837I Institutional Health Insurance Claim Example

“Institutional” (837I) EDI transactions are used by hospitals. Key segments include billing provider and patient/subscriber info, diagnosis codes, provided services and charges, admission and discharge information. Institutional claims typically use special codes and code sets to describe charges and services, such as revenue and “type of bill” codes, occurrence codes and others.

Below is an example of an institutional claim provided by X12. The example was updated to use ICD-10 codes.

It shows a claim submitted by “Jones Hospital” for services provided in September 2016 to John Doe. The hospital provided outpatient lab services.