837P Professional Claim CSV Columns

Claim

Loop: 2300, Segment: CLM CSV Example Interactive Example Open API Schema

Name	Description	Type	EDI Element
id	Unique payment identifier assigned by the converter	String
transactionType	Transaction set identifier code	String	ST01
fileName	Converted X12 EDI file name	String
transactionControlNumber	Transaction set control number	String	ST02
transactionSetPurposeCode	Transaction set purpose code	String	BHT02
originatorApplicationTransactionId	Originator application transaction id	String	BHT03
transactionCreationDateTime	Transaction creation date time	Date and Time	BHT04, BHT05
claimOrEncounterIdentifierType	Claim or encounter identifier type	String	BHT06
patientControlNumber	Patient control number	String	CLM01
chargeAmount	Charge amount	Number	CLM02
placeOfService	Place of service as a string constant (enum)	String	CLM05
facility	Place of service code for professional/dental claims or UB facility code for institutional claims View codes and descriptions	Code	CLM05-1
frequencyTypeCode	Frequency type code View codes and descriptions	String	CLM05-3
providerSignatureIndicator	Provider signature indicator	String	CLM06
assignmentParticipationCode	Assignment participation code	String	CLM07
assignmentCertificationIndicator	Assignment certification indicator	String	CLM08
releaseOfInformationCode	Release of information code	String	CLM09
delayReasonCode	Delay reason code	String	CLM20
billingProvider	Billing provider	Provider	NM1 *85
subscriber	The insured (subscriber)	Subscriber	NM1 *44
patient	Patient if different from the the insured (subscriber)	Patient	NM1 *QC
serviceDateFrom	The earliest service date from service lines	Date
serviceDateTo	The latest service date from service lines	Date
onsetOfCurrentIllnessOrInjuryDate	Onset of current illness or injury date	Date	DTP03 *431
initialTreatmentDate	Initial treatment date	Date	DTP03 *454
lastSeenDate	Last seen date	Date	DTP03 *304
acuteManifestationDate	Acute manifestation date	Date	DTP03 *453
accidentDate	Accident date	Date	DTP03 *439
lastMenstrualPeriodDate	Last menstrual period date	Date	DTP03 *484
lastXRayDate	Last xray date	Date	DTP03 *455
prescriptionDate	Hearing and vision prescription date	Date	DTP03 *471
assumedCareDate	Assumed care date	Date	DTP03 *090
relinquishedCareDate	Relinquished care date	Date	DTP03 *091
admissionDate	Admission date for ambulance claims	Date	DTP03 *435
dischargeDate	Discharge date	Date	DTP03 *096
patientPaidAmount	Patient paid amount	Number	AMT02 *F5
serviceAuthorizationExceptionCode	Service authorization exception code	String	REF02 *4N
referralNumber	Referral number	String	REF02 *9F
priorAuthorizationNumber	Prior authorization number	String	REF02 *G1
payerClaimControlNumber	Payer claim control number	String	REF02 *F8
clearinghouseTraceNumber	Clearinghouse trace number	String	REF02 *D9
repricedReferenceNumber	Repriced reference number	String	REF02 *9A
adjustedRepricedReferenceNumber	Adjusted repriced reference number	String	REF02 *9C
medicalRecordNumber	Medical record number	String	REF02 *EA
demonstrationProjectIdentifier	Demonstration project identifier	String	REF02 *P4
note	Free-form comments or instructions. All note segments are concatenated together into this field.	String	NTE02
diags	Diags View codes and descriptions	List of Code	HI ABK, HI ABF
anesthesiaProcedure	Anesthesia procedure View codes and descriptions	Code	HI *BP
conditions	Conditions View codes and descriptions	List of Code	HI *BG
attachments	Attachments	List of Attachment	PWK
referringProvider	Referring provider	Party	NM1 *DN
renderingProvider	Rendering provider	Provider	NM1 *82
serviceFacility	Service facility	Party	NM1 *77
supervisingProvider	Supervising provider	Party	NM1 *DQ
ambulancePickUp	Ambulance pick up	Party	NM1 *PW
ambulanceDropOff	Ambulance drop off	Party	NM1 *45
otherSubscribers	Other subscribers and their payer's information	List of OtherSubscriber	Loop: 2320
lines	Service lines	List of ProfLineCsv	Loop: 2400

