Appendix E - Data Element Glossary

Data Element Name Index

This section contains an alphabetic listing of data elements used in this implementation guide. Consult the X12N Data Element Dictionary for a complete list of all X12N Data Elements. Data element names in normal type are generic ASC X12 names. Italic type indicates a health care industry defined name.

Legend

Industry Name
Industry name definition.
800 - Transaction Set ID and Name
H=Header, D=Detail, S=Summary | Loop ID | Reference Designator | Composite ID-Position in Composite | X12 Data Element Number
 
Accident Date
Date of the accident related to charges or to the patient's current condition, diagnosis, or treatment referenced in the transaction.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
 
Additional Drug Coverage Code
Code indicating whether or not the patient has other insurance coverage.
837 - Health Care Claim Professional
D | 2410 | SV420 | - | 1735
 
Adjusted Repriced Claim Reference Number
Identification number, assigned by a repricing organization, to identify an adjusted claim.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
 
Adjusted Repriced Line Item Reference Number
Identification number of an adjusted repriced line item adjusted from an original amount.
837 - Health Care Claim Professional
D | 2400 | REF02 | - | 127
 
Adjustment Amount
Adjustment amount for the associated reason code.
837 - Health Care Claim Professional
D | 2320 | RAS01 | - | 782
D | 2430 | RAS01 | - | 782
 
Adjustment Quantity
Numeric quantity associated with the related reason code for coordination of benefits.
837 - Health Care Claim Professional
D | 2430 | RAS04 | - | 380
 
Adjustment Reason Code
Code that indicates the reason for the adjustment.
837 - Health Care Claim Professional
D | 2320 | RAS03 | C058-01 | 1034
D | 2430 | RAS03 | C058-01 | 1034
 
Ambulance Drop-off Address Line
Address line of the ambulance transport drop-off location.
837 - Health Care Claim Professional
D | 2310F | N301 | - | 166
D | 2310F | N302 | - | 166
D | 2420H | N301 | - | 166
D | 2420H | N302 | - | 166
 
Ambulance Drop-off City Name
City name of the ambulance transport drop-off location.
837 - Health Care Claim Professional
D | 2310F | N401 | - | 19
D | 2420H | N401 | - | 19
 
Ambulance Drop-off Country Code
Country code of the ambulance transport drop-off location.
837 - Health Care Claim Professional
D | 2310F | N404 | - | 26
D | 2420H | N404 | - | 26
 
Ambulance Drop-off Country Subdivision Code
Country subdivision code of the ambulance transport drop-off location.
837 - Health Care Claim Professional
D | 2310F | N407 | - | 1715
D | 2420H | N407 | - | 1715
 
Ambulance Drop-off Location
Name of the ambulance transport drop-off location.
837 - Health Care Claim Professional
D | 2310F | NM103 | - | 1035
D | 2420H | NM103 | - | 1035
 
Ambulance Drop-off Postal Zone or ZIP Code
Postal zone code or ZIP code of the ambulance transport drop-off location.
837 - Health Care Claim Professional
D | 2310F | N403 | - | 116
D | 2420H | N403 | - | 116
 
Ambulance Drop-off State or Province Code
State or province of the ambulance transport drop-off location.
837 - Health Care Claim Professional
D | 2310F | N402 | - | 156
D | 2420H | N402 | - | 156
 
Ambulance Patient Count
Number of patients in ambulance transport.
837 - Health Care Claim Professional
D | 2400 | QTY02 | - | 380
 
Ambulance Pick-up Address Line
Address line of the ambulance transport pick-up location.
837 - Health Care Claim Professional
D | 2310E | N301 | - | 166
D | 2310E | N302 | - | 166
D | 2420G | N301 | - | 166
D | 2420G | N302 | - | 166
 
Ambulance Pick-up City Name
City name of the ambulance transport pick-up location.
837 - Health Care Claim Professional
D | 2310E | N401 | - | 19
D | 2420G | N401 | - | 19
 
Ambulance Pick-up Country Code
Country code of the ambulance transport pick-up location.
837 - Health Care Claim Professional
D | 2310E | N404 | - | 26
D | 2420G | N404 | - | 26
 
Ambulance Pick-up Country Subdivision Code
Country subdivision code of the ambulance transport pick-up location.
837 - Health Care Claim Professional
D | 2310E | N407 | - | 1715
D | 2420G | N407 | - | 1715
 
Ambulance Pick-up Postal Zone or ZIP Code
Postal zone code or ZIP code of the ambulance transport pick-up location.
837 - Health Care Claim Professional
D | 2310E | N403 | - | 116
D | 2420G | N403 | - | 116
 
Ambulance Pick-up State or Province Code
State or province of the ambulance transport pick-up location.
837 - Health Care Claim Professional
D | 2310E | N402 | - | 156
D | 2420G | N402 | - | 156
 
Ambulance Transport Reason Code
Code indicating the reason for ambulance transport.
837 - Health Care Claim Professional
D | 2300 | CR104 | - | 1317
D | 2400 | CR104 | - | 1317
 
