-09 67 Other Operating Physician Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code Usage notes Use appropriate NPI number. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 201 579 2310C Other Operating Physician Name Loop end REF 2710 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Operating Physician Name Loop REF Other Operating Physician Secondary Identification To specify identifying information Usage notes Required prior to the mandated HIPAA National Provider Identifier (NPI) implementation date when an identification number other than the NPI is necessary for the receiver to identify the provider. OR Required on or after the mandated NPI Implementation Date when NM109 in this loop is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send. Example REF 0B XXX Max use 4 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim. This is to be used by all payers including: Medicare, Medicaid, Blue Cross, etc. LU Location Number REF-02 127 Other Provider Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 202 579 2310D Rendering Provider Name Loop Max 1 Optional Variants (all may be used) Attending Provider Name Loop Operating Physician Name Loop Other Operating Physician Name Loop Service Facility Location Name Loop Referring Provider Name Loop NM1 2500 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Rendering Provider Name Loop NM1 Rendering Provider Name To supply the full name of an individual or organizational entity Usage notes Required when the Rendering Provider is different than the Attending Provider reported in Loop ID-2310A of this claim. AND When state or federal regulatory requirements call for a "combined claim", that is, a claim that includes both facility and professional components (for example, a Medicaid clinic bill or Critical Access Hospital Claim.) If not required by this implementation guide, do not send. The Rendering Provider is the health care professional who delivers or completes a particular medical service or non-surgical procedure. Information in Loop ID-2310 applies to the entire claim unless overridden on a service line by the presence of Loop ID-2420 with the same value in NM101. Example NM1 82 1 XX XXXX XXXXX XXXX XX XXXXXXX If either Identification Code Qualifier (NM1-08) or Rendering Provider Identifier (NM1-09) is present, then the other is required Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 82 Rendering Provider NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 Person NM1-03 1035 Rendering Provider Last Name Min 1 Max 60 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 203 579 Individual last name or organizational name NM1-04 1036 Rendering Provider First Name Min 1 Max 35 String (AN) Optional Individual first name NM1-05 1037 Rendering Provider Middle Name or Initial Min 1 Max 25 String (AN) Optional Individual middle name or initial NM1-07 1039 Rendering Provider Name Suffix Min 1 Max 10 String (AN) Optional Suffix to individual name NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Medicare and Medicaid Services National Provider Identifier NM1-09 67 Rendering Provider Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 204 579 2310D Rendering Provider Name Loop end REF 2710 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Rendering Provider Name Loop REF Rendering Provider Secondary Identification To specify identifying information Usage notes Required prior to the mandated HIPAA National Provider Identifier (NPI) implementation date when an identification number other than the NPI is necessary for the receiver to identify the provider. OR Required on or after the mandated NPI Implementation Date when NM109 in this loop is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send. Example REF LU XXXXX Max use 4 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim. This is to be used by all payers including: Medicare, Medicaid, Blue | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_51 |
UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim. This is to be used by all payers including: Medicare, Medicaid, Blue Cross, etc. LU Location Number REF-02 127 Rendering Provider Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 205 579 2310E Service Facility Location Name Loop Max 1 Optional Variants (all may be used) Attending Provider Name Loop Operating Physician Name Loop Other Operating Physician Name Loop Rendering Provider Name Loop Referring Provider Name Loop NM1 2500 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Facility Location Name Loop NM1 Service Facility Location Name To supply the full name of an individual or organizational entity Usage notes Required when the location of health care service is different than that carried in Loop ID-2010AA (Billing Provider). If not required by this implementation guide, do not send. When an organization health care provider's NPI is provided to identify the Service Location, the organization health care provider must be external to the entity identified as the Billing Provider (for example, reference lab). It is not permissible to report an organization health care provider NPI as the Service Location if the entity being identified is a component (for example, subpart) of the Billing Provider. In that case, the subpart must be the Billing Provider. Example NM1 77 2 XXXXXX XX XXXXXXX If either Identification Code Qualifier (NM1-08) or Laboratory or Facility Primary Identifier (NM1-09) is present, then the other is required Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 77 Service Location NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 2 Non-Person Entity NM1-03 1035 Laboratory or Facility Name Min 1 Max 60 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 206 579 Individual last name or organizational name NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Medicare and Medicaid Services National Provider Identifier NM1-09 67 Laboratory or Facility Primary Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code Usage notes Use appropriate NPI number. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 207 579 N3 2650 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Facility Location Name Loop N3 Service Facility Location Address To specify the location of the named party Usage notes If service facility location is in an area where there are no street addresses, enter a description of where the service was rendered (for example, "crossroad of State Road 34 and 45" or "Exit near Mile marker 265 on Interstate 80".) Example N3 XXXXXX XXXXXX Max use 1 Required N3-01 166 Laboratory or Facility Address Line Min 1 Max 55 String (AN) Required Address information N3-02 166 Laboratory or Facility Address Line Min 1 Max 55 String (AN) Optional Address information 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 208 579 N4 2700 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Facility Location Name Loop N4 Service Facility Location City, State, ZIP Code To specify the geographic place of the named party Usage notes Include city, 2-character state code and 9-digit ZIP code. Example N4 XXXXXXX XX XXXXX XX Only one of Laboratory or Facility State or Province Code (N4-02) or Country Subdivision Code (N4-07) may be present If Country Subdivision Code (N4-07) is present, then Country Code (N4-04) is required Max use 1 Required N4-01 19 Laboratory or Facility City Name Min 2 Max 30 String (AN) Required Free-form text for city name A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. N4-02 156 Laboratory or Facility State or Province Code Identifier (ID) Optional Min 2 Max 2 Code (Standard State Province) as defined by appropriate government agency N402 is required only if city name (N401) is in the U.S. or Canada. N4-03 116 Laboratory or Facility Postal Zone or ZIP Code Identifier (ID) Optional Min 3 Max 15 Code defining international postal zone code excluding punctuation and blanks (zip code for United States) Usage notes When reporting the ZIP code for U.S. addresses, the full nine digit ZIP code must be provided. N4-04 26 Country Code Min 2 Max 3 Identifier (ID) Optional Code identifying the country Usage notes Use the alpha-2 country codes from Part 1 of ISO 3166. N4-07 1715 Country Subdivision Code Min 1 Max 3 Identifier (ID) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 209 579 Code identifying the country subdivision Usage notes Use the country subdivision codes from Part 2 of ISO 3166. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 210 579 2310E Service Facility Location Name Loop end REF 2710 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Facility Location Name Loop REF Service Facility Location Secondary Identification To specify identifying information Usage notes Required prior to the mandated HIPAA National Provider Identifier (NPI) implementation date when | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_52 |
Facility Location Name Loop end REF 2710 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Facility Location Name Loop REF Service Facility Location Secondary Identification To specify identifying information Usage notes Required prior to the mandated HIPAA National Provider Identifier (NPI) implementation date when an identification number other than the NPI is necessary for the receiver to identify the provider. OR Required on or after the mandated NPI implementation date when the entity is not a Health Care provider (a.k.a. an atypical provider), and an identifier is necessary for the claims processor to identify the entity. If not required by this implementation guide, do not send. Example REF LU XXXXX Max use 3 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number G2 Provider Commercial Number This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim. This is to be used by all payers including: Medicare, Medicaid, Blue Cross, etc. LU Location Number REF-02 127 Laboratory or Facility Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 211 579 2310F Referring Provider Name Loop Max 1 Optional Variants (all may be used) Attending Provider Name Loop Operating Physician Name Loop Other Operating Physician Name Loop Rendering Provider Name Loop Service Facility Location Name Loop NM1 2500 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Referring Provider Name Loop NM1 Referring Provider Name To supply the full name of an individual or organizational entity Usage notes Required on an outpatient claim when the Referring Provider is different than the Attending Provider. If not required by this implementation guide, do not send. The Referring Provider is provider who sends the patient to another provider for services. Information in Loop ID-2310 applies to the entire claim unless overridden on a service line by the presence of Loop ID-2420 with the same value in NM101. Example NM1 DN 1 XXXXXX XXXXX XXX XXXXXX XX XXXXX If either Identification Code Qualifier (NM1-08) or Referring Provider Identifier (NM1-09) is present, then the other is required Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual DN Referring Provider NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 Person NM1-03 1035 Referring Provider Last Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-04 1036 Referring Provider First Name Min 1 Max 35 String (AN) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 212 579 Individual first name NM1-05 1037 Referring Provider Middle Name or Initial Min 1 Max 25 String (AN) Optional Individual middle name or initial NM1-07 1039 Referring Provider Name Suffix Min 1 Max 10 String (AN) Optional Suffix to individual name NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Medicare and Medicaid Services National Provider Identifier NM1-09 67 Referring Provider Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 213 579 2310F Referring Provider Name Loop end REF 2710 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Referring Provider Name Loop REF Referring Provider Secondary Identification To specify identifying information Usage notes Required prior to the mandated HIPAA National Provider Identifier (NPI) implementation date when an identification number other than the NPI is necessary for the receiver to identify the provider. OR Required on or after the mandated NPI Implementation Date when NM109 in this loop is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send. The REF segment in Loop ID-2310 applies to the entire claim unless overridden on the service line level by the presence of a REF segment with the same value in REF01. Example REF G2 X Max use 3 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim. This is to be used by all payers including: Medicare, Medicaid, Blue Cross, etc. REF-02 127 Referring Provider Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 214 579 2320 Other Subscriber Information Loop Max 10 Optional SBR 2900 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop SBR Other Subscriber Information To record information specific to the primary insured and the insurance carrier for that insured Usage notes Required when other payers are known to potentially be involved in paying on this claim. If not required by this implementation guide, do not send. All information contained in Loop ID-2320 applies only to the payer identified in Loop ID-2330B of this iteration of Loop ID-2320. It is specific only to that payer. If information for an additional payer is necessary, repeat Loop ID-2320 with its respective 2330 Loops.; | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_53 |
this implementation guide, do not send. All information contained in Loop ID-2320 applies only to the payer identified in Loop ID-2330B of this iteration of Loop ID-2320. It is specific only to that payer. If information for an additional payer is necessary, repeat Loop ID-2320 with its respective 2330 Loops.; See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example SBR G 20 XXX XX MB Max use 1 Required SBR-01 1138 Payer Responsibility Sequence Number Code Identifier (ID) Required Code identifying the insurance carrier's level of responsibility for a payment of a claim Usage notes Within a given claim, the various values for the Payer Responsibility Sequence Number Code (other than value "U") may occur no more than once. A Payer Responsibility Four B Payer Responsibility Five C Payer Responsibility Six D Payer Responsibility Seven E Payer Responsibility Eight F Payer Responsibility Nine G Payer Responsibility Ten H Payer Responsibility Eleven P Primary S Secondary T Tertiary U Unknown This code may only be used in payer to payer COB claims when the original payer determined the presence of this coverage from eligibility files received from this payer or when the original claim did not provide the responsibility sequence for this payer. SBR-02 1069 Individual Relationship Code Identifier (ID) Required Code indicating the relationship between two individuals or entities SBR02 specifies the relationship to the person insured. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 215 579 01 Spouse 18 Self 19 Child 20 Employee 21 Unknown 39 Organ Donor 40 Cadaver Donor 53 Life Partner G8 Other Relationship SBR-03 127 Insured Group or Policy Number Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier SBR03 is policy or group number. Usage notes This is not the number uniquely identifying the subscriber. The unique subscriber number is submitted in Loop 2330A-NM109 for this iteration of Loop ID-2320. SBR-04 93 Other Insured Group Name Min 1 Max 60 String (AN) Optional Free-form name SBR04 is plan name. SBR-09 1032 Claim Filing Indicator Code Identifier (ID) Required Code identifying type of claim 11 Other Non-Federal Programs 12 Preferred Provider Organization (PPO) 13 Point of Service (POS) 14 Exclusive Provider Organization (EPO) 15 Indemnity Insurance 16 Health Maintenance Organization (HMO) Medicare Risk 17 Dental Maintenance Organization AM Automobile Medical BL Blue Cross Blue Shield CH Champus CI Commercial Insurance Co. DS Disability FI Federal Employees Program HM Health Maintenance Organization LM Liability Medical MA Medicare Part A MB Medicare Part B MC Medicaid OF Other Federal Program Use code OF when submitting Medicare Part D claims. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 216 579 TV Title V VA Veterans Affairs Plan WC Workers' Compensation Health Claim ZZ Mutually Defined Use Code ZZ when Type of Insurance is not known. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 217 579 CAS 2950 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop CAS Claim Level Adjustments To supply adjustment reason codes and amounts as needed for an entire claim or for a particular service within the claim being paid Usage notes Required when the claim has been adjudicated by the payer identified in this loop, and the claim has claim level adjustment information. If not required by this implementation guide, do not send. Submitters must use this CAS segment to report prior payers' claim level adjustments that cause the amount paid to differ from the amount originally charged. Only one Group Code is allowed per CAS. If it is necessary to send more than one Group Code at the claim level, repeat the CAS segment. Codes and associated amounts must come from either paper remittance advice or 835s (Electronic Remittance Advice) received on the claim. When the information originates from a paper remittance advice that does not use the standard Claim Adjustment Reason Codes, the paper values must be converted to standard Claim Adjustment Reason Codes.; A single CAS segment contains six repetitions of the "adjustment trio" composed of adjustment reason code, adjustment amount, and adjustment quantity. These six adjustment trios are used to report up to six adjustments related to a particular Claim Adjustment Group Code (CAS01). The first non-zero adjustment is reported in the first adjustment trio (CAS02-CAS04). If there is a second non-zero adjustment, it is reported in the second adjustment trio (CAS05-CAS07), and so on through the sixth adjustment trio (CAS17-CAS19). Example CAS CR XXX 00000000 00 XX 000000000000000 000000 0 XXXX 000 00000000000 XXXXX 0 0000000000000 XX 0 0000000 00 XXXX 000000000000 000000000 If Adjustment Reason Code (CAS-05) is present, then at least one of Adjustment Amount (CAS-06) or Adjustment Quantity (CAS-07) is required If Adjustment Amount (CAS-06) is present, then Adjustment Reason Code (CAS-05) is required If Adjustment Quantity (CAS-07) is present, then Adjustment Reason Code (CAS-05) is required If Adjustment Reason Code (CAS-08) is present, then at least one of Adjustment Amount (CAS-09) or Adjustment Quantity (CAS-10) is required If Adjustment Amount (CAS-09) is present, then Adjustment Reason Code (CAS-08) is required If Adjustment Quantity (CAS-10) is present, then Adjustment Reason Code (CAS-08) is required If Adjustment Reason Code (CAS-11) is present, then at least one of Adjustment Amount (CAS-12) or Adjustment Quantity (CAS-13) is required If Adjustment Amount (CAS-12) is present, then Adjustment Reason Code (CAS-11) is required If Adjustment Quantity (CAS-13) is present, then Adjustment Reason Code (CAS-11) is required If Adjustment Reason Code (CAS-14) is present, then at least one of Adjustment Amount (CAS-15) or Adjustment Quantity (CAS-16) is required Max use 5 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 218 579 If | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_54 |
(CAS-14) is present, then at least one of Adjustment Amount (CAS-15) or Adjustment Quantity (CAS-16) is required Max use 5 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 218 579 If Adjustment Amount (CAS-15) is present, then Adjustment Reason Code (CAS-14) is required If Adjustment Quantity (CAS-16) is present, then Adjustment Reason Code (CAS-14) is required If Adjustment Reason Code (CAS-17) is present, then at least one of Adjustment Amount (CAS-18) or Adjustment Quantity (CAS-19) is required If Adjustment Amount (CAS-18) is present, then Adjustment Reason Code (CAS-17) is required If Adjustment Quantity (CAS-19) is present, then Adjustment Reason Code (CAS-17) is required CAS-01 1033 Claim Adjustment Group Code Identifier (ID) Required Code identifying the general category of payment adjustment CO Contractual Obligations CR Correction and Reversals OA Other adjustments PI Payor Initiated Reductions PR Patient Responsibility CAS-02 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Required Code identifying the detailed reason the adjustment was made Usage notes See CODE SOURCE 139: Claim Adjustment Reason Code CAS-03 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Required Monetary amount CAS03 is the amount of adjustment. CAS-04 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS04 is the units of service being adjusted. CAS-05 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code identifying the detailed reason the adjustment was made CAS-06 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 219 579 CAS06 is the amount of the adjustment. CAS-07 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS07 is the units of service being adjusted. CAS-08 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code identifying the detailed reason the adjustment was made CAS-09 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CAS09 is the amount of the adjustment. CAS-10 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS10 is the units of service being adjusted. CAS-11 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code identifying the detailed reason the adjustment was made CAS-12 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CAS12 is the amount of the adjustment. CAS-13 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS13 is the units of service being adjusted. CAS-14 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code identifying the detailed reason the adjustment was made 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 220 579 CAS-15 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CAS15 is the amount of the adjustment. CAS-16 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS16 is the units of service being adjusted. CAS-17 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code identifying the detailed reason the adjustment was made CAS-18 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CAS18 is the amount of the adjustment. CAS-19 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS19 is the units of service being adjusted. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 221 579 AMT 3000 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop AMT Coordination of Benefits (COB) Payer Paid Amount To indicate the total monetary amount Usage notes Required when the claim has been adjudicated by the payer identified in Loop ID- 2330B of this loop. OR Required when Loop ID-2010AC is present. In this case, the claim is a post payment recovery claim submitted by a subrogated Medicaid agency. If not required by this implementation guide, do not send.; Example AMT D 0000000000 Variants (all may be used) AMT Coordination of Benefits (COB) Total Non-Covered Amount AMT Remaining Patient Liability Max use 1 Optional AMT-01 522 Amount Qualifier Code Identifier (ID) Required Code to qualify amount D Payor Amount Paid AMT-02 782 Payer Paid Amount Min 1 Max 15 Decimal number (R) Required Monetary amount Usage notes It is acceptable to show "0" as the amount paid. When Loop ID-2010AC is present, this is the amount the Medicaid agency actually paid. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 222 579 AMT 3000 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop AMT Coordination of Benefits (COB) Total Non-Covered Amount To indicate the total monetary amount Usage notes Required when the destination payer's cost avoidance policy allows providers to bypass claim submission to the otherwise prior payer identified in Loop ID-2330B. If not required by this implementation guide, do not send. When this segment is used, the amount reported in AMT02 must equal the total claim charge amount reported in CLM02. Neither the prior payer paid AMT, nor any CAS segments are used as this claim has not been adjudicated by this payer. Example AMT A8 0000 Variants (all may be used) AMT Coordination of Benefits (COB) Payer Paid Amount AMT Remaining Patient Liability Max use 1 Optional AMT-01 522 Amount Qualifier Code Identifier (ID) Required Code to qualify amount A8 Noncovered Charges - Actual AMT-02 782 Non-Covered Charge Amount Min 1 Max 15 Decimal number (R) Required Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_55 |
