JSON Schema for 837P (Professional Claim)

Unique payment identifier assigned by the converter

Type of this object, set to 'CLAIM'

Identifier used to track a claim from creation by the health care provider through payment

Charge amount

Patient paid amount

Place of service code (professional/dental) or UB facility code (institutional) from the original claim

View codes and descriptions

Frequency code

View codes and descriptions

The earliest service date from service lines

The latest service date from service lines

The insured (subscriber)

Patient if different from the the insured (subscriber)

Other subscribers and their payer's information

Service lines

Parent EDI transaction for this object

Provider signature indicator

Assignment participation code

Assignment certification indicator

Release of information code

Patient signature source code

Related cause

Special program code

Delay reason code

Service authorization exception code

Referral number

Prior authorization number

Original reference number

Repriced reference number

Adjusted repriced reference number

Clearinghouse trace number

Medical record number

Demonstration project identifier

Onset of current illness or injury date

Initial treatment date

Last seen date

Acute manifestation date

Accident date

Last menstrual period date

Last xray date

Hearing and vision prescription date

Disability date from

Disability date to

Last worked date

Authorized return to work date

Admission date for ambulance claims

Discharge date

Assumed care date

Relinquished care date

Property casualty first contact date

Repricer received date

Fixed format records

Free-form comments or instructions. All note segments are concatenated together into this field

Billing provider

Pay to address

Pay-to plan for subrogation claims

Providers for this claim, except for the billing provider

Diagnosis codes

View codes and descriptions

Anesthesia-related procedures

View codes and descriptions

Conditions

View codes and descriptions

Attachments

Contract info

Ambulance transport info

Spinal manipulation info

Conditions indicators

Line item control number

Place of service code

Emergency indicator

Epsdt indicator

Family planning indicator

Copay status code

Repriced reference number

Adjusted repriced reference number

Prior authorization

Referral number

Charge amount

Sales tax amount

Purchased service provider identifier

Since: v2.14.9

Purchased service charge amount

Since: v2.14.9

Service date from

Service date to

Prescription date

Last certification date

Certification revision date

Begin therapy date

Last seen date

Test performed date

Last xray date

Initial treatment date

Unit type

Unit count

Ambulance patient count

Drug code (NDC)

View codes and descriptions

Drug quantity

Drug unit type

Prescription number

Line note

Third party note

Procedure

View codes and descriptions

Dme service

Since: v2.14.9

Attachments

Contract info

Ambulance transport info

Dme certification

Conditions indicators

Measurements

Since: v2.14.9

Providers for this service line

Adjudications

Copy of line adjustments from the adjudication list for backward compatibility

Fixed format records

Forms

Since: v2.14.9

Diagnosis pointers. Each pointer is an index of the diagnosis in the 'diags' array at the claim level.

Copy of diagnosis codes from the claim based on diagnosis pointers

View codes and descriptions

Payer responsibility sequence

Values:

EIGHT(E), ELEVEN(H), FIVE(B), FOUR(A), NINE(F), PRIMARY(P), SECONDARY(S), SEVEN(D), SIX(C), TEN(G), TERTIARY(T), UNCONFIRMED(N), UNKNOWN(U)

Relationship type

Values:

CADAVER_DONOR(40), CHILD(19), EMPLOYEE(20), LIFE_PARTNER(53), ORGAN_DONOR(39), OTHER(G8), SELF(18), SPOUSE(1), UNKNOWN(21)

Group or policy number

Group name

Claim filing indicator code

Insurance plan type

Values:

AUTOMOBILE_MEDICAL(AM), BCBS(BL), CHAMPUS(CH), COMMERCIAL(CI), EPO(14), FEDERAL_EMPLOYEE_PROGRAM(FI), HMO(HM), HMO_MEDICARE(16), INDEMNITY_INSURANCE(15), MEDICAID(MC), MEDICARE_A(MA), MEDICARE_B(MB), MUTUALLY_DEFINED(ZZ), OTHER_FEDERAL(OF), OTHER_NON_FEDERAL(11), POS(13), PPO(12), VETERAN_AFFAIRS(VA), WORKERS_COMPENSATION(WC)

Person

Death date

Patient weight in pounds

Pregnancy indicator

Property casualty claim number

Payer

Relationship type

Values:

CADAVER_DONOR(40), CHILD(19), EMPLOYEE(20), LIFE_PARTNER(53), ORGAN_DONOR(39), OTHER(G8), SELF(18), SPOUSE(1), UNKNOWN(21)

Person

Death date

Patient weight in pounds

Pregnancy indicator

Payer responsibility sequence

Values:

EIGHT(E), ELEVEN(H), FIVE(B), FOUR(A), NINE(F), PRIMARY(P), SECONDARY(S), SEVEN(D), SIX(C), TEN(G), TERTIARY(T), UNCONFIRMED(N), UNKNOWN(U)

Relationship type

Values:

CADAVER_DONOR(40), CHILD(19), EMPLOYEE(20), LIFE_PARTNER(53), ORGAN_DONOR(39), OTHER(G8), SELF(18), SPOUSE(1), UNKNOWN(21)

