837I Institutional Claim CSV Columns

Claim

NameDescriptionTypeEDI Element
idUnique payment identifier assigned by the converterString
transactionTypeTransaction set identifier codeStringST01
fileNameConverted X12 EDI file nameString
transactionControlNumberTransaction set control numberStringST02
transactionSetPurposeCodeTransaction set purpose codeStringBHT02
originatorApplicationTransactionIdOriginator application transaction idStringBHT03
transactionCreationDateTimeTransaction creation date timeDate and TimeBHT04, BHT05
claimOrEncounterIdentifierTypeClaim or encounter identifier typeStringBHT06
patientControlNumberPatient control numberStringCLM01
chargeAmountCharge amountNumberCLM02
facilityPlace of service code for professional/dental claims or UB facility code for institutional claims
View codes and descriptions
CodeCLM05-1
frequencyTypeCodeFrequency type code
View codes and descriptions
StringCLM05-3
assignmentParticipationCodeAssignment participation codeStringCLM07
assignmentCertificationIndicatorAssignment certification indicatorStringCLM08
releaseOfInformationCodeRelease of information codeStringCLM09
delayReasonCodeDelay reason codeStringCLM20
billingProviderBilling providerProviderNM1 *85
subscriberThe insured (subscriber)SubscriberNM1 *44
patientPatient if different from the the insured (subscriber)PatientNM1 *QC
statementDateFromStatement date fromDateDTP03 *434
statementDateToStatement date toDateDTP03 *434
dischargeTimeDischarge timeTimeDTP03 *096
admissionDateAndHourAdmission date and hourDate and TimeDTP03 *435
admissionTypeCodeAdmission type codeStringCL101
admissionSourceCodeAdmission source codeStringCL102
patientStatusCodePatient status codeString
Required
CL103
patientResponsibilityAmountPatient responsibility amountNumberAMT02 *F3
serviceAuthorizationExceptionCodeService authorization exception codeStringREF02 *4N
referralNumberReferral numberStringREF02 *9F
priorAuthorizationNumberPrior authorization numberStringREF02 *G1
payerClaimControlNumberPayer claim control numberStringREF02 *F8
clearinghouseTraceNumberClearinghouse trace numberStringREF02 *D9
repricedReferenceNumberRepriced reference numberStringREF02 *9A
adjustedRepricedReferenceNumberAdjusted repriced reference numberStringREF02 *9C
accidentStateAccident stateStringREF02 *LU
medicalRecordNumberMedical record numberStringREF02 *EA
demonstrationProjectIdentifierDemonstration project identifierStringREF02 *P4
noteFree-form comments or instructions. All note segments are concatenated together into this field.StringNTE02
billingNoteBilling noteStringNTE02 *ADD
principalDiagPrincipal diagnosisInstDiagnosisHI *ABK
admittingDiagAdmitting diagnosis
View codes and descriptions
CodeHI *ABJ
reasonForVisitDiagsReason for visit diags
View codes and descriptions
List of CodeHI *APR
externalCauseOfInjuryDiagsExternal cause of injury diags
View codes and descriptions
List of CodeHI *ABN
drgDrgCode
otherDiagsOther diagsList of InstDiagnosisHI *ABF
principalProcedurePrincipal procedure
View codes and descriptions
CodeAndDateHI *BBR, HI *CAH
otherProceduresOther procedures
View codes and descriptions
List of CodeAndDateHI *BBQ
occurrencesOccurrences
View codes and descriptions
List of CodeAndDateHI *BH
occurrenceSpansOccurrence spans
View codes and descriptions
List of CodeAndDateHI *BI
conditionsConditions
View codes and descriptions
List of CodeHI *BG
valueInfosValue infos
View codes and descriptions
List of CodeAndAmountHI *BE
attachmentsAttachmentsList of AttachmentPWK
attendingProviderAttending providerPartyNM1 *71
operatingPhysicianOperating physicianProviderNM1 *72
otherOperatingPhysicianOther operating physicianPartyNM1 *ZZ
referringProviderReferring providerPartyNM1 *DN
renderingProviderRendering providerProviderNM1 *82
serviceFacilityService facilityPartyNM1 *77
otherSubscribersOther subscribers and their payer's informationList of OtherSubscriberLoop: 2320
linesService linesList of InstLineCsvLoop: 2400

Service Line

Loop: 2400 Open API Schema
NameDescriptionTypeEDI Element
controlNumberControl numberStringREF02 *6R
revenueCodeRevenue code
View codes and descriptions
Code
Required
SV201
procedureProcedure
View codes and descriptions
ProcedureSV202 *HC, SV202 *AD, SV202 *WK, SV202 *IV
chargeAmountCharge amountNumber
Required
SV203
unitTypeUnit typeString
Required
SV204
unitCountUnit countNumber
Required
SV205
nonCoveredAmountNon covered amountNumberSV207
serviceDateFromService period start dateDateDTP03 *472, DTP03 *150
serviceDateToService period end date. If not provided in EDI (single day), it is set to 'serviceDateFrom'DateDTP03 *151
repricedReferenceNumberRepriced reference numberStringREF02 *9B
adjustedRepricedReferenceNumberAdjusted repriced reference numberStringREF02 *9D
serviceTaxAmountService tax amountNumberAMT02 *GT
facilityTaxAmountFacility tax amountNumberAMT02 *N8
thirdPartyNoteThird party noteStringNTE02
drugDrug
View codes and descriptions
CodeLIN03
drugQuantityDrug quantityNumberCTP04
drugUnitTypeDrug unit typeStringCTP05-1
prescriptionNumberPrescription numberStringREF02 *XZ
attachmentsAttachmentsList of AttachmentPWK
operatingPhysicianOperating physicianProviderNM1 *72
otherOperatingPhysicianOther operating physicianPartyNM1 *ZZ
renderingProviderRendering providerProviderNM1 *82
referringProviderReferring providerPartyNM1 *DN