use 1 Optional AMT-01 522 Amount Qualifier Code Identifier (ID) Required Code to qualify amount A8 Noncovered Charges - Actual AMT-02 782 Non-Covered Charge Amount Min 1 Max 15 Decimal number (R) Required Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 223 579 AMT 3000 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop AMT Remaining Patient Liability To indicate the total monetary amount Usage notes Required when the Other Payer identified in Loop ID-2330B (of this iteration of Loop ID-2320) has adjudicated this claim and provided claim level information only. OR Required when the Other Payer identified in Loop ID-2330B (of this iteration of Loop ID-2320) has adjudicated this claim and the provider received a paper remittance advice and the provider does not have the ability to report line item information. If not required by this implementation guide, do not send. In the judgment of the provider, this is the remaining amount to be paid after adjudication by the Other Payer identified in Loop ID-2330B of this iteration of Loop ID-2320. This segment is only used in provider submitted claims. It is not used in Payer-to-Payer Coordination of Benefits (COB). This segment is not used if the line level (Loop ID-2430) Remaining Patient Liability AMT segment is used for this Other Payer. Example AMT EAF 000000000 Variants (all may be used) AMT Coordination of Benefits (COB) Payer Paid Amount AMT Coordination of Benefits (COB) Total Non-Covered Amount Max use 1 Optional AMT-01 522 Amount Qualifier Code Identifier (ID) Required Code to qualify amount EAF Amount Owed AMT-02 782 Remaining Patient Liability Min 1 Max 15 Decimal number (R) Required Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 224 579 OI 3100 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop OI Other Insurance Coverage Information To specify information associated with other health insurance coverage Usage notes All information contained in the OI segment applies only to the payer identified in Loop ID-2330B in this iteration of Loop ID-2320. Example OI W I Max use 1 Required OI-03 1073 Benefits Assignment Certification Indicator Identifier (ID) Required Code indicating a Yes or No condition or response OI03 is the assignment of benefits indicator. A "Y" value indicates insured or authorized person authorizes benefits to be assigned to the provider; an "N" value indicates benefits have not been assigned to the provider. Usage notes This is a crosswalk from CLM08 when doing COB. This element answers the question whether or not the insured has authorized the plan to remit payment directly to the provider. N No W Not Applicable Use code W' when the patient refuses to assign benefits. Y Yes OI-06 1363 Release of Information Code Identifier (ID) Required Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations Usage notes This is a crosswalk from CLM09 when doing COB. The Release of Information response is limited to the information carried in this claim. I Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes Required when the provider has not collected a signature AND state or federal laws do not require a signature be collected. Y Yes, Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim Required when the provider has collected a signature. OR Required when state or federal laws require a signature be collected. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 225 579 MIA 3150 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop MIA Inpatient Adjudication Information To provide claim-level data related to the adjudication of Medicare inpatient claims Usage notes Required when inpatient adjudication information is reported in the remittance advice. OR Required when it is necessary to report remark codes. If not required by this implementation guide, do not send. Example MIA 0000 0000000 0000 X 000000000000 000000 0000 00 00 000 000000000 0 0 000 0000 0 000000 0000000 000 00000000 X XXXX XXX XXX 000000000 Max use 1 Optional MIA-01 380 Covered Days or Visits Count Min 1 Max 15 Decimal number (R) Required Numeric value of quantity MIA01 is the covered days. MIA-03 380 Lifetime Psychiatric Days Count Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity MIA03 is the lifetime psychiatric days. MIA-04 782 Claim DRG Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount MIA04 is the Diagnosis Related Group (DRG) amount. MIA-05 127 Claim Payment Remark Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier MIA05 is the Claim Payment Remark Code. See Code Source 411. MIA-06 782 Claim Disproportionate Share Amount Decimal number (R) Optional Min 1 Max 15 Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 226 579 MIA06 is the disproportionate share amount. MIA-07 782 Claim MSP Pass-through Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount MIA07 is the Medicare Secondary Payer (MSP) pass-through amount. MIA-08 782 Claim PPS Capital Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount MIA08 is the total Prospective Payment System (PPS) capital amount. MIA-09 782 PPS-Capital FSP DRG Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount MIA09 is the Prospective Payment System (PPS) capital, federal specific portion, Diagnosis Related Group (DRG) amount. MIA-10 782 PPS-Capital HSP DRG Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount MIA10 is the Prospective Payment System (PPS) capital, hospital specific portion, | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_56 |
15 Decimal number (R) Optional Monetary amount MIA09 is the Prospective Payment System (PPS) capital, federal specific portion, Diagnosis Related Group (DRG) amount. MIA-10 782 PPS-Capital HSP DRG Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount MIA10 is the Prospective Payment System (PPS) capital, hospital specific portion, Diagnosis Related Group (DRG), amount. MIA-11 782 PPS-Capital DSH DRG Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount MIA11 is the Prospective Payment System (PPS) capital, disproportionate share, hospital Diagnosis Related Group (DRG) amount. MIA-12 782 Old Capital Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount MIA12 is the old capital amount. MIA-13 782 PPS-Capital IME amount Min 1 Max 15 Decimal number (R) Optional Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 227 579 MIA13 is the Prospective Payment System (PPS) capital indirect medical education claim amount. MIA-14 782 PPS-Operating Hospital Specific DRG Amount Decimal number (R) Optional Min 1 Max 15 Monetary amount MIA14 is hospital specific Diagnosis Related Group (DRG) Amount. MIA-15 380 Cost Report Day Count Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity MIA15 is the cost report days. MIA-16 782 PPS-Operating Federal Specific DRG Amount Decimal number (R) Optional Min 1 Max 15 Monetary amount MIA16 is the federal specific Diagnosis Related Group (DRG) amount. MIA-17 782 Claim PPS Capital Outlier Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount MIA17 is the Prospective Payment System (PPS) Capital Outlier amount. MIA-18 782 Claim Indirect Teaching Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount MIA18 is the indirect teaching amount. MIA-19 782 Non-Payable Professional Component Billed Amount Decimal number (R) Optional Min 1 Max 15 Monetary amount MIA19 is the professional component amount billed but not payable. MIA-20 127 Claim Payment Remark Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 228 579 MIA20 is the Claim Payment Remark Code. See Code Source 411. MIA-21 127 Claim Payment Remark Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier MIA21 is the Claim Payment Remark Code. See Code Source 411. MIA-22 127 Claim Payment Remark Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier MIA22 is the Claim Payment Remark Code. See Code Source 411. MIA-23 127 Claim Payment Remark Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier MIA23 is the Claim Payment Remark Code. See Code Source 411. MIA-24 782 PPS-Capital Exception Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount MIA24 is the capital exception amount. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 229 579 MOA 3200 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop MOA Outpatient Adjudication Information To convey claim-level data related to the adjudication of Medicare claims not related to an inpatient setting Usage notes Required when outpatient adjudication information is reported in the remittance advice OR Required when it is necessary to report remark codes. If not required by this implementation guide, do not send. Example MOA 0 000 XX XXXXXX XXXX XX XXXX 000000000 000000 000 Max use 1 Optional MOA-01 954 Reimbursement Rate Min 1 Max 10 Decimal number (R) Optional Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0 through 100 ) MOA01 is the reimbursement rate. MOA-02 782 HCPCS Payable Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount MOA02 is the claim Health Care Financing Administration Common Procedural Coding System (HCPCS) payable amount. MOA-03 127 Claim Payment Remark Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier MOA03 is the Claim Payment Remark Code. See Code Source 411. MOA-04 127 Claim Payment Remark Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier MOA04 is the Claim Payment Remark Code. See Code Source 411. MOA-05 127 Claim Payment Remark Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 230 579 MOA05 is the Claim Payment Remark Code. See Code Source 411. MOA-06 127 Claim Payment Remark Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier MOA06 is the Claim Payment Remark Code. See Code Source 411. MOA-07 127 Claim Payment Remark Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier MOA07 is the Claim Payment Remark Code. See Code Source 411. MOA-08 782 End Stage Renal Disease Payment Amount Decimal number (R) Optional Min 1 Max 15 Monetary amount MOA08 is the End Stage Renal Disease (ESRD) payment amount. MOA-09 782 Non-Payable Professional Component Billed Amount Decimal number (R) Optional Min 1 Max 15 Monetary amount MOA09 is the professional component amount billed but not payable. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 231 579 | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_57 |
Billed Amount Decimal number (R) Optional Min 1 Max 15 Monetary amount MOA09 is the professional component amount billed but not payable. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 231 579 2330A Other Subscriber Name Loop Max 1 Required Variants (all may be used) Other Payer Name Loop Other Payer Attending Provider Loop Other Payer Operating Physician Loop Other Payer Other Operating Physician Loop Other Payer Service Facility Location Loop Other Payer Rendering Provider Name Loop Other Payer Referring Provider Loop Other Payer Billing Provider Loop NM1 3250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Subscriber Name Loop NM1 Other Subscriber Name To supply the full name of an individual or organizational entity Usage notes If the patient can be uniquely identified to the Other Payer indicated in this iteration of Loop ID-2320 by a unique Member Identification Number, then the patient is the subscriber or is considered to be the subscriber and is identified in this Other Subscriber's Name Loop ID-2330A.; If the patient is a dependent of the subscriber for this other coverage and cannot be uniquely identified to the Other Payer indicated in this iteration of Loop ID-2320 by a unique Member Identification Number, then the subscriber for this other coverage is identified in this Other Subscriber's Name Loop ID-2330A. See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example NM1 IL 1 X XXXXX XXXXXX XXXXX II XXXX Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual IL Insured or Subscriber NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 Person 2 Non-Person Entity NM1-03 1035 Other Insured Last Name Min 1 Max 60 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 232 579 Individual last name or organizational name NM1-04 1036 Other Insured First Name Min 1 Max 35 String (AN) Optional Individual first name NM1-05 1037 Other Insured Middle Name Min 1 Max 25 String (AN) Optional Individual middle name or initial NM1-07 1039 Other Insured Name Suffix Min 1 Max 10 String (AN) Optional Suffix to individual name NM1-08 66 Identification Code Qualifier Identifier (ID) Required Code designating the system method of code structure used for Identification Code (67) II Standard Unique Health Identifier for each Individual in the United States Required if the HIPAA Individual Patient Identifier is mandated use. If not required, use value MI' instead. MI Member Identification Number The code MI is intended to be the subscriber's identification number as assigned by the payer. (For example, Insured's ID, Subscriber's ID, Health Insurance Claim Number (HIC), etc.) MI is also intended to be used in claims submitted to the Indian Health Service Contract Health Services (IHS CHS) Fiscal Intermediary for the purpose of reporting the Tribe Residency Code (Tribe County State). In the event that a Social Security Number (SSN) is also available on an IHS CHS claim, put the SSN in REF02. When sending the Social Security Number as the Member ID, it must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid. NM1-09 67 Other Insured Identifier Min 2 Max 80 String (AN) Required Code identifying a party or other code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 233 579 N3 3320 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Subscriber Name Loop N3 Other Subscriber Address To specify the location of the named party Usage notes Required when the information is available. If not required by this implementation guide, do not send. Example N3 XXX XXXX Max use 1 Optional N3-01 166 Other Insured Address Line Min 1 Max 55 String (AN) Required Address information N3-02 166 Other Insured Address Line Min 1 Max 55 String (AN) Optional Address information 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 234 579 N4 3400 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Subscriber Name Loop N4 Other Subscriber City, State, ZIP Code To specify the geographic place of the named party Usage notes Required when the information is available. If not required by this implementation guide, do not send. Example N4 XXXXXX XX XXXXXXXX XX Only one of Other Insured State Code (N4-02) or Country Subdivision Code (N4-07) may be present If Country Subdivision Code (N4-07) is present, then Country Code (N4-04) is required Max use 1 Optional N4-01 19 Other Insured City Name Min 2 Max 30 String (AN) Required Free-form text for city name A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. N4-02 156 Other Insured State Code Min 2 Max 2 Identifier (ID) Optional Code (Standard State Province) as defined by appropriate government agency N402 is required only if city name (N401) is in the U.S. or Canada. N4-03 116 Other Insured Postal Zone or ZIP Code Min 3 Max 15 Identifier (ID) Optional Code defining international postal zone code excluding punctuation and blanks (zip code for United States) N4-04 26 Country Code Min 2 Max 3 Identifier (ID) Optional Code identifying the country Usage notes Use the alpha-2 country codes from Part 1 of ISO 3166. N4-07 1715 Country Subdivision Code Min 1 Max 3 Identifier (ID) Optional Code identifying the country subdivision Usage notes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_58 |
alpha-2 country codes from Part 1 of ISO 3166. N4-07 1715 Country Subdivision Code Min 1 Max 3 Identifier (ID) Optional Code identifying the country subdivision Usage notes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 235 579 Use the country subdivision codes from Part 2 of ISO 3166. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 236 579 2330A Other Subscriber Name Loop end REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Subscriber Name Loop REF Other Subscriber Secondary Identification To specify identifying information Usage notes Required when an additional identification number to that provided in NM109 of this loop is necessary for the claim processor to identify the entity. If not required by this implementation guide, do not send. Example REF SY XXXX Max use 2 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification SY Social Security Number The Social Security Number must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid. REF-02 127 Other Insured Additional Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 237 579 2330B Other Payer Name Loop Max 1 Required Variants (all may be used) Other Subscriber Name Loop Other Payer Attending Provider Loop Other Payer Operating Physician Loop Other Payer Other Operating Physician Loop Other Payer Service Facility Location Loop Other Payer Rendering Provider Name Loop Other Payer Referring Provider Loop Other Payer Billing Provider Loop NM1 3250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Name Loop NM1 Other Payer Name To supply the full name of an individual or organizational entity Usage notes See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example NM1 PR 2 XXXXXX PI XXXXX Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual PR Payer NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 2 Non-Person Entity NM1-03 1035 Other Payer Last or Organization Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-08 66 Identification Code Qualifier Identifier (ID) Required Code designating the system method of code structure used for Identification Code (67) Usage notes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 238 579 Use code value "PI" when reporting Payor Identification. Use code value "XV" when reporting Health Plan ID (HPID) or Other Entity Identifier (OEID). Prior to the mandated implementation date for Health Plan Identifier, willing trading partners may agree to: Follow a dual use approach in which both the HPID or OEID and the Payor Identification are sent. Send XV qualifier in NM108 with HPID or OEID in NM109 and the Payor Identification, that would have been sent using qualifier PI, in the corresponding REF segment using qualifier 2U (Payer Identification Number). OR Follow an early implementation approach in which the HPID or OEID is sent in NM109. PI Payor Identification XV Centers for Medicare and Medicaid Services PlanID NM1-09 67 Other Payer Primary Identifier Min 2 Max 80 String (AN) Required Code identifying a party or other code Usage notes When sending Line Adjudication Information for this payer, the identifier sent in SVD01 (Payer Identifier) of Loop ID-2430 (Line Adjudication Information) must match this value.; 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 239 579 N3 3320 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Name Loop N3 Other Payer Address To specify the location of the named party Usage notes Required when the payer address is available and the submitter intends for the claim to be printed on paper at the next EDI location (for example, a clearinghouse). If not required by this implementation guide, do not send. Example N3 XXXXXX XXXX Max use 1 Optional N3-01 166 Other Payer Address Line Min 1 Max 55 String (AN) Required Address information N3-02 166 Other Payer Address Line Min 1 Max 55 String (AN) Optional Address information 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 240 579 N4 3400 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Name Loop N4 Other Payer City, State, ZIP Code To specify the geographic place of the named party Usage notes Required when the payer address is available and the submitter intends for the claim to be printed on paper at the next EDI location (for example, a clearinghouse). If not required by this implementation guide, do not send. Example N4 XX XX XXXX XX Only one of Other Payer State Code (N4-02) or Country Subdivision Code (N4-07) may be present If Country Subdivision Code (N4-07) is present, then Country Code (N4-04) is required Max use 1 Optional N4-01 19 Other Payer City Name Min 2 Max 30 String (AN) Required Free-form text for city name A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. N4-02 156 Other Payer State Code Min 2 Max 2 Identifier (ID) Optional Code (Standard State Province) as defined by appropriate | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_59 |