Amount Qualifier Code
Code to qualify amount.
837 - Health Care Claim Professional
D | 2300 | AMT01 | - | 522
D | 2320 | AMT01 | - | 522
D | 2320 | AMT01 | - | 522
D | 2320 | AMT01 | - | 522
D | 2320 | AMT01 | - | 522
D | 2400 | AMT01 | - | 522
D | 2400 | AMT01 | - | 522
D | 2400 | AMT01 | - | 522
D | 2400 | AMT01 | - | 522
D | 2430 | AMT01 | - | 522
D | 2430 | AMT01 | - | 522
 
Anesthesia Related Surgical Procedure
Code identifying the surgical procedure performed during this anesthesia session.
837 - Health Care Claim Professional
D | 2300 | HI01 | C022-02 | 1271
 
Assigned Number
Number assigned for differentiation within a transaction set.
837 - Health Care Claim Professional
D | 2400 | LX01 | - | 554
 
Assumed Care Date
Date post-operative care was assumed by another provider.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
 
Attachment Control Number
Identification number of attachment related to the claim.
837 - Health Care Claim Professional
D | 2300 | PWK06 | - | 67
D | 2400 | PWK06 | - | 67
 
Attachment Report Type Code
Code to specify the type of attachment that is related to the claim.
837 - Health Care Claim Professional
D | 2300 | PWK01 | - | 755
D | 2400 | PWK01 | - | 755
D | 2400 | PWK01 | - | 755
 
Attachment Transmission Code
Code defining timing, transmission method or format by which an attachment report is to be sent or has been sent.
837 - Health Care Claim Professional
D | 2300 | PWK02 | - | 756
D | 2400 | PWK02 | - | 756
D | 2400 | PWK02 | - | 756
 
Auto Accident State or Province Code
State or Province where auto accident occurred.
837 - Health Care Claim Professional
D | 2300 | CLM11 | C024-04 | 156
 
Basis of Cost Determination Code
Code indicating the method by which the ingredient cost was calculated.
837 - Health Care Claim Professional
D | 2410 | SV412 | - | 1319
 
Begin Therapy Date
Date therapy begins.
837 - Health Care Claim Professional
D | 2400 | DTP03 | - | 1251
 
Benefits Assignment Certification Indicator
A code showing whether the provider has a signed form authorizing the third party payer to pay the provider.
837 - Health Care Claim Professional
D | 2300 | CLM08 | - | 1073
D | 2320 | OI03 | - | 1073
 
Billing Provider Address Line
Address line of the billing provider or billing entity address.
837 - Health Care Claim Professional
D | 2010AA | N301 | - | 166
D | 2010AA | N302 | - | 166
 
Billing Provider City Name
City of the billing provider or billing entity
837 - Health Care Claim Professional
D | 2010AA | N401 | - | 19
 
Billing Provider Contact Name
Person at billing organization to contact regarding the billing transaction.
837 - Health Care Claim Professional
D | 2010AA | PER02 | - | 93
 
Billing Provider Country Code
Country code for the provider or billing entity billing for services.
837 - Health Care Claim Professional
D | 2010AA | N404 | - | 26
 
Billing Provider Country Subdivision Code
Country subdivision code for the provider or billing entity billing for services.
837 - Health Care Claim Professional
D | 2010AA | N407 | - | 1715
 
Billing Provider First Name
First name of the billing provider or billing entity
837 - Health Care Claim Professional
D | 2010AA | NM104 | - | 1036
 
Billing Provider Identifier
Identification number for the provider or organization in whose name the bill is submitted and to whom payment should be made.
837 - Health Care Claim Professional
D | 2010AA | NM109 | - | 67
 
Billing Provider Last or Organizational Name
Last name or organization name of the provider billing or billing entity for services.
837 - Health Care Claim Professional
D | 2010AA | NM103 | - | 1035
 
Billing Provider Middle Name or Initial
The middle name or initial of the provider billing for services.
837 - Health Care Claim Professional
D | 2010AA | NM105 | - | 1037
 
Billing Provider Name Suffix
Suffix, including generation, for the name of the provider or billing entity submitting the claim.
837 - Health Care Claim Professional
D | 2010AA | NM107 | - | 1039
 
Billing Provider Postal Zone or ZIP Code
Postal zone code or ZIP code for the provider or billing entity billing for services.
837 - Health Care Claim Professional
D | 2010AA | N403 | - | 116
 
Billing Provider Secondary Identifier
Secondary identification number for the provider or organization in whose name the bill is submitted and to whom payment should be made.
837 - Health Care Claim Professional
D | 2010BB | REF02 | - | 127
 
Billing Provider State or Province Code
State or province for provider or billing entity billing for services.
837 - Health Care Claim Professional
D | 2010AA | N402 | - | 156
 
Billing Provider Tax Identification Number
Tax identification number for the provider or organization in whose name the bill is submitted and to whom payment should be made.
837 - Health Care Claim Professional
D | 2010AA | REF02 | - | 127
 
Bundled Line Number
Identification of line item bundled by payer in payment of benefits.
837 - Health Care Claim Professional
D | 2430 | SVD06 | - | 554
 