Subscriber

NameDescriptionTypeEDI Element
payerResponsibilitySequencePayer responsibility sequenceString
Required
SBR01
relationshipTypeRelationship typeStringSBR02, PAT01
groupOrPolicyNumberGroup or policy numberStringSBR03
groupNameGroup nameStringSBR04
claimFilingIndicatorCodeClaim filing indicator codeStringSBR09
insurancePlanTypeInsurance plan typeStringSBR09
personPersonPersonWithDemographicNM1
deathDateDeath dateDatePAT06
weightPatient weight in poundsNumberPAT08
pregnancyIndicatorPregnancy indicatorStringPAT09
propertyCasualtyClaimNumberProperty casualty claim numberStringREF02 *Y4
payerPayerPartyNM1 *PR
Loop: 2330B

Patient

NameDescriptionTypeEDI Element
relationshipTypeRelationship typeStringSBR02, PAT01
personPersonPersonWithDemographicNM1
deathDateDeath dateDatePAT06
weightPatient weight in poundsNumberPAT08
pregnancyIndicatorPregnancy indicatorStringPAT09

Other Subscriber

NameDescriptionTypeEDI Element
payerResponsibilitySequencePayer responsibility sequenceString
Required
SBR01
relationshipTypeRelationship typeStringSBR02, PAT01
groupOrPolicyNumberGroup or policy numberStringSBR03
groupNameGroup nameStringSBR04
claimFilingIndicatorCodeClaim filing indicator codeStringSBR09
insurancePlanTypeInsurance plan typeStringSBR09
personPersonPersonWithDemographicNM1
adjustmentsClaim-level adjustments from this payerList of AdjustmentCAS
payerPaidAmountPayer paid amountNumberAMT02 *D
nonCoveredAmountNon covered amountNumberAMT02 *A8
remainingPatientLiabilityAmountRemaining patient liability amountNumberAMT02 *EAF
payerPriorAuthorizationNumberPayer prior authorization numberStringREF02 *G1
payerReferralNumberPayer referral numberStringREF02 *9F
payerClaimControlNumberPayer claim control numberStringREF02 *F8
payerPayerPartyNM1 *PR
Loop: 2330B
providersOther payer's providersList of PartyNM1

Organization Or Person ID and Name

NameDescriptionTypeEDI Element
entityRoleEntity role
View codes and descriptions
String
Required
NM101, N101
entityTypeType of this entity: 'BUSINESS' for organization, 'INDIVIDUAL' for personString
Required
NM102
identificationTypeIdentification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum)StringNM108, N103
identifierIdentifierStringNM109, N104
taxIdTax idStringREF02 *TJ, REF02 *SY, REF02 *EI
lastNameOrOrgNameOrganization name or person last nameStringNM103, N102
firstNameFirst nameStringNM104
middleNameMiddle nameStringNM105

Organization or Person (Party)

Extends: PartyIdName
NameDescriptionTypeEDI Element
addressAddressAddress
contactsContactsList of ContactInfo
additionalIdsOther identificationsList of ReferenceREF

Provider

Extends: Party
NameDescriptionTypeEDI Element
providerTaxonomyProvider's specialty information (taxonomy). Populated only for billing, rendering, operating providers.
View codes and descriptions
CodePRV

Person with Demographic Info

Extends: Party
NameDescriptionTypeEDI Element
birthDateBirth dateDateDMG02
genderGenderStringDMG03

Address

NameDescriptionTypeEDI Element
lineLineStringN301
line2Line2StringN302
cityCityStringN401
stateCodeState codeStringN402
zipCodeZip codeStringN403
countryCodeCountry codeStringN404

Contact Info

Segment: PER Open API Schema
NameDescriptionTypeEDI Element
functionCodeFunction codeString
Required
PER01
nameNameStringPER02
contactNumbersContact numbersList of ContactNumber

Contact Number

Segment: PER Open API Schema
NameDescriptionTypeEDI Element
typeType of contact number, such as PHONE, EMAIL, URLString
Required
PER03,PER05,PER07
numberNumberString
Required
PER04,PER06,PER08

Diagnosis

Extends: Code
NameDescriptionTypeEDI Element
presentOnAdmissionIndicatorPresent on admission indicatorStringHI01-9

Procedure

Procedure code with description and optional modifiers
Segment: HI,SV1,SV2,SV3,SVC Open API Schema
Extends: Code
NameDescriptionTypeEDI Element
modifiersModifiersList of Code837P:SV101-3-6, 837I:SV201-3-6, 835:SVC01-3-6, 277:SVC01-3-6

Code with Date

The date is provided for procedures at a claim level and for occurrence codes.

Extends: Code
NameDescriptionTypeEDI Element
occurrenceDateOccurrence dateDateHI01-4

Code

Code and description
NameDescriptionTypeEDI Element
subTypeHealthcare code subtype, such as CPT, HCPCS, ICD_10, NDCString
codeHealthcare codeString
Required
descCode description String

Attachment

Segment: PWK Open API Schema
NameDescriptionTypeEDI Element
reportTypeCodeReport type codeString
Required
PWK01
reportTransmissionCodeReport transmission codeString
Required
PWK02
controlNumberControl numberStringPWK06

Reference Identifications

Segment: REF Open API Schema
NameDescriptionTypeEDI Element
qualifierCodeCode qualifying the reference identificationString
Required
REF01
typeType of reference; qualifier code as a string constant (enum)
View codes and descriptions
StringREF01
identificationReference identificationString
Required
REF02