2 Max 30 String (AN) Required Free-form text for city name A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. N4-02 156 Other Payer State Code Min 2 Max 2 Identifier (ID) Optional Code (Standard State Province) as defined by appropriate government agency N402 is required only if city name (N401) is in the U.S. or Canada. N4-03 116 Other Payer Postal Zone or ZIP Code Min 3 Max 15 Identifier (ID) Optional Code defining international postal zone code excluding punctuation and blanks (zip code for United States) N4-04 26 Country Code Min 2 Max 3 Identifier (ID) Optional Code identifying the country Usage notes Use the alpha-2 country codes from Part 1 of ISO 3166. N4-07 1715 Country Subdivision Code Min 1 Max 3 Identifier (ID) Optional Code identifying the country subdivision Usage notes Use the country subdivision codes from Part 2 of ISO 3166. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 241 579 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 242 579 DTP 3500 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Name Loop DTP Claim Check or Remittance Date To specify any or all of a date, a time, or a time period Usage notes Required when the payer identified in this loop has previously adjudicated the claim and Loop ID-2430, Line Check or Remittance Date, is not used. If not required by this implementation guide, do not send.; Example DTP 573 D8 XXXXX Max use 1 Optional DTP-01 374 Date Time Qualifier Identifier (ID) Required Code specifying type of date or time, or both date and time 573 Date Claim Paid DTP-02 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. D8 Date Expressed in Format CCYYMMDD DTP-03 1251 Adjudication or Payment Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 243 579 REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Name Loop REF Other Payer Claim Adjustment Indicator To specify identifying information Usage notes Required when the claim is being sent in the payer-to-payer COB model, AND the destination payer is secondary to the payer identified in this Loop ID-2330B, AND the payer identified in this Loop ID-2330B has re-adjudicated the claim. If not required by this implementation guide, do not send. Example REF T4 XXXXX Variants (all may be used) REF Other Payer Claim Control Number REF Other Payer Prior Authorization Number REF Other Payer Referral Number REF Other Payer Secondary Identifier Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification T4 Signal Code REF-02 127 Other Payer Claim Adjustment Indicator Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes Only allowed value is "Y". 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 244 579 REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Name Loop REF Other Payer Claim Control Number To specify identifying information Usage notes Required when it is necessary to identify the Other Payer's Claim Control Number in a payer-to-payer COB situation. OR Required when the Other Payer's Claim Control Number is available. If not required by this implementation guide, do not send. Example REF F8 XX Variants (all may be used) REF Other Payer Claim Adjustment Indicator REF Other Payer Prior Authorization Number REF Other Payer Referral Number REF Other Payer Secondary Identifier Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification F8 Original Reference Number This is the payer's internal Claim Control Number for this claim for the payer identified in this iteration of Loop ID-2330. This value is typically used in payer-to-payer COB situations only. REF-02 127 Other Payer's Claim Control Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 245 579 REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Name Loop REF Other Payer Prior Authorization Number To specify identifying information Usage notes Required when the payer identified in this loop has assigned a prior authorization number to this claim. If not required by this implementation guide, do not send. Example REF G1 X Variants (all may be used) REF Other Payer Claim Adjustment Indicator REF Other Payer Claim Control Number REF Other Payer Referral Number REF Other Payer Secondary Identifier Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification G1 Prior Authorization Number REF-02 127 Other Payer Prior Authorization Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 246 579 REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_60 |
or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 246 579 REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Name Loop REF Other Payer Referral Number To specify identifying information Usage notes Required when the payer identified in this loop has assigned a referral number to this claim. If not required by this implementation guide, do not send. Example REF 9F XXXXXX Variants (all may be used) REF Other Payer Claim Adjustment Indicator REF Other Payer Claim Control Number REF Other Payer Prior Authorization Number REF Other Payer Secondary Identifier Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 9F Referral Number REF-02 127 Other Payer Prior Authorization or Referral Number String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 247 579 2330B Other Payer Name Loop end REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Name Loop REF Other Payer Secondary Identifier To specify identifying information Usage notes Required when an additional identification number to that provided in the NM109 of this loop is necessary to identify the entity. If not required by this implementation guide, do not send. Example REF 2U XX Variants (all may be used) REF Other Payer Claim Adjustment Indicator REF Other Payer Claim Control Number REF Other Payer Prior Authorization Number REF Other Payer Referral Number Max use 2 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 2U Payer Identification Number This code is only allowed when the qualifier XV is reported in NM108 of this loop. EI Employer's Identification Number The Employer's Identification Number must be a string of exactly nine numbers with no separators. For example, "001122333" would be valid, while sending "001-12-2333" or "00-1122333" would be invalid. FY Claim Office Number NF National Association of Insurance Commissioners (NAIC) Code REF-02 127 Other Payer Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 248 579 2330C Other Payer Attending Provider Loop Max 1 Optional Variants (all may be used) Other Subscriber Name Loop Other Payer Name Loop Other Payer Operating Physician Loop Other Payer Other Operating Physician Loop Other Payer Service Facility Location Loop Other Payer Rendering Provider Name Loop Other Payer Referring Provider Loop Other Payer Billing Provider Loop NM1 3250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Attending Provider Loop NM1 Other Payer Attending Provider To supply the full name of an individual or organizational entity Usage notes Required prior to the mandated implementation of the HIPAA National Provider Identifier (NPI) rule when the provider in the corresponding Loop ID-2310 is sent and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. OR Required after the mandated implementation of the NPI rule for providers who are not Health Care Providers when the provider is sent in the corresponding Loop ID-2310 and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. If not required by this implementation guide, do not send. See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example NM1 71 1 Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 71 Attending Physician NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 249 579 1 Person 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 250 579 2330C Other Payer Attending Provider Loop end REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Attending Provider Loop REF Other Payer Attending Provider Secondary Identification To specify identifying information Usage notes Non-destination (COB) payer's provider identification number(s). See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example REF G2 XXXXX Max use 4 Required REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the non-destination payer identified in the Other Payer Name Loop ID-2330B for this iteration of Loop ID-2320. This is true regardless of whether that payer is Medicare, Medicaid, a Blue Cross Blue Shield plan, a commercial plan, or any other health plan. LU Location Number REF-02 127 Other Payer Attending Provider Secondary Identifier String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 251 579 2330D Other Payer Operating Physician Loop Max 1 Optional Variants (all may be used) Other Subscriber Name Loop Other Payer Name Loop Other Payer Attending Provider Loop Other Payer Other | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_61 |
837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 251 579 2330D Other Payer Operating Physician Loop Max 1 Optional Variants (all may be used) Other Subscriber Name Loop Other Payer Name Loop Other Payer Attending Provider Loop Other Payer Other Operating Physician Loop Other Payer Service Facility Location Loop Other Payer Rendering Provider Name Loop Other Payer Referring Provider Loop Other Payer Billing Provider Loop NM1 3250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Operating Physician Loop NM1 Other Payer Operating Physician To supply the full name of an individual or organizational entity Usage notes Required prior to the mandated implementation of the HIPAA National Provider Identifier (NPI) rule when the provider in the corresponding Loop ID-2310 is sent and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. OR Required after the mandated implementation of the NPI rule for providers who are not Health Care Providers when the provider is sent in the corresponding Loop ID-2310 and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. If not required by this implementation guide, do not send. See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example NM1 72 1 Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 72 Operating Physician NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 252 579 1 Person 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 253 579 2330D Other Payer Operating Physician Loop end REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Operating Physician Loop REF Other Payer Operating Physician Secondary Identification To specify identifying information Usage notes Non-destination (COB) payer's provider identification number(s). See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example REF 0B XXXXX Max use 4 Required REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the non-destination payer identified in the Other Payer Name Loop ID-2330B for this iteration of Loop ID-2320. This is true regardless of whether that payer is Medicare, Medicaid, a Blue Cross Blue Shield plan, a commercial plan, or any other health plan. LU Location Number REF-02 127 Other Payer Operating Provider Secondary Identifier String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 254 579 2330E Other Payer Other Operating Physician Loop Max 1 Optional Variants (all may be used) Other Subscriber Name Loop Other Payer Name Loop Other Payer Attending Provider Loop Other Payer Operating Physician Loop Other Payer Service Facility Location Loop Other Payer Rendering Provider Name Loop Other Payer Referring Provider Loop Other Payer Billing Provider Loop NM1 3250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Other Operating Physician Loop NM1 Other Payer Other Operating Physician To supply the full name of an individual or organizational entity Usage notes Required prior to the mandated implementation of the HIPAA National Provider Identifier (NPI) rule when the provider in the corresponding Loop ID-2310 is sent and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. OR Required after the mandated implementation of the NPI rule for providers who are not Health Care Providers when the provider is sent in the corresponding Loop ID-2310 and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. If not required by this implementation guide, do not send. See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example NM1 ZZ 1 Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual ZZ Mutually Defined ZZ is used to indicate Other Operating Physician. NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 255 579 1 Person 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 256 579 2330E Other Payer Other Operating Physician Loop end REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Other Operating Physician Loop REF Other Payer Other Operating Physician Secondary Identification To specify identifying information Usage notes Non-destination (COB) payer's provider identification number(s). See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example REF 0B XXX Max use 4 Required REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the non-destination payer identified in the Other Payer Name Loop ID-2330B for | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_62 |
Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the non-destination payer identified in the Other Payer Name Loop ID-2330B for this iteration of Loop ID-2320. This is true regardless of whether that payer is Medicare, Medicaid, a Blue Cross Blue Shield plan, a commercial plan, or any other health plan. LU Location Number REF-02 127 Other Payer Other Operating Physician Secondary Identifier String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 257 579 2330F Other Payer Service Facility Location Loop Max 1 Optional Variants (all may be used) Other Subscriber Name Loop Other Payer Name Loop Other Payer Attending Provider Loop Other Payer Operating Physician Loop Other Payer Other Operating Physician Loop Other Payer Rendering Provider Name Loop Other Payer Referring Provider Loop Other Payer Billing Provider Loop NM1 3250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Service Facility Location Loop NM1 Other Payer Service Facility Location To supply the full name of an individual or organizational entity Usage notes Required prior to the mandated implementation of the HIPAA National Provider Identifier (NPI) rule when the provider in the corresponding Loop ID-2310 is sent and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. OR Required after the mandated implementation of the NPI rule for providers who are not Health Care Providers when the provider is sent in the corresponding Loop ID-2310 and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. If not required by this implementation guide, do not send. See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example NM1 77 2 Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 77 Service Location NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 258 579 2 Non-Person Entity 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 259 579 2330F Other Payer Service Facility Location Loop end REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Service Facility Location Loop REF Other Payer Service Facility Location Secondary Identification To specify identifying information Usage notes Non-destination (COB) payer's provider identification number(s). See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example REF G2 XXX Max use 3 Required REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number G2 Provider Commercial Number This code designates a proprietary provider number for the non-destination payer identified in the Other Payer Name Loop ID-2330B for this iteration of Loop ID-2320. This is true regardless of whether that payer is Medicare, Medicaid, a Blue Cross Blue Shield plan, a commercial plan, or any other health plan. LU Location Number REF-02 127 Other Payer Service Facility Location Identifier String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 260 579 2330G Other Payer Rendering Provider Name Loop Max 1 Optional Variants (all may be used) Other Subscriber Name Loop Other Payer Name Loop Other Payer Attending Provider Loop Other Payer Operating Physician Loop Other Payer Other Operating Physician Loop Other Payer Service Facility Location Loop Other Payer Referring Provider Loop Other Payer Billing Provider Loop NM1 3250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Rendering Provider Name Loop NM1 Other Payer Rendering Provider Name To supply the full name of an individual or organizational entity Usage notes Required prior to the mandated implementation of the HIPAA National Provider Identifier (NPI) rule when the provider in the corresponding Loop ID-2310 is sent and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. OR Required after the mandated implementation of the NPI rule for providers who are not Health Care Providers when the provider is sent in the corresponding Loop ID-2310 and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. If not required by this implementation guide, do not send. See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example NM1 82 1 Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 82 Rendering Provider NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 261 579 1 Person 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 262 579 2330G Other Payer Rendering Provider Name Loop end REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_63 |
Person 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 262 579 2330G Other Payer Rendering Provider Name Loop end REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Rendering Provider Name Loop REF Other Payer Rendering Provider Secondary Identification To specify identifying information Usage notes Non-destination (COB) payer's provider identification number(s). See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example REF LU X Max use 4 Required REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the non-destination payer identified in the Other Payer Name Loop ID-2330B for this iteration of Loop ID-2320. This is true regardless of whether that payer is Medicare, Medicaid, a Blue Cross Blue Shield plan, a commercial plan, or any other health plan. LU Location Number REF-02 127 Other Payer Rendering Provider Secondary Identifier String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 263 579 2330H Other Payer Referring Provider Loop Max 1 Optional Variants (all may be used) Other Subscriber Name Loop Other Payer Name Loop Other Payer Attending Provider Loop Other Payer Operating Physician Loop Other Payer Other Operating Physician Loop Other Payer Service Facility Location Loop Other Payer Rendering Provider Name Loop Other Payer Billing Provider Loop NM1 3250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Referring Provider Loop NM1 Other Payer Referring Provider To supply the full name of an individual or organizational entity Usage notes Required prior to the mandated implementation of the HIPAA National Provider Identifier (NPI) rule when the provider in the corresponding Loop ID-2310 is sent and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. OR Required after the mandated implementation of the NPI rule for providers who are not Health Care Providers when the provider is sent in the corresponding Loop ID-2310 and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. If not required by this implementation guide, do not send. See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example NM1 DN 1 Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual DN Referring Provider NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 264 579 1 Person 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 265 579 2330H Other Payer Referring Provider Loop end REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Referring Provider Loop REF Other Payer Referring Provider Secondary Identification To specify identifying information Usage notes Non-destination (COB) payer's provider identification number(s). See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example REF 0B XX Max use 3 Required REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the non-destination payer identified in the Other Payer Name Loop ID-2330B for this iteration of Loop ID-2320. This is true regardless of whether that payer is Medicare, Medicaid, a Blue Cross Blue Shield plan, a commercial plan, or any other health plan. REF-02 127 Other Payer Referring Provider Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 266 579 2330I Other Payer Billing Provider Loop Max 1 Optional Variants (all may be used) Other Subscriber Name Loop Other Payer Name Loop Other Payer Attending Provider Loop Other Payer Operating Physician Loop Other Payer Other Operating Physician Loop Other Payer Service Facility Location Loop Other Payer Rendering Provider Name Loop Other Payer Referring Provider Loop NM1 3250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Billing Provider Loop NM1 Other Payer Billing Provider To supply the full name of an individual or organizational entity Usage notes Required prior to the mandated implementation of the HIPAA National Provider Identifier (NPI) rule when the provider in the corresponding Loop ID-2310 is sent and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. OR Required after the mandated implementation of the NPI rule for providers who are not Health Care Providers when the provider is sent in the corresponding Loop ID-2310 and one or more additional payer-specific provider identification numbers are required by this non-destination payer (Loop ID-2330B) to identify the provider. If not required by this implementation guide, do not send. See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example NM1 85 2 Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_64 |