Service Line

Loop: 2400 Open API Schema

Name	Description	Type	EDI Element
controlNumber	Control number	String	REF02 *6R
procedure	Procedure View codes and descriptions	Procedure	SV101 HC, SV101 AD, SV101 WK, SV101 IV
chargeAmount	Charge amount	Number Required	SV102
unitType	Unit type	String Required	SV103
unitCount	Unit count	Number Required	SV104
placeOfService	Place of service	String	SV105
placeOfServiceCode	Place of service code	String	SV105
diagPointers	Diag pointers	List of Integer Required	SV107
emergencyIndicator	Emergency indicator	String	SV109
epsdtIndicator	Epsdt indicator	String	SV111
familyPlanningIndicator	Family planning indicator	String	SV112
copayStatusCode	Copay status code	String	SV115
serviceDateFrom	Service period start date	Date	DTP03 472, DTP03 150
serviceDateTo	Service period end date. If not provided in EDI (single day), it is set to 'serviceDateFrom'	Date	DTP03 *151
prescriptionDate	Prescription date	Date	DTP03 *471
beginTherapyDate	Begin therapy date	Date	DTP03 *463
lastSeenDate	Last seen date	Date	DTP03 *304
testPerformedDate	Test performed date	Date	DTP03 738, DTP03 739
lastXRayDate	Last xray date	Date	DTP03 *455
initialTreatmentDate	Initial treatment date	Date	DTP03 *454
priorAuthorization	Prior authorization	String	REF02 *G1
referralNumber	Referral number	String	REF02 *9F
repricedReferenceNumber	Repriced reference number	String	REF02 *9B
adjustedRepricedReferenceNumber	Adjusted repriced reference number	String	REF02 *9D
note	Note	String	NTE02 ADD, NTE02 DCP
thirdPartyNote	Third party note	String	NTE02
drug	Drug View codes and descriptions	Code	LIN03
drugQuantity	Drug quantity	Number	CTP04
drugUnitType	Drug unit type	String	CTP05-1
prescriptionNumber	Prescription number	String	REF02 *XZ
attachments	Attachments	List of Attachment	PWK
renderingProvider	Rendering provider	Provider	NM1 *82
purchasedServiceProvider	Purchased service provider	Party	NM1 *QB
serviceFacility	Service facility	Party	NM1 *77
supervisingProvider	Supervising provider	Party	NM1 *DQ
referringProvider	Referring provider	Party	NM1 *DN
orderingProvider	Ordering provider	Party	NM1 *DK
ambulancePickUp	Ambulance pick up	Party	NM1 *PW
ambulanceDropOff	Ambulance drop off	Party	NM1 *45

Subscriber

Open API Schema

Name	Description	Type	EDI Element
payerResponsibilitySequence	Payer responsibility sequence	String Required	SBR01
relationshipType	Relationship type	String	SBR02, PAT01
groupOrPolicyNumber	Group or policy number	String	SBR03
groupName	Group name	String	SBR04
claimFilingIndicatorCode	Claim filing indicator code	String	SBR09
insurancePlanType	Insurance plan type	String	SBR09
person	Person	PersonWithDemographic	NM1
deathDate	Death date	Date	PAT06
weight	Patient weight in pounds	Number	PAT08
pregnancyIndicator	Pregnancy indicator	String	PAT09
propertyCasualtyClaimNumber	Property casualty claim number	String	REF02 *Y4
payer	Payer	Party	NM1 *PR Loop: 2330B

Patient

Open API Schema

Name	Description	Type	EDI Element
relationshipType	Relationship type	String	SBR02, PAT01
person	Person	PersonWithDemographic	NM1
deathDate	Death date	Date	PAT06
weight	Patient weight in pounds	Number	PAT08
pregnancyIndicator	Pregnancy indicator	String	PAT09