Group or policy number

Group name

Coordination of benefits code, post-adjudicated claims only

Claim filing indicator code

Insurance plan type

Values:

AUTOMOBILE_MEDICAL(AM), BCBS(BL), CHAMPUS(CH), COMMERCIAL(CI), EPO(14), FEDERAL_EMPLOYEE_PROGRAM(FI), HMO(HM), HMO_MEDICARE(16), INDEMNITY_INSURANCE(15), MEDICAID(MC), MEDICARE_A(MA), MEDICARE_B(MB), MUTUALLY_DEFINED(ZZ), OTHER_FEDERAL(OF), OTHER_NON_FEDERAL(11), POS(13), PPO(12), VETERAN_AFFAIRS(VA), WORKERS_COMPENSATION(WC)

Person

Claim-level adjustments from this payer

Payer paid amount

Non covered amount

Remaining patient liability amount

Outpatient adjudication

Payer prior authorization number

Payer referral number

Payer claim control number

Payer

Patient's information; post-adjudicated claims only

Other payer's providers

Reimbursement rate

Claim HCPCS Payable Amount

Esrd payment amount

Nonpayable Professional Component Amount

Remark codes

View codes and descriptions

Entity role

View codes and descriptions

Type of this entity: 'BUSINESS' for organization, 'INDIVIDUAL' for person

Values:

BUSINESS(2), INDIVIDUAL(1)

Identification type, e.g., NPI or EIN. This is a qualifier code translated to a string constant (enum)

View codes and descriptions

Identifier

Tax id

Organization name or person last name

First name

Middle name

Address

Contacts

Other identifications

Provider's specialty information (taxonomy). Populated only for billing, rendering, operating providers.

View codes and descriptions

Birth date

Gender

Values:

FEMALE(F), MALE(M), UNKNOWN(U)

Line

Line2

City

State code

Zip code

Country code

Function code

Name

Contact numbers

Type of contact number

Values:

ALTERNATE_PHONE, BEEPER, CELL_PHONE, EMAIL, EXTENSION, FAX, HOME_PHONE, PHONE, UNKNOWN, URL, WORK_PHONE

Number

Related cause code

Related cause code2

State code

Country code

Payer identifier

Paid amount

Unit count

Bundled or unbundled line number

Procedure

View codes and descriptions

Line adjustments

Adjudication or payment date

Remaining patient liability amount

Claim adjustment group code as a string constant

Values:

CONTRACTUAL(CO), CORRECTION(CR), OTHER(OA), PATIENT_RESPONSIBILITY(PR), PAYOR_INITIATED(PI)

Claim adjustment reason code

View codes and descriptions

Adjustment amount

Adjustment quantity

Report type code

Report transmission code

Control number

Contract type code

Amount

Percentage

Contract code

Term discount percentage

Version identifier

Patient weight

Reason code

Ambulance transport reason code as a string constant

Values:

FAMILY_MEMBER(C), NEAREST_FACILITY(A), PHYSICIAN(B), REHAB(E), RESIDENTIAL_FACILITY(618), SPECIALIST(D)

Transport distance

Round trip purpose description

Stretcher purpose description

Certification type code

Unit of measurement for the length of time for DME equipment

Length of time DME equipment is needed

Unit of measurement for the length of medical treatment

Length of medical treatment required

Rental price

Purchase price

Frequency at which the rental equipment is billed

Values:

1, 4, 6

Frequency at which the rental equipment is billed, expressed as enum (string constant)

Values:

DAILY(6), MONTHLY(4), WEEKLY(1)

Condition code

Description of the patient’s condition

Additional description of the patient’s condition

Category code

Category code as constant (enum)

Values:

AMBULANCE_CERTIFICATION(07), DME_CERTIFICATION(09), EPSDT_MUTUALLY_DEFINED(ZZ), FUNCTIONAL_LIMITATIONS(75), HOSPICE(75), VISION_CONTACT_LENSES(E2), VISION_SPECTACLE_FRAMES(E3), VISION_SPECTACLE_LENSES(E1)

Yes or no condition

Values:

Y, N

Condition codes

Code identifying the broad category to which a measurement applies

Values:

OG, TR

Code identifying a specific product or process characteristic to which a measurement applies

Code identifying a specific product or process characteristic to which a measurement applies, expressed as enum (string constant)

Values:

CREATININE(R4), EPOETIN(R3), HEIGHT(HT), HEMATOCRIT(R2), HEMOGLOBIN(R1)

The value of the measurement

Form type

Values:

AS, UT

Specific form number

Responses

Question identifier

Yes or no response

Values:

Y, N, W

Text response

Date response

Number response

Modifiers

Healthcare code subtype, such as CPT, HCPCS, ICD_10, NDC

Healthcare code

Code description

Control number

Transaction type translated to string constant, PROF for 837P, INST for 837I, etc.

Hierarchical structure code

Purpose code

Originator application transaction id

Creation date

Creation time

Claim or encounter identifier type

Transaction set identifier code

Implementation convention reference

File info

Submitter or sender of this transaction

Receiver of this transaction

File name

URL of the file, including the full path

Last modified date and time of the file