(Loop ID-2330B) to identify the provider. If not required by this implementation guide, do not send. See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example NM1 85 2 Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 85 Billing Provider NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 267 579 2 Non-Person Entity 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 268 579 2330I Other Payer Billing Provider Loop end 2320 Other Subscriber Information Loop end REF 3550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Other Subscriber Information Loop Other Payer Billing Provider Loop REF Other Payer Billing Provider Secondary Identification To specify identifying information Usage notes See Crosswalking COB Data Elements section for more information on handling COB in the 837. Example REF G2 XXXXXX Max use 2 Required REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification G2 Provider Commercial Number This code designates a proprietary provider number for the non-destination payer identified in the Other Payer Name Loop ID-2330B for this iteration of Loop ID-2320. This is true regardless of whether that payer is Medicare, Medicaid, a Blue Cross Blue Shield plan, a commercial plan, or any other health plan. LU Location Number REF-02 127 Other Payer Billing Provider Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 269 579 2400 Service Line Number Loop Max 999 Required LX 3650 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop LX Service Line Number To reference a line number in a transaction set Usage notes The LX functions as a line counter. The Service Line LX segment must begin with one and is incremented by one for each additional service line of a claim. LX01 is used to indicate bundling in SVD06 in the Line Item Adjudication loop. See Section 1.4.1.2 for more information on bundling and unbundling. Example LX 000 Max use 1 Required LX-01 554 Assigned Number Min 1 Max 6 Numeric (N0) Required Number assigned for differentiation within a transaction set 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 270 579 SV2 3750 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop SV2 Institutional Service Line To specify the service line item detail for a health care institution Example SV2 XXXXX HP XX XX XX XX XX XX 000000000000 DA 0 000000000000 Max use 1 Required SV2-01 234 Service Line Revenue Code Min 1 Max 48 String (AN) Required Identifying number for a product or service SV201 is the revenue code. Usage notes See Code Source 132: National Uniform Billing Committee (NUBC) Codes. SV2-02 C003 Composite Medical Procedure Identifier To identify a medical procedure by its standardized codes and applicable modifiers Usage notes Required for outpatient claims when an appropriate procedure code exists for this service line item. OR Required for inpatient claims when an appropriate HCPCS (drugs and or biologics only) or HIPPS code exists for this service line item. If not required by this implementation guide, do not send.; Max use 1 Optional C003-01 235 Product or Service ID Qualifier Identifier (ID) Required Code identifying the type source of the descriptive number used in Product Service ID (234) C003-01 qualifies C003-02 and C003-08. ER Jurisdiction Specific Procedure and Supply Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the Jurisdiction Specific Procedure and Supply Codes as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. HC Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes Because the AMA's CPT codes are also level 1 HCPCS codes, they are reported under HC. HP Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code IV Home Infusion EDI Coalition (HIEC) Product Service Code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 271 579 This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the Home Infusion EDI Coalition (HIEC) Product Service Codes as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA.; WK Advanced Billing Concepts (ABC) Codes At the time of this writing, this code set has been approved by the Secretary of HHS as a pilot project allowed under HIPAA law. The qualifier may only be used in transactions covered under HIPAA; By parties registered in the pilot project and their trading partners, OR If a new rule names the Complementary, Alternative, or Holistic Procedure Codes as an allowable code set under HIPAA, OR For claims which are not covered under HIPAA. C003-02 234 Procedure Code Min 1 Max 48 String (AN) Required Identifying number for a product or service If C003-08 is used, then C003-02 represents the beginning value in the range in which the code occurs. | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_65 |
allowable code set under HIPAA, OR For claims which are not covered under HIPAA. C003-02 234 Procedure Code Min 1 Max 48 String (AN) Required Identifying number for a product or service If C003-08 is used, then C003-02 represents the beginning value in the range in which the code occurs. C003-03 1339 Procedure Modifier Min 2 Max 2 String (AN) Optional This identifies special circumstances related to the performance of the service, as defined by trading partners C003-03 modifies the value in C003-02 and C003-08. C003-04 1339 Procedure Modifier Min 2 Max 2 String (AN) Optional This identifies special circumstances related to the performance of the service, as defined by trading partners C003-04 modifies the value in C003-02 and C003-08. C003-05 1339 Procedure Modifier Min 2 Max 2 String (AN) Optional This identifies special circumstances related to the performance of the service, as defined by trading partners C003-05 modifies the value in C003-02 and C003-08. C003-06 1339 Procedure Modifier Min 2 Max 2 String (AN) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 272 579 This identifies special circumstances related to the performance of the service, as defined by trading partners C003-06 modifies the value in C003-02 and C003-08. C003-07 352 Description Min 1 Max 80 String (AN) Optional A free-form description to clarify the related data elements and their content C003-07 is the description of the procedure identified in C003-02. SV2-03 782 Line Item Charge Amount Min 1 Max 15 Decimal number (R) Required Monetary amount SV203 is the submitted service line item amount. Usage notes This is the total charge amount for this service line. The amount is inclusive of the provider's base charge and any applicable tax amounts reported within this line's AMT segments. Zero "0" is an acceptable value for this element. SV2-04 355 Unit or Basis for Measurement Code Identifier (ID) Required Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken DA Days UN Unit SV2-05 380 Service Unit Count Min 1 Max 15 Decimal number (R) Required Numeric value of quantity Usage notes The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. SV2-07 782 Line Item Denied Charge or Non-Covered Charge Amount Decimal number (R) Optional Min 1 Max 15 Monetary amount SV207 is a non-covered service amount. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 273 579 PWK 4200 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop PWK Line Supplemental Information To identify the type or transmission or both of paperwork or supporting information Usage notes Required when there is a paper attachment following this claim. OR Required when attachments are sent electronically (PWK02 EL) but are transmitted in another functional group (for example, 275) rather than by paper. PWK06 is then used to identify the attached electronic documentation. The number in PWK06 is carried in the TRN of the electronic attachment. OR Required when the provider deems it necessary to identify additional information that is being held at the provider's office and is available upon request by the payer (or appropriate entity), but the information is not being submitted with the claim. Use the value of "AA" in PWK02 to convey this specific use of the PWK segment. If not required by this implementation guide, do not send. Example PWK CK AA AC XXXXXXX If either Identification Code Qualifier (PWK-05) or Attachment Control Number (PWK-06) is present, then the other is required Max use 10 Optional PWK-01 755 Attachment Report Type Code Identifier (ID) Required Code indicating the title or contents of a document, report or supporting item 03 Report Justifying Treatment Beyond Utilization Guidelines 04 Drugs Administered 05 Treatment Diagnosis 06 Initial Assessment 07 Functional Goals 08 Plan of Treatment 09 Progress Report 10 Continued Treatment 11 Chemical Analysis 13 Certified Test Report 15 Justification for Admission 21 Recovery Plan A3 Allergies Sensitivities Document A4 Autopsy Report AM Ambulance Certification AS Admission Summary B2 Prescription B3 Physician Order B4 Referral Form BR Benchmark Testing Results BS Baseline BT Blanket Test Results CB Chiropractic Justification 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 274 579 CK Consent Form(s) CT Certification D2 Drug Profile Document DA Dental Models DB Durable Medical Equipment Prescription DG Diagnostic Report DJ Discharge Monitoring Report DS Discharge Summary EB Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payor) HC Health Certificate HR Health Clinic Records I5 Immunization Record IR State School Immunization Records LA Laboratory Results M1 Medical Record Attachment MT Models NN Nursing Notes OB Operative Note OC Oxygen Content Averaging Report OD Orders and Treatments Document OE Objective Physical Examination (including vital signs) Document OX Oxygen Therapy Certification OZ Support Data for Claim P4 Pathology Report P5 Patient Medical History Document PE Parenteral or Enteral Certification PN Physical Therapy Notes PO Prosthetics or Orthotic Certification PQ Paramedical Results PY Physician's Report PZ Physical Therapy Certification RB Radiology Films RR Radiology Reports RT Report of Tests and Analysis Report RX Renewable Oxygen Content Averaging Report SG Symptoms Document V5 Death Notification XP Photographs PWK-02 756 Attachment Transmission Code Identifier (ID) Required Code defining timing, transmission method or format by which reports are to be sent AA Available on Request at Provider Site This means that the additional information is not being sent with the claim at this time. Instead, it is available to the payer (or appropriate entity) at their request. BM By Mail EL Electronically Only Indicates that the attachment is being transmitted in a separate X12 functional group. EM E-Mail FT File Transfer 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_66 |
the payer (or appropriate entity) at their request. BM By Mail EL Electronically Only Indicates that the attachment is being transmitted in a separate X12 functional group. EM E-Mail FT File Transfer 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 275 579 Required when the actual attachment is maintained by an attachment warehouse or similar vendor. FX By Fax PWK-05 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) PWK05 and PWK06 may be used to identify the addressee by a code number. AC Attachment Control Number PWK-06 67 Attachment Control Number Min 2 Max 80 String (AN) Optional Code identifying a party or other code Usage notes PWK06 is used to identify the attached electronic documentation. The number in PWK06 is carried in the TRN of the electronic attachment. For the purpose of this implementation, the maximum field length is 50. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 276 579 DTP 4550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop DTP Date - Service Date To specify any or all of a date, a time, or a time period Usage notes Required on outpatient service lines where a drug is not being billed and the Statement Covers Period is greater than one day. OR Required on service lines where a drug is being billed and the payer's adjudication is known to be impacted by the drug duration or the date the prescription was written. If not required by this implementation guide, do not send. In cases where a drug is being billed on a service line, date range may be used to indicate drug duration for which the drug supply will be used by the patient. The difference in dates, including both the begin and end dates, are the days supply of the drug. Example: 20000101 - 20000107 (1 1 00 to 1 7 00) is used for a 7 day supply where the first day of the drug used by the patient is 1 1 00. In the event a drug is administered on less than a daily basis (for example, every other day) the date range would include the entire period during which the drug was supplied, including the last day the drug was used. Example: 20000101 - 20000108 (1 1 00 to 1 8 00) is used for an 8 days supply where the prescription is written for Q48 (every 48 hours), four doses of the drug are dispensed and the first dose is used on 1 1 00. In cases where a drug is being billed on a service line, a single date may be used to indicate the date the prescription was written (or otherwise communicated by the prescriber if not written). Example DTP 472 RD8 XXXXX Max use 1 Optional DTP-01 374 Date Time Qualifier Identifier (ID) Required Code specifying type of date or time, or both date and time 472 Service DTP-02 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. Usage notes RD8 is required only when the "To and From" dates are different. However, at the discretion of the submitter, RD8 can also be used when the "To and From" dates are the same. D8 Date Expressed in Format CCYYMMDD RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD DTP-03 1251 Service Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 277 579 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 278 579 REF 4700 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop REF Adjusted Repriced Line Item Reference Number To specify identifying information Usage notes Required when a repricing (pricing) organization needs to have an identifying number on an adjusted service line in their submission to their payer organization. This segment is not completed by providers. If not required by this implementation guide, do not send. Example REF 9D XXXX Variants (all may be used) REF Line Item Control Number REF Repriced Line Item Reference Number Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 9D Adjusted Repriced Line Item Reference Number REF-02 127 Adjusted Repriced Line Item Reference Number String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 279 579 REF 4700 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop REF Line Item Control Number To specify identifying information Usage notes Required when the submitter needs a line item control number for subsequent communications to or from the payer. If not required by this implementation guide, do not send. The line item control number must be unique within a patient control number (CLM01). Payers are required to return this number in the remittance advice transaction (835) if the provider sends it to them in the 837 and adjudication is based upon line item detail regardless of whether bundling or unbundling has occurred. Submitters are STRONGLY encouraged to routinely send a unique line item control number on all service lines, particularly if the submitter automatically posts their remittance advice. Submitting a unique line item control number | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_67 |
837 and adjudication is based upon line item detail regardless of whether bundling or unbundling has occurred. Submitters are STRONGLY encouraged to routinely send a unique line item control number on all service lines, particularly if the submitter automatically posts their remittance advice. Submitting a unique line item control number allows the capability to automatically post by service line. Example REF 6R XXXXXX Variants (all may be used) REF Adjusted Repriced Line Item Reference Number REF Repriced Line Item Reference Number Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 6R Provider Control Number REF-02 127 Line Item Control Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes The maximum number of characters to be supported for this field is 30'. A submitter may submit fewer characters depending upon their needs. However, the HIPAA maximum requirement to be supported by any receiving system is 30'. Characters beyond 30 are not required to be stored nor returned by any 837-receiving system. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 280 579 REF 4700 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop REF Repriced Line Item Reference Number To specify identifying information Usage notes Required when a repricing (pricing) organization needs to have an identifying number on the service line in their submission to their payer organization. This segment is not completed by providers. If not required by this implementation guide, do not send. Example REF 9B XXXXXX Variants (all may be used) REF Adjusted Repriced Line Item Reference Number REF Line Item Control Number Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 9B Repriced Line Item Reference Number REF-02 127 Repriced Line Item Reference Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 281 579 AMT 4750 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop AMT Facility Tax Amount To indicate the total monetary amount Usage notes Required when a facility tax or surcharge applies to the service being reported in SV201 and the submitter is required to report that information to the receiver. If not required by this implementation guide, do not send. When reporting the Facility Tax Amount (AMT02), the amount reported in the Line Item Charge Amount (SV203) for this service line must include the amount reported in the Facility Tax Amount. Example AMT N8 00000000 Variants (all may be used) AMT Service Tax Amount Max use 1 Optional AMT-01 522 Amount Qualifier Code Identifier (ID) Required Code to qualify amount N8 Miscellaneous Taxes AMT-02 782 Facility Tax Amount Min 1 Max 15 Decimal number (R) Required Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 282 579 AMT 4750 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop AMT Service Tax Amount To indicate the total monetary amount Usage notes Required when a service tax or surcharge applies to the service being reported in SV201 and the submitter is required to report that information to the receiver. If not required by this implementation guide, do not send. When reporting the Service Tax Amount (AMT02), the amount reported in the Line Item Charge Amount (SV203) for this service line must include the amount reported in the Service Tax Amount. Example AMT GT 0 Variants (all may be used) AMT Facility Tax Amount Max use 1 Optional AMT-01 522 Amount Qualifier Code Identifier (ID) Required Code to qualify amount GT Goods and Services Tax AMT-02 782 Service Tax Amount Min 1 Max 15 Decimal number (R) Required Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 283 579 NTE 4850 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop NTE Third Party Organization Notes To transmit information in a free-form format, if necessary, for comment or special instruction Usage notes Required when the TPO repricer needs to forward additional information to the payer. This segment is not completed by providers. If not required by this implementation guide, do not send. Example NTE TPO X Max use 1 Optional NTE-01 363 Note Reference Code Identifier (ID) Required Code identifying the functional area or purpose for which the note applies TPO Third Party Organization Notes NTE-02 352 Line Note Text Min 1 Max 80 String (AN) Required A free-form description to clarify the related data elements and their content 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 284 579 HCP 4920 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop HCP Line Pricing Repricing Information To specify pricing or repricing information about a health care claim or line item Usage notes Required when this information is deemed necessary by the repricer. The segment is not completed by providers. The information is completed by repricers only. If not required by this implementation guide, do not send. This information is specific to the destination payer reported in Loop ID-2010BB. For capitated encounters, pricing or repricing information usually is not applicable and is provided to qualify other information within the claim. Example HCP 09 00000000000 00000 XXXXX 00 XXXXXX 00000000 0000 XXXXX IV XXXX UN 0 T6 3 1 If either Product or Service ID | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_68 |
payer reported in Loop ID-2010BB. For capitated encounters, pricing or repricing information usually is not applicable and is provided to qualify other information within the claim. Example HCP 09 00000000000 00000 XXXXX 00 XXXXXX 00000000 0000 XXXXX IV XXXX UN 0 T6 3 1 If either Product or Service ID Qualifier (HCP-09) or Repriced Approved HCPCS Code (HCP-10) is present, then the other is required If either Unit or Basis for Measurement Code (HCP-11) or Quantity (HCP-12) is present, then the other is required Max use 1 Optional HCP-01 1473 Pricing Methodology Identifier (ID) Required Code specifying pricing methodology at which the claim or line item has been priced or repriced Usage notes Specific code use is determined by Trading Partner Agreement due to the variances in contracting policies in the industry. 00 Zero Pricing (Not Covered Under Contract) 01 Priced as Billed at 100 02 Priced at the Standard Fee Schedule 03 Priced at a Contractual Percentage 04 Bundled Pricing 05 Peer Review Pricing 06 Per Diem Pricing 07 Flat Rate Pricing 08 Combination Pricing 09 Maternity Pricing 10 Other Pricing 11 Lower of Cost 12 Ratio of Cost 13 Cost Reimbursed 14 Adjustment Pricing HCP-02 782 Monetary Amount Min 1 Max 15 Decimal number (R) Required Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 285 579 HCP02 is the allowed amount. HCP-03 782 Monetary Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount HCP03 is the savings amount. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. HCP-04 127 Reference Identification Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier HCP04 is the repricing organization identification number. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. HCP-05 118 Rate Min 1 Max 9 Decimal number (R) Optional Rate expressed in the standard monetary denomination for the currency specified HCP05 is the pricing rate associated with per diem or flat rate repricing. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. HCP-06 127 Reference Identification Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier HCP06 is the approved DRG code. HCP06, HCP07, HCP08, HCP10, and HCP12 are fields that will contain different values from the original submitted values. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. HCP-07 782 Monetary Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount HCP07 is the approved DRG amount. Usage notes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 286 579 This information is specific to the destination payer reported in Loop ID-2010BB. HCP-08 234 Product or Service ID Min 1 Max 48 String (AN) Optional Identifying number for a product or service HCP08 is the approved revenue code. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. HCP-09 235 Product or Service ID Qualifier Identifier (ID) Optional Code identifying the type source of the descriptive number used in Product Service ID (234) ER Jurisdiction Specific Procedure and Supply Codes This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the Jurisdiction Specific Procedure and Supply Codes as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. HC Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes Because the AMA's CPT codes are also level 1 HCPCS codes, they are reported under HC. HP Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code IV Home Infusion EDI Coalition (HIEC) Product Service Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the Home Infusion EDI Coalition (HIEC) Product Service Codes as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA.; WK Advanced Billing Concepts (ABC) Codes At the time of this writing, this code set has been approved by the Secretary of HHS as a pilot project allowed under HIPAA law. The qualifier may only be used in transactions covered under HIPAA; By parties registered in the pilot project and their trading partners, OR If a new rule names the Complementary, Alternative, or Holistic Procedure Codes as an allowable code set under HIPAA, OR For claims which are not covered under HIPAA. HCP-10 234 Repriced Approved HCPCS Code Min 1 Max 48 String (AN) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 287 579 Identifying number for a product or service HCP10 is the approved procedure code. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. HCP-11 355 Unit or Basis for Measurement Code Identifier (ID) Optional Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken DA Days UN Unit HCP-12 380 Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity HCP12 is the approved service units or inpatient days. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. HCP-13 901 Reject Reason Code Identifier | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_69 |