Other Subscriber

Open API Schema

Name	Description	Type	EDI Element
payerResponsibilitySequence	Payer responsibility sequence	String Required	SBR01
relationshipType	Relationship type	String	SBR02, PAT01
groupOrPolicyNumber	Group or policy number	String	SBR03
groupName	Group name	String	SBR04
claimFilingIndicatorCode	Claim filing indicator code	String	SBR09
insurancePlanType	Insurance plan type	String	SBR09
person	Person	PersonWithDemographic	NM1
adjustments	Claim-level adjustments from this payer	List of Adjustment	CAS
payerPaidAmount	Payer paid amount	Number	AMT02 *D
nonCoveredAmount	Non covered amount	Number	AMT02 *A8
remainingPatientLiabilityAmount	Remaining patient liability amount	Number	AMT02 *EAF
payerPriorAuthorizationNumber	Payer prior authorization number	String	REF02 *G1
payerReferralNumber	Payer referral number	String	REF02 *9F
payerClaimControlNumber	Payer claim control number	String	REF02 *F8
payer	Payer	Party	NM1 *PR Loop: 2330B
providers	Other payer's providers	List of Party	NM1

Organization Or Person ID and Name

Open API Schema

Name	Description	Type	EDI Element
entityRole	Entity role View codes and descriptions	String Required	NM101, N101
entityType	Type of this entity: 'BUSINESS' for organization, 'INDIVIDUAL' for person	String Required	NM102
identificationType	Identification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum)	String	NM108, N103
identifier	Identifier	String	NM109, N104
taxId	Tax id	String	REF02 TJ, REF02 SY, REF02 *EI
lastNameOrOrgName	Organization name or person last name	String	NM103, N102
firstName	First name	String	NM104
middleName	Middle name	String	NM105

Organization or Person (Party)

Open API Schema

Extends: PartyIdName

Name	Description	Type	EDI Element
address	Address	Address
contacts	Contacts	List of ContactInfo
additionalIds	Other identifications	List of Reference	REF

Provider

Open API Schema

Extends: Party

Name	Description	Type	EDI Element
providerTaxonomy	Provider's specialty information (taxonomy). Populated only for billing, rendering, operating providers. View codes and descriptions	Code	PRV

Person with Demographic Info

Open API Schema

Extends: Party

Name	Description	Type	EDI Element
birthDate	Birth date	Date	DMG02
gender	Gender	String	DMG03

Contact Info

Segment: PER Open API Schema

Name	Description	Type	EDI Element
functionCode	Function code	String Required	PER01
name	Name	String	PER02
contactNumbers	Contact numbers	List of ContactNumber

Contact Number

Segment: PER Open API Schema

Name	Description	Type	EDI Element
type	Type of contact number, such as PHONE, EMAIL, URL	String Required	PER03,PER05,PER07
number	Number	String Required	PER04,PER06,PER08

Address

Open API Schema

Name	Description	Type	EDI Element
line	Line	String	N301
line2	Line2	String	N302
city	City	String	N401
stateCode	State code	String	N402
zipCode	Zip code	String	N403
countryCode	Country code	String	N404

Procedure

Procedure code with description and optional modifiers

Segment: HI,SV1,SV2,SV3,SVC Open API Schema

Extends: Code

Name	Description	Type	EDI Element
modifiers	Modifiers	List of Code	837P:SV101-3-6, 837I:SV201-3-6, 835:SVC01-3-6, 277:SVC01-3-6

Code

Code and description

Open API Schema

Name	Description	Type
subType	Healthcare code subtype, such as CPT, HCPCS, ICD_10, NDC	String
code	Healthcare code	String Required
desc	Code description	String

Attachment

Segment: PWK Open API Schema

Name	Description	Type	EDI Element
reportTypeCode	Report type code	String Required	PWK01
reportTransmissionCode	Report transmission code	String Required	PWK02
controlNumber	Control number	String	PWK06

Reference Identifications

Segment: REF Open API Schema

Name	Description	Type	EDI Element
qualifierCode	Code qualifying the reference identification	String Required	REF01
type	Type of reference; qualifier code as a string constant (enum) View codes and descriptions	String	REF01
identification	Reference identification	String Required	REF02