notes This information is specific to the destination payer reported in Loop ID-2010BB. The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. HCP-13 901 Reject Reason Code Identifier (ID) Optional Code assigned by issuer to identify reason for rejection HCP13 is the rejection message returned from the third party organization. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. T1 Cannot Identify Provider as TPO (Third Party Organization) Participant T2 Cannot Identify Payer as TPO (Third Party Organization) Participant T3 Cannot Identify Insured as TPO (Third Party Organization) Participant T4 Payer Name or Identifier Missing T5 Certification Information Missing T6 Claim does not contain enough information for re-pricing HCP-14 1526 Policy Compliance Code Identifier (ID) Optional Code specifying policy compliance Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. 1 Procedure Followed (Compliance) 2 Not Followed - Call Not Made (Non-Compliance Call Not Made) 3 Not Medically Necessary (Non-Compliance Non-Medically Necessary) 4 Not Followed Other (Non-Compliance Other) 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 288 579 5 Emergency Admit to Non-Network Hospital HCP-15 1527 Exception Code Identifier (ID) Optional Code specifying the exception reason for consideration of out-of-network health care services HCP15 is the exception reason generated by a third party organization. Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. 1 Non-Network Professional Provider in Network Hospital 2 Emergency Care 3 Services or Specialist not in Network 4 Out-of-Service Area 5 State Mandates 6 Other 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 289 579 2410 Drug Identification Loop Max 1 Optional LIN 4930 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Drug Identification Loop LIN Drug Identification To specify basic item identification data Usage notes Drugs and biologics reported in this segment are a further specification of service(s) described in the SV2 segment of this Service Line Loop ID-2400. Required when government regulation mandates that prescribed drugs and biologics are reported with NDC numbers. OR Required when the provider or submitter chooses to report NDC numbers to enhance the claim reporting or adjudication processes. If not required by this implementation guide, do not send. Example LIN N4 XXX Max use 1 Required LIN-02 235 Product or Service ID Qualifier Identifier (ID) Required Code identifying the type source of the descriptive number used in Product Service ID (234) LIN02 through LIN31 provide for fifteen different product service IDs for each item. For example: Case, Color, Drawing No., U.P.C. No., ISBN No., Model No., or SKU. N4 National Drug Code in 5-4-2 Format LIN-03 234 National Drug Code Min 1 Max 48 String (AN) Required Identifying number for a product or service 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 290 579 CTP 4940 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Drug Identification Loop CTP Drug Quantity To specify pricing information Example CTP 0000000 ME Max use 1 Required CTP-04 380 National Drug Unit Count Min 1 Max 15 Decimal number (R) Required Numeric value of quantity CTP-05 C001 Composite Unit of Measure To identify a composite unit of measure (See Figures Appendix for examples of use) Max use 1 Required C001-01 355 Code Qualifier Identifier (ID) Required Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken F2 International Unit GR Gram ME Milligram ML Milliliter UN Unit 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 291 579 2410 Drug Identification Loop end REF 4950 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Drug Identification Loop REF Prescription or Compound Drug Association Number To specify identifying information Usage notes In cases where a compound drug is being billed, the components of the compound will all have the same prescription number. Payers receiving the claim can relate all the components by matching the prescription number. Required when dispensing of the drug has been done with an assigned prescription number. OR Required when the provided medication involves the compounding of two or more drugs being reported and there is no prescription number. If not required by this implementation guide, do not send. For cases where the drug is provided without a prescription (for example, from a physician's office), the value provided in this segment is a "link sequence number". The link sequence number is a provider assigned number that is unique to this claim. Its purpose is to enable the receiver to piece together the components of the compound. Example REF XZ XXXXXX Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification VY Link Sequence Number XZ Pharmacy Prescription Number REF-02 127 Prescription Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 292 579 2420A Operating Physician Name Loop Max 1 Optional Variants (all may be used) Other Operating Physician Name Loop Rendering Provider Name Loop Referring Provider Name Loop NM1 5000 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Operating Physician Name Loop NM1 Operating Physician Name To supply the full name of an individual or organizational entity Usage notes Required when a surgical procedure code is | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_70 |
Provider Name Loop NM1 5000 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Operating Physician Name Loop NM1 Operating Physician Name To supply the full name of an individual or organizational entity Usage notes Required when a surgical procedure code is listed on this claim. AND The Operating Physician for this line is different than the Operating Physician reported in Loop ID-2310B (claim level). If not required by this implementation guide, do not send. The Operating Physician is the individual with primary responsibility for performing the surgical procedure(s). Example NM1 72 1 XX XXXX XXXX XX XX XXXXXX If either Identification Code Qualifier (NM1-08) or Operating Physician Primary Identifier (NM1-09) is present, then the other is required Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 72 Operating Physician NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 Person NM1-03 1035 Operating Physician Last Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-04 1036 Operating Physician First Name Min 1 Max 35 String (AN) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 293 579 Individual first name NM1-05 1037 Operating Physician Middle Name or Initial String (AN) Optional Min 1 Max 25 Individual middle name or initial NM1-07 1039 Operating Physician Name Suffix Min 1 Max 10 String (AN) Optional Suffix to individual name NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Medicare and Medicaid Services National Provider Identifier NM1-09 67 Operating Physician Primary Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code Usage notes Use appropriate NPI number. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 294 579 REF 5250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Operating Physician Name Loop REF Operating Physician Secondary Identification To specify identifying information Usage notes Required prior to the mandated HIPAA National Provider Identifier (NPI) implementation date when an identification number other than the NPI is necessary for the receiver to identify the provider. OR Required on or after the mandated NPI Implementation Date when NM109 in this loop is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send. When it is necessary to report one or more non-destination payer Secondary Identifiers, the composite data element in REF04 is used to identify the payer who assigned this identifier. Example REF LU XXXXX 2U XXXXX Max use 20 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim. This is to be used by all payers including: Medicare, Medicaid, Blue Cross, etc. LU Location Number REF-02 127 Operating Physician Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier REF-04 C040 Reference Identifier To identify one or more reference numbers or identification numbers as specified by the Reference Qualifier - REF04 contains data relating to the value cited in REF02. Usage notes Required when the identifier reported in REF02 of this segment is for a non-destination payer. Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 295 579 2420A Operating Physician Name Loop end C040-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 2U Payer Identification Number C040-02 127 Other Payer Primary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes The payer identifier reported in this field must match the cooresponding payer identifier reported in Loop ID-2330B NM109. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 296 579 2420B Other Operating Physician Name Loop Max 1 Optional Variants (all may be used) Operating Physician Name Loop Rendering Provider Name Loop Referring Provider Name Loop NM1 5000 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Other Operating Physician Name Loop NM1 Other Operating Physician Name To supply the full name of an individual or organizational entity Usage notes Required when another Operating Physician is involved, AND The Other Operating Physician for this line is different than the Other Operating Physician reported in Loop ID-2310C (claim level). If not required by this implementation guide, do not send.; Example NM1 ZZ 1 X XXX XX XXXXXX XX XXXXX If either Identification Code Qualifier (NM1-08) or Other Operating Physician Identifier (NM1-09) is present, then the other is required Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual ZZ Mutually Defined ZZ is used to indicate Other Operating Physician. NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 Person NM1-03 1035 Other Operating Physician Last Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-04 1036 Other Operating Physician First Name Min 1 Max 35 String (AN) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_71 |
qualifies NM103. 1 Person NM1-03 1035 Other Operating Physician Last Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-04 1036 Other Operating Physician First Name Min 1 Max 35 String (AN) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 297 579 Individual first name NM1-05 1037 Other Operating Physician Middle Name or Initial String (AN) Optional Min 1 Max 25 Individual middle name or initial NM1-07 1039 Other Operating Physician Name Suffix Min 1 Max 10 String (AN) Optional Suffix to individual name NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Medicare and Medicaid Services National Provider Identifier NM1-09 67 Other Operating Physician Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code Usage notes Use appropriate NPI number. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 298 579 REF 5250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Other Operating Physician Name Loop REF Other Operating Physician Secondary Identification To specify identifying information Usage notes Required prior to the mandated HIPAA National Provider Identifier (NPI) implementation date when an identification number other than the NPI is necessary for the receiver to identify the provider. OR Required on or after the mandated NPI Implementation Date when NM109 in this loop is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send. When it is necessary to report one or more non-destination payer Secondary Identifiers, the composite data element in REF04 is used to identify the payer who assigned this identifier. Example REF LU XXXXXX 2U XXX Max use 20 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim. This is to be used by all payers including: Medicare, Medicaid, Blue Cross, etc. LU Location Number REF-02 127 Other Provider Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier REF-04 C040 Reference Identifier To identify one or more reference numbers or identification numbers as specified by the Reference Qualifier - REF04 contains data relating to the value cited in REF02. Usage notes Required when the identifier reported in REF02 of this segment is for a non-destination payer. Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 299 579 2420B Other Operating Physician Name Loop end C040-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 2U Payer Identification Number C040-02 127 Other Payer Primary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes The payer identifier reported in this field must match the cooresponding payer identifier reported in Loop ID-2330B NM109. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 300 579 2420C Rendering Provider Name Loop Max 1 Optional Variants (all may be used) Operating Physician Name Loop Other Operating Physician Name Loop Referring Provider Name Loop NM1 5000 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Rendering Provider Name Loop NM1 Rendering Provider Name To supply the full name of an individual or organizational entity Usage notes Required when Rendering Provider is different than the Attending Provider reported in the 2310A loop of this claim. AND State or federal regulatory requirements call for a "combined claim", that is, a claim that includes both facility and professional components (for example, a Medicaid clinic bill or Critical Access Hospital Claim.) AND The Rendering Provider for this line is different than the Rendering Provider reported in Loop ID 2310D (claim level). If not required by this implementation guide, do not send. The Rendering Provider is the health care professional who delivers or completes a particular medical service or non-surgical procedure. Example NM1 82 1 XXXXX XX XXXX XXX XX XX If either Identification Code Qualifier (NM1-08) or Rendering Provider Identifier (NM1-09) is present, then the other is required Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual 82 Rendering Provider NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 Person NM1-03 1035 Rendering Provider Last Name Min 1 Max 60 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 301 579 Individual last name or organizational name NM1-04 1036 Rendering Provider First Name Min 1 Max 35 String (AN) Optional Individual first name NM1-05 1037 Rendering Provider Middle Name or Initial Min 1 Max 25 String (AN) Optional Individual middle name or initial NM1-07 1039 Rendering Provider Name Suffix Min 1 Max 10 String (AN) Optional Suffix to individual name NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Medicare and Medicaid Services National Provider Identifier NM1-09 67 Rendering Provider Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code 1 30 25, 11:52 AM Health | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_72 |
(ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Medicare and Medicaid Services National Provider Identifier NM1-09 67 Rendering Provider Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 302 579 REF 5250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Rendering Provider Name Loop REF Rendering Provider Secondary Identification To specify identifying information Usage notes Required prior to the mandated HIPAA National Provider Identifier (NPI) implementation date when an identification number other than the NPI is necessary for the receiver to identify the provider. OR Required on or after the mandated NPI Implementation Date when NM109 in this loop is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send. When it is necessary to report one or more non-destination payer Secondary Identifiers, the composite data element in REF04 is used to identify the payer who assigned this identifier. Example REF 1G XXXXX 2U XXXXX Max use 20 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim. This is to be used by all payers including: Medicare, Medicaid, Blue Cross, etc. LU Location Number REF-02 127 Rendering Provider Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier REF-04 C040 Reference Identifier To identify one or more reference numbers or identification numbers as specified by the Reference Qualifier - REF04 contains data relating to the value cited in REF02. Usage notes Required when the identifier reported in REF02 of this segment is for a non-destination payer. Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 303 579 2420C Rendering Provider Name Loop end C040-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 2U Payer Identification Number C040-02 127 Other Payer Primary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes The payer identifier reported in this field must match the cooresponding payer identifier reported in Loop ID-2330B NM109. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 304 579 2420D Referring Provider Name Loop Max 1 Optional Variants (all may be used) Operating Physician Name Loop Other Operating Physician Name Loop Rendering Provider Name Loop NM1 5000 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Referring Provider Name Loop NM1 Referring Provider Name To supply the full name of an individual or organizational entity Usage notes Required on an outpatient claim when the Referring Provider is different than the Attending Provider. AND The Referring Provider for this line is different than the Referring Provider reported in Loop ID 2310F (claim level). If not required by this implementation guide, do not send. The Referring Provider is provider who sends the patient to another provider for services. Example NM1 DN 1 XXXXXX XXX XXXXXX XXXX XX XXXXX If either Identification Code Qualifier (NM1-08) or Referring Provider Identifier (NM1-09) is present, then the other is required Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual DN Referring Provider NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 Person NM1-03 1035 Referring Provider Last Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-04 1036 Referring Provider First Name Min 1 Max 35 String (AN) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 305 579 Individual first name NM1-05 1037 Referring Provider Middle Name or Initial Min 1 Max 25 String (AN) Optional Individual middle name or initial NM1-07 1039 Referring Provider Name Suffix Min 1 Max 10 String (AN) Optional Suffix to individual name NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Medicare and Medicaid Services National Provider Identifier NM1-09 67 Referring Provider Identifier Min 2 Max 80 String (AN) Optional Code identifying a party or other code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 306 579 REF 5250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Referring Provider Name Loop REF Referring Provider Secondary Identification To specify identifying information Usage notes Required prior to the mandated HIPAA National Provider Identifier (NPI) implementation date when an identification number other than the NPI is necessary for the receiver to identify the provider. OR Required on or after the mandated NPI Implementation Date when NM109 in this loop is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send. When it is necessary to report one or more non-destination payer Secondary Identifiers, the composite data element in REF04 is used to identify the payer who assigned this identifier. Example REF 1G XXXX 2U XX | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_73 |
receiver to identify the provider. If not required by this implementation guide, do not send. When it is necessary to report one or more non-destination payer Secondary Identifiers, the composite data element in REF04 is used to identify the payer who assigned this identifier. Example REF 1G XXXX 2U XX Max use 20 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number UPINs must be formatted as either X99999 or XXX999. G2 Provider Commercial Number This code designates a proprietary provider number for the destination payer identified in the Payer Name loop, Loop ID-2010BB, associated with this claim. This is to be used by all payers including: Medicare, Medicaid, Blue Cross, etc. REF-02 127 Referring Provider Secondary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier REF-04 C040 Reference Identifier To identify one or more reference numbers or identification numbers as specified by the Reference Qualifier - REF04 contains data relating to the value cited in REF02. Usage notes Required when the identifier reported in REF02 of this segment is for a non-destination payer. Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 307 579 2420D Referring Provider Name Loop end C040-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 2U Payer Identification Number C040-02 127 Other Payer Primary Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes The payer identifier reported in this field must match the cooresponding payer identifier reported in Loop ID-2330B NM109. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 308 579 2430 Line Adjudication Information Loop Max 15 Optional SVD 5400 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Line Adjudication Information Loop SVD Line Adjudication Information To convey service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers Usage notes Required when the claim has been previously adjudicated by payer identified in Loop ID-2330B and this service line has payments and or adjustments applied to it. If not required by this implementation guide, do not send. To show unbundled lines: If, in the original claim, line 3 is unbundled into (for example) 2 additional lines, then the SVD for line 3 is used 3 times: once for the original adjustment to line 3 and then two more times for the additional unbundled lines. Example SVD XX 0000 ER XXXXXX XX XX XX XX XXXXX XXXXXX 0 0 0000 Max use 1 Required SVD-01 67 Other Payer Primary Identifier Min 2 Max 80 String (AN) Required Code identifying a party or other code SVD01 is the payer identification code. Usage notes This identifier indicates the payer responsible for the reimbursement described in this iteration of the 2430 loop. The identifier indicates the Other Payer by matching the appropriate Other Payer Primary Identifier (Loop ID-2330B, element NM109). SVD-02 782 Service Line Paid Amount Min 1 Max 15 Decimal number (R) Required Monetary amount SVD02 is the amount paid for this service line. Usage notes Zero "0" is an acceptable value for this element. SVD-03 C003 Composite Medical Procedure Identifier To identify a medical procedure by its standardized codes and applicable modifiers - SVD03 represents the medical procedure code upon which adjudication of this service line was based. This may be different than the submitted medical procedure code. Usage notes Required when a line level procedure code other than a revenue code was returned on the 835 remittance advice (SVC01). Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 309 579 If not required by this implementation guide, do not send. C003-01 235 Product or Service ID Qualifier Identifier (ID) Required Code identifying the type source of the descriptive number used in Product Service ID (234) C003-01 qualifies C003-02 and C003-08. ER Jurisdiction Specific Procedure and Supply Codes HC Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes Because the AMA's CPT codes are also level 1 HCPCS codes, they are reported under HC. HP Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code IV Home Infusion EDI Coalition (HIEC) Product Service Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the Home Infusion EDI Coalition (HIEC) Product Service Codes as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA.; WK Advanced Billing Concepts (ABC) Codes At the time of this writing, this code set has been approved by the Secretary of HHS as a pilot project allowed under HIPAA law. The qualifier may only be used in transactions covered under HIPAA; By parties registered in the pilot project and their trading partners, OR If a new rule names the Complementary, Alternative, or Holistic Procedure Codes as an allowable code set under HIPAA, OR For claims which are not covered under HIPAA. C003-02 234 Procedure Code Min 1 Max 48 String (AN) Required Identifying number for a product or service If C003-08 is used, then C003-02 represents the beginning value in the range in which the code occurs. C003-03 1339 Procedure Modifier Min 2 Max 2 String (AN) Optional This identifies special circumstances related to the performance of the service, as defined by trading partners C003-03 modifies the value in C003-02 and C003-08. C003-04 1339 Procedure Modifier Min 2 Max 2 String | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_74 |
range in which the code occurs. C003-03 1339 Procedure Modifier Min 2 Max 2 String (AN) Optional This identifies special circumstances related to the performance of the service, as defined by trading partners C003-03 modifies the value in C003-02 and C003-08. C003-04 1339 Procedure Modifier Min 2 Max 2 String (AN) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 310 579 This identifies special circumstances related to the performance of the service, as defined by trading partners C003-04 modifies the value in C003-02 and C003-08. C003-05 1339 Procedure Modifier Min 2 Max 2 String (AN) Optional This identifies special circumstances related to the performance of the service, as defined by trading partners C003-05 modifies the value in C003-02 and C003-08. C003-06 1339 Procedure Modifier Min 2 Max 2 String (AN) Optional This identifies special circumstances related to the performance of the service, as defined by trading partners C003-06 modifies the value in C003-02 and C003-08. C003-07 352 Procedure Code Description Min 1 Max 80 String (AN) Optional A free-form description to clarify the related data elements and their content C003-07 is the description of the procedure identified in C003-02. SVD-04 234 Service Line Revenue Code Min 1 Max 48 String (AN) Required Identifying number for a product or service SVD04 is the revenue code. SVD-05 380 Paid Service Unit Count Min 1 Max 15 Decimal number (R) Required Numeric value of quantity SVD05 is the paid units of service. Usage notes This is the number of paid units from the remittance advice. When paid units are not present on the remittance advice, use the original billed units. The maximum length for this field is 8 digits excluding the decimal. When a decimal is used, the maximum number of digits allowed to the right of the decimal is three. SVD-06 554 Bundled Line Number Min 1 Max 6 Numeric (N0) Optional Number assigned for differentiation within a transaction set 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 311 579 SVD06 is only used for bundling of service lines. It references the LX Assigned Number of the service line into which this service line was bundled. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 312 579 CAS 5450 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Line Adjudication Information Loop CAS Line Adjustment To supply adjustment reason codes and amounts as needed for an entire claim or for a particular service within the claim being paid Usage notes Required when the payer identified in Loop 2330B made line level adjustments which caused the amount paid to differ from the amount originally charged. If not required by this implementation guide, do not send. A single CAS segment contains six repetitions of the "adjustment trio" composed of adjustment reason code, adjustment amount, and adjustment quantity. These six adjustment trios are used to report up to six adjustments related to a particular Claim Adjustment Group Code (CAS01). The first non-zero adjustment is reported in the first adjustment trio (CAS02-CAS04). If there is a second non-zero adjustment, it is reported in the second adjustment trio (CAS05-CAS07), and so on through the sixth adjustment trio (CAS17-CAS19). Example CAS CO XX 00000000000000 00000000 XXXXX 0000000 0 00000000000000 XXXX 00000000000000 00000000 XXX X 0000000000 000000000000 XX 0000000 000000000000 000 XXXX 0000 000000000000000 If Adjustment Reason Code (CAS-05) is present, then at least one of Adjustment Amount (CAS-06) or Adjustment Quantity (CAS-07) is required If Adjustment Amount (CAS-06) is present, then Adjustment Reason Code (CAS-05) is required If Adjustment Quantity (CAS-07) is present, then Adjustment Reason Code (CAS-05) is required If Adjustment Reason Code (CAS-08) is present, then at least one of Adjustment Amount (CAS-09) or Adjustment Quantity (CAS-10) is required If Adjustment Amount (CAS-09) is present, then Adjustment Reason Code (CAS-08) is required If Adjustment Quantity (CAS-10) is present, then Adjustment Reason Code (CAS-08) is required If Adjustment Reason Code (CAS-11) is present, then at least one of Adjustment Amount (CAS-12) or Adjustment Quantity (CAS-13) is required If Adjustment Amount (CAS-12) is present, then Adjustment Reason Code (CAS-11) is required If Adjustment Quantity (CAS-13) is present, then Adjustment Reason Code (CAS-11) is required If Adjustment Reason Code (CAS-14) is present, then at least one of Adjustment Amount (CAS-15) or Adjustment Quantity (CAS-16) is required If Adjustment Amount (CAS-15) is present, then Adjustment Reason Code (CAS-14) is required If Adjustment Quantity (CAS-16) is present, then Adjustment Reason Code (CAS-14) is required If Adjustment Reason Code (CAS-17) is present, then at least one of Adjustment Amount (CAS-18) or Adjustment Quantity (CAS-19) is required If Adjustment Amount (CAS-18) is present, then Adjustment Reason Code (CAS-17) is required Max use 5 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 313 579 If Adjustment Quantity (CAS-19) is present, then Adjustment Reason Code (CAS-17) is required CAS-01 1033 Claim Adjustment Group Code Identifier (ID) Required Code identifying the general category of payment adjustment CO Contractual Obligations CR Correction and Reversals OA Other adjustments PI Payor Initiated Reductions PR Patient Responsibility CAS-02 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Required Code identifying the detailed reason the adjustment was made CAS-03 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Required Monetary amount CAS03 is the amount of adjustment. CAS-04 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS04 is the units of service being adjusted. CAS-05 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code identifying the detailed reason the adjustment was made Usage notes See CODE SOURCE 139: Claim Adjustment Reason Code CAS-06 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CAS06 is the amount of the | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_75 |
1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code identifying the detailed reason the adjustment was made Usage notes See CODE SOURCE 139: Claim Adjustment Reason Code CAS-06 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CAS06 is the amount of the adjustment. CAS-07 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 314 579 CAS07 is the units of service being adjusted. CAS-08 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code identifying the detailed reason the adjustment was made Usage notes See CODE SOURCE 139: Claim Adjustment Reason Code CAS-09 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CAS09 is the amount of the adjustment. CAS-10 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS10 is the units of service being adjusted. CAS-11 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code identifying the detailed reason the adjustment was made Usage notes See CODE SOURCE 139: Claim Adjustment Reason Code CAS-12 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CAS12 is the amount of the adjustment. CAS-13 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS13 is the units of service being adjusted. CAS-14 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code identifying the detailed reason the adjustment was made Usage notes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 315 579 See CODE SOURCE 139: Claim Adjustment Reason Code CAS-15 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CAS15 is the amount of the adjustment. CAS-16 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS16 is the units of service being adjusted. CAS-17 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code identifying the detailed reason the adjustment was made Usage notes See CODE SOURCE 139: Claim Adjustment Reason Code CAS-18 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CAS18 is the amount of the adjustment. CAS-19 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS19 is the units of service being adjusted. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 316 579 DTP 5500 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Line Adjudication Information Loop DTP Line Check or Remittance Date To specify any or all of a date, a time, or a time period Example DTP 573 D8 XX Max use 1 Required DTP-01 374 Date Time Qualifier Identifier (ID) Required Code specifying type of date or time, or both date and time 573 Date Claim Paid DTP-02 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. D8 Date Expressed in Format CCYYMMDD DTP-03 1251 Adjudication or Payment Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 317 579 2430 Line Adjudication Information Loop end 2400 Service Line Number Loop end 2300 Claim Information Loop end AMT 5505 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Service Line Number Loop Line Adjudication Information Loop AMT Remaining Patient Liability To indicate the total monetary amount Usage notes In the judgment of the provider, this is the remaining amount to be paid after adjudication by the Other Payer referenced in SVD01 of this iteration of Loop ID-2430. This segment is only used in provider submitted claims. It is not used in Payer-to-Payer Coordination of Benefits (COB). Required when the Other Payer referenced in SVD01 of this iteration of Loop ID-2430 has adjudicated this claim, provided line level information, and the provider has the ability to report line item information. If not required by this implementation guide, do not send. This segment is not used if the claim level (Loop ID-2320) Remaining Patient Liability AMT segment is used for this Other Payer. Example AMT EAF 00000000000 Max use 1 Optional AMT-01 522 Amount Qualifier Code Identifier (ID) Required Code to qualify amount EAF Amount Owed AMT-02 782 Remaining Patient Liability Min 1 Max 15 Decimal number (R) Required Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 318 579 2000C Patient Hierarchical Level Loop Max 1 Optional HL 0010 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop HL Hierarchical Level To identify dependencies among and the content of hierarchically related groups of data segments Example HL 3 2 23 0 Max use 1 Required HL-01 628 Hierarchical ID Number Min 1 Max 12 String (AN) Required A unique number assigned by the sender to identify a particular data segment in a hierarchical structure HL01 shall contain a unique alphanumeric number for each occurrence of the HL segment in the transaction set. For example, HL01 could be used to indicate the number of occurrences of the HL segment, in which case the value of HL01 would be "1" for the initial HL segment and would be incremented by one in each subsequent HL segment within the transaction. HL-02 734 Hierarchical Parent ID Number Min 1 Max 12 String (AN) Required | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_76 |
the number of occurrences of the HL segment, in which case the value of HL01 would be "1" for the initial HL segment and would be incremented by one in each subsequent HL segment within the transaction. HL-02 734 Hierarchical Parent ID Number Min 1 Max 12 String (AN) Required Identification number of the next higher hierarchical data segment that the data segment being described is subordinate to HL02 identifies the hierarchical ID number of the HL segment to which the current HL segment is subordinate. HL-03 735 Hierarchical Level Code Identifier (ID) Required Code defining the characteristic of a level in a hierarchical structure HL03 indicates the context of the series of segments following the current HL segment up to the next occurrence of an HL segment in the transaction. For example, HL03 is used to indicate that subsequent segments in the HL loop form a logical grouping of data referring to shipment, order, or item-level information. 23 Dependent HL-04 736 Hierarchical Child Code Identifier (ID) Optional Code indicating if there are hierarchical child data segments subordinate to the level being described HL04 indicates whether or not there are subordinate (or child) HL segments related to the current HL segment. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 319 579 0 No Subordinate HL Segment in This Hierarchical Structure. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 320 579 PAT 0070 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop PAT Patient Information To supply patient information Example PAT 19 Max use 1 Required PAT-01 1069 Individual Relationship Code Identifier (ID) Required Code indicating the relationship between two individuals or entities Usage notes Specifies the patient's relationship to the person insured. 01 Spouse 19 Child 20 Employee 21 Unknown 39 Organ Donor 40 Cadaver Donor 53 Life Partner G8 Other Relationship 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 321 579 2010CA Patient Name Loop Max 1 Required NM1 0150 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Patient Name Loop NM1 Patient Name To supply the full name of an individual or organizational entity Example NM1 QC 1 XXX XX XXXXX XXXXX Max use 1 Required NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual QC Patient NM1-02 1065 Entity Type Qualifier Identifier (ID) Required Code qualifying the type of entity NM102 qualifies NM103. 1 Person NM1-03 1035 Patient Last Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-04 1036 Patient First Name Min 1 Max 35 String (AN) Optional Individual first name NM1-05 1037 Patient Middle Name or Initial Min 1 Max 25 String (AN) Optional Individual middle name or initial NM1-07 1039 Patient Name Suffix Min 1 Max 10 String (AN) Optional Suffix to individual name 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 322 579 N3 0250 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Patient Name Loop N3 Patient Address To specify the location of the named party Example N3 XXXXXX XXXX Max use 1 Required N3-01 166 Patient Address Line Min 1 Max 55 String (AN) Required Address information N3-02 166 Patient Address Line Min 1 Max 55 String (AN) Optional Address information 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 323 579 N4 0300 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Patient Name Loop N4 Patient City, State, ZIP Code To specify the geographic place of the named party Example N4 XXXXXXX XX XXX XX Only one of Patient State Code (N4-02) or Country Subdivision Code (N4-07) may be present If Country Subdivision Code (N4-07) is present, then Country Code (N4-04) is required Max use 1 Required N4-01 19 Patient City Name Min 2 Max 30 String (AN) Required Free-form text for city name A combination of either N401 through N404, or N405 and N406 may be adequate to specify a location. N4-02 156 Patient State Code Min 2 Max 2 Identifier (ID) Optional Code (Standard State Province) as defined by appropriate government agency N402 is required only if city name (N401) is in the U.S. or Canada. N4-03 116 Patient Postal Zone or ZIP Code Min 3 Max 15 Identifier (ID) Optional Code defining international postal zone code excluding punctuation and blanks (zip code for United States) N4-04 26 Country Code Min 2 Max 3 Identifier (ID) Optional Code identifying the country Usage notes Use the alpha-2 country codes from Part 1 of ISO 3166. N4-07 1715 Country Subdivision Code Min 1 Max 3 Identifier (ID) Optional Code identifying the country subdivision Usage notes Use the country subdivision codes from Part 2 of ISO 3166. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 324 579 DMG 0320 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Patient Name Loop DMG Patient Demographic Information To supply demographic information Example DMG D8 XXXX U Max use 1 Required DMG-01 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format D8 Date Expressed in Format CCYYMMDD DMG-02 1251 Patient Birth Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times DMG02 is the date of birth. DMG-03 1068 Patient Gender Code Identifier (ID) Required Code indicating the sex of the | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_77 |
in Format CCYYMMDD DMG-02 1251 Patient Birth Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times DMG02 is the date of birth. DMG-03 1068 Patient Gender Code Identifier (ID) Required Code indicating the sex of the individual F Female M Male U Unknown 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 325 579 REF 0350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Patient Name Loop REF Property and Casualty Claim Number To specify identifying information Usage notes This is a property and casualty payer-assigned claim number. Providers receive this number from the property and casualty payer during eligibility determinations or some other communication with that payer. See Section 1.4.2, Property and Casualty, for additional information about property and casualty claims.; This segment is not a HIPAA requirement as of this writing. Required when the services included in this claim are to be considered as part of a property and casualty claim. If not required by this implementation guide, do not send. Example REF Y4 XXXXXX Variants (all may be used) REF Property and Casualty Patient Identifier Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification Y4 Agency Claim Number REF-02 127 Property Casualty Claim Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 326 579 2010CA Patient Name Loop end REF 0350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Patient Name Loop REF Property and Casualty Patient Identifier To specify identifying information Usage notes Required when an identification number is needed by the receiver to identify the patient for Property and Casualty claims. If not required by this implementation guide, do not send. Example REF SY XX Variants (all may be used) REF Property and Casualty Claim Number Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 1W Member Identification Number This code designates a patient identification number used by the destination payer identified in the Payer Name loop, Loop ID 2010BB, associated with this claim. SY Social Security Number The Social Security Number must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid. REF-02 127 Property and Casualty Patient Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 327 579 2300 Claim Information Loop Max 100 Required CLM 1300 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop CLM Claim Information To specify basic data about the claim Usage notes The developers of this implementation guide recommend that trading partners limit the size of the transaction (ST-SE envelope) to a maximum of 5000 CLM segments. There is no recommended limit to the number of ST-SE transactions within a GS-GE or ISA- IEA. Willing trading partners can agree to set limits higher. For purposes of this documentation, the claim detail information is presented only in the dependent level. Specific claim detail information can be given in either the subscriber or the dependent hierarchical level. Because of this, the claim information is said to "float." Claim information is positioned in the same hierarchical level that describes its owner-participant, either the subscriber or the dependent. In other words, the claim information, Loop ID-2300, is placed following Loop ID-2010BB in the Subscriber Hierarchical Level (HL) when patient information is sent in Loop ID-2010BA of the Subscriber HL. Claim information is placed in the Patient HL when the patient information is sent in Loop ID-2010CA of the Patient HL. When the patient is the subscriber or is considered to be the subscriber, Loop ID-2000C and Loop ID-2010CA are not sent. See Subscriber Patient HL Segment explanation in section 1.4.3.2.2.1 for details. Example CLM XXXX 000 XX A X A Y Y 7 Max use 1 Required CLM-01 1028 Patient Control Number Min 1 Max 38 String (AN) Required Identifier used to track a claim from creation by the health care provider through payment Usage notes The number that the submitter transmits in this position is echoed back to the submitter in the 835 and other transactions. This permits the submitter to use the value in this field as a key in the submitter's system to match the claim to the payment information returned in the 835 transaction. The two recommended identifiers are either the Patient Account Number or the Claim Number in the billing submitter's patient management system. The developers of this implementation guide strongly recommend that submitters use unique numbers for this field for each individual claim. When Loop ID-2010AC is present, CLM01 represents the subrogated Medicaid agency's claim number (ICN DCN) from their original 835 CLP07 - Payer Claim Control Number. See Section 1.4.1.4 of the front matter for a description of post payment recovery claims for subrogated Medicaid agencies. The maximum number of characters to be supported for this field is 20'. Characters beyond the maximum are not required to be stored nor returned by any 837-receiving system. CLM-02 782 Total Claim Charge Amount Min 1 Max 15 Decimal number (R) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 328 579 Monetary amount CLM02 is the total amount of all submitted charges of service segments for this claim. Usage notes The Total Claim Charge Amount must be greater | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_78 |
Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 328 579 Monetary amount CLM02 is the total amount of all submitted charges of service segments for this claim. Usage notes The Total Claim Charge Amount must be greater than or equal to zero. The total claim charge amount must balance to the sum of all service line charge amounts reported in the Institutional Service Line (SV2) segments for this claim. CLM-05 C023 Health Care Service Location Information To provide information that identifies the place of service or the type of bill related to the location at which a health care service was rendered Max use 1 Required C023-01 1331 Facility Type Code Min 1 Max 2 String (AN) Required Code identifying where services were, or may be, performed; the first and second positions of the Uniform Bill Type Code for Institutional Services or the Place of Service Codes for Professional or Dental Services. C023-02 1332 Facility Code Qualifier Identifier (ID) Required Code identifying the type of facility referenced C023-02 qualifies C023-01 and C023-03. A Uniform Billing Claim Form Bill Type C023-03 1325 Claim Frequency Code Min 1 Max 1 Identifier (ID) Required Code specifying the frequency of the claim; this is the third position of the Uniform Billing Claim Form Bill Type CLM-07 1359 Assignment or Plan Participation Code Identifier (ID) Required Code indicating whether the provider accepts assignment Usage notes Within this element the context of the word assignment is related to the relationship between the provider and the payer. This is NOT the field for reporting whether the patient has or has not assigned benefits to the provider. The benefit assignment indicator is in CLM08. A Assigned Required when the provider accepts assignment and or has a participation agreement with the destination payer. OR Required when the provider does not accept assignment and or have a participation agreement, but is advising the payer to adjudicate this specific claim under participating provider benefits as allowed under certain plans. B Assignment Accepted on Clinical Lab Services Only 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 329 579 Required when the provider accepts assignment for Clinical Lab Services only. C Not Assigned Required when neither codes A' nor B' apply. CLM-08 1073 Benefits Assignment Certification Indicator Identifier (ID) Required Code indicating a Yes or No condition or response CLM08 is assignment of benefits indicator. A "Y" value indicates insured or authorized person authorizes benefits to be assigned to the provider; an "N" value indicates benefits have not been assigned to the provider. Usage notes This element answers the question whether or not the insured has authorized the plan to remit payment directly to the provider. N No W Not Applicable Use code W' when the patient refuses to assign benefits. Y Yes CLM-09 1363 Release of Information Code Identifier (ID) Required Code indicating whether the provider has on file a signed statement by the patient authorizing the release of medical data to other organizations Usage notes The Release of Information response is limited to the information carried in this claim. I Informed Consent to Release Medical Information for Conditions or Diagnoses Regulated by Federal Statutes Required when the provider has not collected a signature AND state or federal laws do not require a signature be collected. Y Yes, Provider has a Signed Statement Permitting Release of Medical Billing Data Related to a Claim Required when the provider has collected a signature. OR Required when state or federal laws require a signature be collected. CLM-20 1514 Delay Reason Code Identifier (ID) Optional Code indicating the reason why a request was delayed 1 Proof of Eligibility Unknown or Unavailable 2 Litigation 3 Authorization Delays 4 Delay in Certifying Provider 5 Delay in Supplying Billing Forms 6 Delay in Delivery of Custom-made Appliances 7 Third Party Processing Delay 8 Delay in Eligibility Determination 9 Original Claim Rejected or Denied Due to a Reason Unrelated to the Billing Limitation Rules 10 Administration Delay in the Prior Approval Process 11 Other 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 330 579 15 Natural Disaster 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 331 579 DTP 1350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop DTP Admission Date Hour To specify any or all of a date, a time, or a time period Usage notes Required on inpatient claims. If not required by this implementation guide, do not send. Example DTP 435 DT X Variants (all may be used) DTP Date - Repricer Received Date DTP Discharge Hour DTP Statement Dates Max use 1 Optional DTP-01 374 Date Time Qualifier Identifier (ID) Required Code specifying type of date or time, or both date and time 435 Admission DTP-02 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. Usage notes Selection of the appropriate qualifier is designated by the NUBC Billing Manual. D8 Date Expressed in Format CCYYMMDD DT Date and Time Expressed in Format CCYYMMDDHHMM DTP-03 1251 Admission Date and Hour Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 332 579 DTP 1350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop DTP Date - Repricer Received Date To specify any or all of a date, a time, or a time period Usage notes Required when a repricer is passing the claim | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_79 |
579 DTP 1350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop DTP Date - Repricer Received Date To specify any or all of a date, a time, or a time period Usage notes Required when a repricer is passing the claim onto the payer. If not required by this implementation guide, do not send. Example DTP 050 D8 XXX Variants (all may be used) DTP Admission Date Hour DTP Discharge Hour DTP Statement Dates Max use 1 Optional DTP-01 374 Date Time Qualifier Identifier (ID) Required Code specifying type of date or time, or both date and time 050 Received DTP-02 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. D8 Date Expressed in Format CCYYMMDD DTP-03 1251 Repricer Received Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 333 579 DTP 1350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop DTP Discharge Hour To specify any or all of a date, a time, or a time period Usage notes Required on all final inpatient claims. If not required by this implementation guide, do not send. Example DTP 096 TM XXXX Variants (all may be used) DTP Admission Date Hour DTP Date - Repricer Received Date DTP Statement Dates Max use 1 Optional DTP-01 374 Date Time Qualifier Identifier (ID) Required Code specifying type of date or time, or both date and time 096 Discharge DTP-02 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. TM Time Expressed in Format HHMM DTP-03 1251 Discharge Time Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 334 579 DTP 1350 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop DTP Statement Dates To specify any or all of a date, a time, or a time period Example DTP 434 RD8 XXX Variants (all may be used) DTP Admission Date Hour DTP Date - Repricer Received Date DTP Discharge Hour Max use 1 Required DTP-01 374 Date Time Qualifier Identifier (ID) Required Code specifying type of date or time, or both date and time 434 Statement DTP-02 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. RD8 Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD Use RD8 to indicate the from and through date of the statement. When the statement is for a single date of service, the from and through date are the same. DTP-03 1251 Statement From and To Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and times 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 335 579 CL1 1400 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop CL1 Institutional Claim Code To supply information specific to hospital claims Example CL1 X X XX Max use 1 Required CL1-01 1315 Admission Type Code Min 1 Max 1 Identifier (ID) Required Code indicating the priority of this admission CL1-02 1314 Admission Source Code Min 1 Max 1 Identifier (ID) Optional Code indicating the source of this admission CL1-03 1352 Patient Status Code Min 1 Max 2 Identifier (ID) Required Code indicating patient status as of the "statement covers through date" 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 336 579 PWK 1550 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop PWK Claim Supplemental Information To identify the type or transmission or both of paperwork or supporting information Usage notes Required when there is a paper attachment following this claim. OR Required when attachments are sent electronically (PWK02 EL) but are transmitted in another functional group (for example, 275) rather than by paper. PWK06 is then used to identify the attached electronic documentation. The number in PWK06 is carried in the TRN of the electronic attachment. OR Required when the provider deems it necessary to identify additional information that is being held at the provider's office and is available upon request by the payer (or appropriate entity), but the information is not being submitted with the claim. Use the value of "AA" in PWK02 to convey this specific use of the PWK segment. If not required by this implementation guide, do not send. Example PWK RT AA AC XXXXXXX If either Identification Code Qualifier (PWK-05) or Attachment Control Number (PWK-06) is present, then the other is required Max use 10 Optional PWK-01 755 Attachment Report Type Code Identifier (ID) Required Code indicating the title or contents of a document, report or supporting item 03 Report Justifying Treatment Beyond Utilization Guidelines 04 Drugs Administered 05 Treatment Diagnosis 06 Initial Assessment 07 Functional Goals 08 Plan of Treatment 09 Progress Report 10 Continued Treatment 11 Chemical Analysis 13 Certified Test Report 15 Justification for Admission 21 Recovery Plan A3 Allergies Sensitivities Document A4 Autopsy Report AM Ambulance Certification AS Admission Summary B2 Prescription B3 Physician Order B4 Referral Form | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_80 |
Initial Assessment 07 Functional Goals 08 Plan of Treatment 09 Progress Report 10 Continued Treatment 11 Chemical Analysis 13 Certified Test Report 15 Justification for Admission 21 Recovery Plan A3 Allergies Sensitivities Document A4 Autopsy Report AM Ambulance Certification AS Admission Summary B2 Prescription B3 Physician Order B4 Referral Form BR Benchmark Testing Results BS Baseline BT Blanket Test Results CB Chiropractic Justification 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 337 579 CK Consent Form(s) CT Certification D2 Drug Profile Document DA Dental Models DB Durable Medical Equipment Prescription DG Diagnostic Report DJ Discharge Monitoring Report DS Discharge Summary EB Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payor) HC Health Certificate HR Health Clinic Records I5 Immunization Record IR State School Immunization Records LA Laboratory Results M1 Medical Record Attachment MT Models NN Nursing Notes OB Operative Note OC Oxygen Content Averaging Report OD Orders and Treatments Document OE Objective Physical Examination (including vital signs) Document OX Oxygen Therapy Certification OZ Support Data for Claim P4 Pathology Report P5 Patient Medical History Document PE Parenteral or Enteral Certification PN Physical Therapy Notes PO Prosthetics or Orthotic Certification PQ Paramedical Results PY Physician's Report PZ Physical Therapy Certification RB Radiology Films RR Radiology Reports RT Report of Tests and Analysis Report RX Renewable Oxygen Content Averaging Report SG Symptoms Document V5 Death Notification XP Photographs PWK-02 756 Attachment Transmission Code Identifier (ID) Required Code defining timing, transmission method or format by which reports are to be sent AA Available on Request at Provider Site This means that the additional information is not being sent with the claim at this time. Instead, it is available to the payer (or appropriate entity) at their request. BM By Mail EL Electronically Only Indicates that the attachment is being transmitted in a separate X12 functional group. EM E-Mail FT File Transfer 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 338 579 Required when the actual attachment is maintained by an attachment warehouse or similar vendor. FX By Fax PWK-05 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) PWK05 and PWK06 may be used to identify the addressee by a code number. AC Attachment Control Number PWK-06 67 Attachment Control Number Min 2 Max 80 String (AN) Optional Code identifying a party or other code Usage notes PWK06 is used to identify the attached electronic documentation. The number in PWK06 is carried in the TRN of the electronic attachment. For the purpose of this implementation, the maximum field length is 50. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 339 579 CN1 1600 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop CN1 Contract Information To specify basic data about the contract or contract line item Usage notes Required when the submitter is contractually obligated to supply this information on post-adjudicated claims. If not required by this implementation guide, do not send. The developers of this implementation guide note that the CN1 segment is for use only for post-adjudicated claims, which do not meet the definition of a health care claim under HIPAA. Consequently, at the time of this writing, the CN1 segment is for non- HIPAA use only. Example CN1 02 0000 000000 X 0 XXXXXX Max use 1 Optional CN1-01 1166 Contract Type Code Identifier (ID) Required Code identifying a contract type 01 Diagnosis Related Group (DRG) 02 Per Diem 03 Variable Per Diem 04 Flat 05 Capitated 06 Percent 09 Other CN1-02 782 Contract Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CN102 is the contract amount. CN1-03 332 Contract Percentage Min 1 Max 6 Decimal number (R) Optional Percent given in decimal format (e.g., 0.0 through 100.0 represents 0 through 100 ) CN103 is the allowance or charge percent. CN1-04 127 Contract Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier CN104 is the contract code. CN1-05 338 Terms Discount Percentage Min 1 Max 6 Decimal number (R) Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 340 579 Terms discount percentage, expressed as a percent, available to the purchaser if an invoice is paid on or before the Terms Discount Due Date CN1-06 799 Contract Version Identifier Min 1 Max 30 String (AN) Optional Revision level of a particular format, program, technique or algorithm CN106 is an additional identifying number for the contract. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 341 579 AMT 1750 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop AMT Patient Estimated Amount Due To indicate the total monetary amount Usage notes Required when the Patient Responsibility Amount is applicable to this claim. If not required by this implementation guide, do not send. Example AMT F3 000000000 Max use 1 Optional AMT-01 522 Amount Qualifier Code Identifier (ID) Required Code to qualify amount F3 Patient Responsibility - Estimated AMT-02 782 Patient Responsibility Amount Min 1 Max 15 Decimal number (R) Required Monetary amount 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 342 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Adjusted Repriced Claim Number To specify identifying information Usage notes Required when this information is deemed necessary by the repricer. The segment is not completed by providers. The information | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_81 |
579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Adjusted Repriced Claim Number To specify identifying information Usage notes Required when this information is deemed necessary by the repricer. The segment is not completed by providers. The information is completed by repricers only. If not required by this implementation guide, do not send. This information is specific to the destination payer reported in Loop ID-2010BB. Example REF 9C XXX Variants (all may be used) REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 9C Adjusted Repriced Claim Reference Number REF-02 127 Adjusted Repriced Claim Reference Number String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 343 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Auto Accident State To specify identifying information Usage notes Required when the services reported on this claim are related to an auto accident and the accident occurred in a country or location that has a state, province, or sub- country code named in code source 22. If not required by this implementation guide, do not send. Example REF LU X Variants (all may be used) REF Adjusted Repriced Claim Number REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification LU Location Number REF-02 127 Auto Accident State or Province Code Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes Values in this field must be valid codes found in code source 22. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 344 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Claim Identifier For Transmission Intermediaries To specify identifying information Usage notes Required when this information is deemed necessary by transmission intermediaries (Automated Clearinghouses, and others) who need to attach their own unique claim number. If not required by this implementation guide, do not send. Although this REF is supplied for transmission intermediaries to attach their own unique claim number to a claim, 837-recipients are not required under HIPAA to return this number in any HIPAA transaction. Trading partners may voluntarily agree to this interaction if they wish. Example REF D9 XXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification Usage notes Number assigned by clearinghouse, van, etc. D9 Claim Number REF-02 127 Value Added Network Trace Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 345 579 The value carried in this element is limited to a maximum of 20 positions. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 346 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Demonstration Project Identifier To specify identifying information Usage notes Required when it is necessary to identify claims which are atypical in ways such as content, purpose, and or payment, as could be the case for a demonstration or other special project, or a clinical trial. If not required by this implementation guide, do not send. Example REF P4 XXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification P4 Project Code REF-02 127 Demonstration Project Identifier Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 347 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Investigational Device Exemption Number To specify identifying information Usage notes Required when claim involves a Food and Drug Administration (FDA) assigned investigational device exemption (IDE) number. When more than one IDE applies, they must be split into separate claims. If not required by this implementation guide, do | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_82 |
Information Loop REF Investigational Device Exemption Number To specify identifying information Usage notes Required when claim involves a Food and Drug Administration (FDA) assigned investigational device exemption (IDE) number. When more than one IDE applies, they must be split into separate claims. If not required by this implementation guide, do not send. Example REF LX XXXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 5 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification LX Qualified Products List REF-02 127 Investigational Device Exemption Identifier String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 348 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Medical Record Number To specify identifying information Usage notes Required when the provider needs to identify for future inquiries, the actual medical record of the patient identified in either Loop ID-2010BA or Loop ID-2010CA for this episode of care. If not required by this implementation guide, do not send. Example REF EA XXXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification EA Medical Record Identification Number REF-02 127 Medical Record Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 349 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Payer Claim Control Number To specify identifying information Usage notes Required when CLM05-3 (Claim Frequency Code) indicates this claim is a replacement or void to a previously adjudicated claim. If not required by this implementation guide, do not send. This information is specific to the destination payer reported in Loop ID-2010BB. Example REF F8 XXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification F8 Original Reference Number REF-02 127 Payer Claim Control Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 350 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Peer Review Organization (PRO) Approval Number To specify identifying information Usage notes Required when an external Peer Review Organization assigns an Approval Number to services deemed medically necessary by that organization. If not required by this implementation guide, do not send. Example REF G4 XXXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Prior Authorization REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification G4 Peer Review Organization (PRO) Approval Number REF-02 127 Peer Review Authorization Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 351 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Prior Authorization To specify identifying information Usage notes Generally, preauthorization numbers are assigned by the payer or UMO to authorize a service prior to its being performed. The UMO (Utilization Management Organization) is generally the entity empowered to make a decision regarding the outcome of a health services review or the owner of information. The prior authorization number carried in this REF is specific to the destination payer reported in the Loop ID-2010BB. If other payers have similar numbers for this claim, report that information in the Loop ID-2330 loop REF which holds that payer's information. Numbers at this position apply to the entire claim unless they are overridden in the REF segment in Loop ID-2400. A reference identification is considered to be overridden if the value in REF01 is the same in both the Loop ID-2300 REF segment and the Loop ID-2400 REF segment. In that case, the Loop ID-2400 REF applies only to that specific line. Required when an authorization number is assigned by the payer or UMO AND the services on this claim were preauthorized. If not required by this implementation guide, do not send. Example REF G1 XXXXX Variants (all may be used) | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_83 |
case, the Loop ID-2400 REF applies only to that specific line. Required when an authorization number is assigned by the payer or UMO AND the services on this claim were preauthorized. If not required by this implementation guide, do not send. Example REF G1 XXXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Referral Number REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification G1 Prior Authorization Number REF-02 127 Prior Authorization Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 352 579 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 353 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Referral Number To specify identifying information Usage notes Required when a referral number is assigned by the payer or Utilization Management Organization (UMO) AND a referral is involved. If not required by this implementation guide, do not send. Numbers at this position apply to the entire claim unless they are overridden in the REF segment in Loop ID-2400. A reference identification is considered to be overridden if the value in REF01 is the same in both the Loop ID-2300 REF segment and the Loop ID-2400 REF segment. In that case, the Loop ID-2400 REF applies only to that specific line. Example REF 9F X Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Repriced Claim Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 9F Referral Number REF-02 127 Referral Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 354 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Repriced Claim Number To specify identifying information Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. Required when this information is deemed necessary by the repricer. The segment is not completed by providers. The information is completed by repricers only. If not required by this implementation guide, do not send. Example REF 9A XXXXXX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Service Authorization Exception Code Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 9A Repriced Claim Reference Number REF-02 127 Repriced Claim Reference Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 355 579 REF 1800 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop REF Service Authorization Exception Code To specify identifying information Usage notes Required when mandated by government law or regulation to obtain authorization for specific service(s) but, for the reasons listed in REF02, the service was performed without obtaining the authorization. If not required by this implementation guide, do not send. Example REF 4N XX Variants (all may be used) REF Adjusted Repriced Claim Number REF Auto Accident State REF Claim Identifier For Transmission Intermediaries REF Demonstration Project Identifier REF Investigational Device Exemption Number REF Medical Record Number REF Payer Claim Control Number REF Peer Review Organization (PRO) Approval Number REF Prior Authorization REF Referral Number REF Repriced Claim Number Max use 1 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 4N Special Payment Reference Number REF-02 127 Service Authorization Exception Code Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier Usage notes Allowable values for this element are: 1 Immediate Urgent Care 2 Services Rendered in a Retroactive Period 3 Emergency Care 4 Client has Temporary Medicaid 5 Request from County for Second Opinion to Determine if Recipient Can Work 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 356 579 6 Request for Override Pending 7 Special Handling 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 357 579 K3 1850 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop K3 File Information To transmit a fixed-format record or matrix contents Usage notes Required when ALL of the following conditions are met: A regulatory agency concludes it must use the K3 to meet an emergency legislative requirement; The administering regulatory agency | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_84 |
Level Loop Patient Hierarchical Level Loop Claim Information Loop K3 File Information To transmit a fixed-format record or matrix contents Usage notes Required when ALL of the following conditions are met: A regulatory agency concludes it must use the K3 to meet an emergency legislative requirement; The administering regulatory agency or other state organization has completed each one of the following steps: contacted the X12N workgroup, requested a review of the K3 data requirement to ensure there is not an existing method within the implementation guide to meet this requirement X12N determines that there is no method to meet the requirement. If not required by this implementation guide, do not send. At the time of publication of this implementation, K3 segments have no specific use. The K3 segment is expected to be used only when necessary to meet the unexpected data requirement of a legislative authority. Before this segment can be used: The X12N Health Care Claim workgroup must conclude there is no other available option in the implementation guide to meet the emergency legislative requirement. The requestor must submit a proposal for approval accompanied by the relevant business documentation to the X12N Health Care Claim workgroup chairs and receive approval for the request. Upon review of the request, X12N will issue an approval or denial decision to the requesting entity. Approved usage(s) of the K3 segment will be reviewed by the X12N Health Care Claim workgroup to develop a permanent change to include the business case in future transaction implementations. Only when all of the requirements above have been met, may the regulatory agency require the temporary use of the K3 segment. X12N will submit the necessary data maintenance and refer the request to the appropriate data content committee(s). Example K3 XX Max use 10 Optional K3-01 449 Fixed Format Information Min 1 Max 80 String (AN) Required Data in fixed format agreed upon by sender and receiver 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 358 579 NTE 1900 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop NTE Billing Note To transmit information in a free-form format, if necessary, for comment or special instruction Usage notes Required when in the judgment of the provider, the information is needed to substantiate the medical treatment and is not supported elsewhere within the claim data set. If not required by this implementation guide, do not send. Example NTE ADD XXXX Variants (all may be used) NTE Claim Note Max use 1 Optional NTE-01 363 Note Reference Code Identifier (ID) Required Code identifying the functional area or purpose for which the note applies ADD Additional Information NTE-02 352 Billing Note Text Min 1 Max 80 String (AN) Required A free-form description to clarify the related data elements and their content 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 359 579 NTE 1900 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop NTE Claim Note To transmit information in a free-form format, if necessary, for comment or special instruction Usage notes Required when in the judgment of the provider, the information is needed to substantiate the medical treatment and is not supported elsewhere within the claim data set. OR Required when in the judgment of the provider, narrative information from the forms "Home Health Certification and Plan of Treatment" or "Medical Update and Patient Information" is needed to substantiate home health services. If not required by this implementation guide, do not send. The developers of this implementation guide discourage using narrative information within the 837. Trading partners who use narrative information with claims are strongly encouraged to codify that information within the X12 environment.; Example NTE SPT XXXX Variants (all may be used) NTE Billing Note Max use 10 Optional NTE-01 363 Note Reference Code Identifier (ID) Required Code identifying the functional area or purpose for which the note applies ALG Allergies DCP Goals, Rehabilitation Potential, or Discharge Plans DGN Diagnosis Description DME Durable Medical Equipment (DME) and Supplies MED Medications NTR Nutritional Requirements ODT Orders for Disciplines and Treatments RHB Functional Limitations, Reason Homebound, or Both RLH Reasons Patient Leaves Home RNH Times and Reasons Patient Not at Home SET Unusual Home, Social Environment, or Both SFM Safety Measures SPT Supplementary Plan of Treatment UPI Updated Information NTE-02 352 Claim Note Text Min 1 Max 80 String (AN) Required A free-form description to clarify the related data elements and their content 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 360 579 CRC 2200 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop CRC EPSDT Referral To supply information on conditions Usage notes Required on Early Periodic Screening, Diagnosis, and Treatment (EPSDT) claims when the screening service is being billed in this claim. If not required by this implementation guide, do not send. Example CRC ZZ N S2 XXX XX Max use 1 Optional CRC-01 1136 Code Qualifier Identifier (ID) Required Specifies the situation or category to which the code applies CRC01 qualifies CRC03 through CRC07. ZZ Mutually Defined EPSDT Screening referral information. CRC-02 1073 Certification Condition Code Applies Indicator Identifier (ID) Required Code indicating a Yes or No condition or response CRC02 is a Certification Condition Code applies indicator. A "Y" value indicates the condition codes in CRC03 through CRC07 apply; an "N" value indicates the condition codes in CRC03 through CRC07 do not apply. Usage notes The response answers the question: Was an EPSDT referral given to the patient? N No If no, then choose "NU" in CRC03 indicating no referral given. Y Yes CRC-03 1321 Condition Indicator Identifier (ID) Required Code indicating a condition Usage notes The codes for CRC03 also can be used for CRC04 through CRC05. AV Available - Not Used Patient refused | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_85 |
to the patient? N No If no, then choose "NU" in CRC03 indicating no referral given. Y Yes CRC-03 1321 Condition Indicator Identifier (ID) Required Code indicating a condition Usage notes The codes for CRC03 also can be used for CRC04 through CRC05. AV Available - Not Used Patient refused referral. NU Not Used This conditioner indicator must be used when the submitter answers "N" in CRC02. S2 Under Treatment Patient is currently under treatment for referred diagnostic or corrective health problem. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 361 579 ST New Services Requested Patient is referred to another provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals). OR Patient is scheduled for another appointment with screening provider for diagnostic or corrective treatment for at least one health problem identified during an initial or periodic screening service (not including dental referrals).; CRC-04 1321 Condition Indicator Min 2 Max 3 Identifier (ID) Optional Code indicating a condition Usage notes Use the codes listed in CRC03. CRC-05 1321 Condition Indicator Min 2 Max 3 Identifier (ID) Optional Code indicating a condition Usage notes Use the codes listed in CRC03. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 362 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop HI Admitting Diagnosis To supply information related to the delivery of health care Usage notes Required when claim involves an inpatient admission. If not required by this implementation guide, do not send.; Do not transmit the decimal point for ICD codes. The decimal point is implied. Example HI BJ X Variants (all may be used) HI Condition Information HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 1 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABJ International Classification of Diseases Clinical Modification (ICD-10-CM) Admitting Diagnosis This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BJ International Classification of Diseases Clinical Modification (ICD-9-CM) Admitting Diagnosis C022-02 1271 Admitting Diagnosis Code Min 1 Max 30 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 363 579 Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 364 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop HI Condition Information To supply information related to the delivery of health care Usage notes Required when there is a Condition Code that applies to this claim. If not required by this implementation guide, do not send. Example HI BG X BG XXXXXX BG XXXX BG X BG XXX BG XXXX B G XXXX BG XXX BG XXXX BG XXXX BG X BG XXXXX Variants (all may be used) HI Admitting Diagnosis HI Diagnosis Related Group (DRG) Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 2 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-02 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 365 579 Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-03 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_86 |
C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-04 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 366 579 Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-05 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-06 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 367 579 Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-07 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-08 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-09 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 368 579 Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-10 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_87 |
codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-11 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 369 579 C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. HI-12 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional condition code and the preceding HI data elements have been used to report other condition codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 370 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop HI Diagnosis Related Group (DRG) Information To supply information related to the delivery of health care Usage notes Required when an inpatient hospital is under DRG contract with a payer and the contract requires the provider to identify the DRG to the payer. If not required by this implementation guide, do not send. Example HI DR X Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI External Cause of Injury HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 1 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. DR Diagnosis Related Group (DRG) C022-02 1271 Diagnosis Related Group (DRG) Code String (AN) Required Min 1 Max 30 Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 371 579 HI 2310 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop HI External Cause of Injury To supply information related to the delivery of health care Usage notes Required when an external Cause of Injury is needed to describe an injury, poisoning, or adverse effect. If not required by this implementation guide, do not send. Do not transmit the decimal point for ICD codes. The decimal point is implied. In order to fully describe an injury using ICD-10-CM, it will be necessary to report a series of 3 external cause of injury codes. Example HI ABN X N BN XXX Y BN XXXX N B N XX U ABN XX N ABN XXX Y ABN X X Y ABN X Y ABN XXXX N BN XX Y ABN XXX N BN XXX U Variants (all may be used) HI Admitting Diagnosis HI Condition Information HI Diagnosis Related Group (DRG) Information HI Occurrence Information HI Occurrence Span Information HI Other Diagnosis Information HI Other Procedure Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 1 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 372 579 OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_88 |
of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-02 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 373 579 BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-03 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 374 579 ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-04 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 375 579 This code set | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_89 |
C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 375 579 This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-05 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 376 579 If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-06 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 377 579 The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-07 C022 Health Care Code Information To send health care codes and their | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_90 |
would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-07 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 378 579 OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-08 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 379 579 BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-09 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 380 579 ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_91 |
Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-10 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 381 579 This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-11 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 382 579 If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR The Secretary grants an exception to use the code set as a pilot project as allowed under the law, OR For claims which are not covered under HIPAA. BN International Classification of Diseases Clinical Modification (ICD-9-CM) External Cause of Injury Code (E-codes) C022-02 1271 External Cause of Injury Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. C022-09 1073 Present on Admission Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response C022-09 is used to identify the diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospital or not. C022-09 would only need to be reported to data collectors requiring this information when C022-01 is "BF" (Diagnosis Code) and range of diagnosis codes were NOT given in C022-08. N No U Unknown W Not Applicable Y Yes HI-12 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Usage notes Required when an additional External Cause of Injury must be sent and the preceding HI data elements have been used to report other causes of injury. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABN International Classification of Diseases Clinical Modification (ICD-10-CM) External Cause of Injury Code This code set is not allowed for use under HIPAA at the time of this writing. The qualifier can only be used: If a new rule names the ICD-10-CM as an allowable code set under HIPAA, OR 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: | /kaggle/input/edi-db/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_92 |
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