Care Plan Oversight Number
Medicare provider number of the home health agency or hospice providing Medicare covered services to the patient for the period during which CPO services were furnished and for which the physician signed the plan of care.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
 
Certification Condition Code Applies Indicator
Code indicating whether or not the condition codes apply to the patient or another entity.
837 - Health Care Claim Professional
D | 2300 | CRC02 | - | 1073
 
Certification Condition Indicator
Code indicating whether or not the condition codes apply to the patient or another entity.
837 - Health Care Claim Professional
D | 2300 | CRC02 | - | 1073
D | 2300 | CRC02 | - | 1073
D | 2300 | CRC02 | - | 1073
D | 2400 | CRC02 | - | 1073
D | 2400 | CRC02 | - | 1073
 
Certification Revision or Recertification Date
Date the certification was revised or recertified.
837 - Health Care Claim Professional
D | 2400 | DTP03 | - | 1251
 
Certification Type Code
Code indicating the type of certification.
837 - Health Care Claim Professional
D | 2400 | CR301 | - | 1322
 
Claim Adjustment Group Code
Code identifying the general category of payment adjustment.
837 - Health Care Claim Professional
D | 2320 | RAS02 | - | 1785
D | 2430 | RAS02 | - | 1785
 
Claim Allowed Amount
The amount the payer deems payable for this claim, prior to considering patient responsibility.
837 - Health Care Claim Professional
D | 2320 | AMT02 | - | 782
 
Claim Authorization Exception Code
Code identifying the reason for requesting an exception to standard processing of the claim.
837 - Health Care Claim Professional
D | 2300 | CLM21 | - | 1774
 
Claim Filing Indicator Code
Code identifying type of claim or expected adjudication process.
837 - Health Care Claim Professional
D | 2000B | SBR09 | - | 1032
D | 2320 | SBR09 | - | 1032
 
Claim Frequency Code
Code specifying the frequency of the claim. This is the third position of the Uniform Billing Claim Form Bill Type.
837 - Health Care Claim Professional
D | 2300 | CLM05 | C023-03 | 1325
 
Claim Note Text
Narrative text providing additional information related to the claim.
837 - Health Care Claim Professional
D | 2300 | NTE02 | - | 352
 
Claim or Encounter Identifier
Code indicating whether the transaction is a claim or reporting encounter information.
837 - Health Care Claim Professional
H | | BHT06 | - | 640
 
Clinical Laboratory Improvement Amendment Number
The CLIA Certificate of Waiver or the CLIA Certificate of Registration Identification Number assigned to the laboratory testing site that rendered the services on this claim.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
D | 2400 | REF02 | - | 127
 
Co-Pay Status Code
A code indicating the status of the co-payment requirements for this service.
837 - Health Care Claim Professional
D | 2400 | SV115 | - | 1327
 
Code Category
Specifies the situation or category to which the code applies.
837 - Health Care Claim Professional
D | 2300 | CRC01 | - | 1136
D | 2300 | CRC01 | - | 1136
D | 2300 | CRC01 | - | 1136
D | 2400 | CRC01 | - | 1136
D | 2400 | CRC01 | - | 1136
 
Code List Qualifier Code
Code identifying a specific industry code list.
837 - Health Care Claim Professional
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI03 | C022-01 | 1270
D | 2300 | HI04 | C022-01 | 1270
D | 2300 | HI05 | C022-01 | 1270
D | 2300 | HI06 | C022-01 | 1270
D | 2300 | HI07 | C022-01 | 1270
D | 2300 | HI08 | C022-01 | 1270
D | 2300 | HI09 | C022-01 | 1270
D | 2300 | HI10 | C022-01 | 1270
D | 2300 | HI11 | C022-01 | 1270
D | 2300 | HI12 | C022-01 | 1270
D | 2320 | RAS03 | C058-02 | 1270
D | 2320 | LQ01 | - | 1270
D | 2400 | TOO01 | - | 1270
D | 2430 | RAS03 | C058-02 | 1270
D | 2430 | III01 | - | 1270
D | 2430 | LQ01 | - | 1270
D | 2440 | LQ01 | - | 1270
 
Code Qualifier
Code identifying the type of unit or measurement.
837 - Health Care Claim Professional
D | 2300 | CRC01 | - | 1136
D | 2410 | CTP05 | C001-01 | 355
 
Communication Number
Complete communications number including country or area code when applicable
837 - Health Care Claim Professional
H | 1000A | PER04 | - | 364
H | 1000A | PER06 | - | 364
H | 1000A | PER08 | - | 364
D | 2010AA | PER04 | - | 364
D | 2010AA | PER06 | - | 364
D | 2010AA | PER08 | - | 364
D | 2010AD | PER04 | - | 364
D | 2010AD | PER06 | - | 364
D | 2010AD | PER08 | - | 364
D | 2010BA | PER04 | - | 364
D | 2010BA | PER06 | - | 364
D | 2010CA | PER04 | - | 364
D | 2010CA | PER06 | - | 364
D | 2420E | PER04 | - | 364
D | 2420E | PER06 | - | 364
D | 2420E | PER08 | - | 364
 
Communication Number Qualifier
Code identifying the type of communication number.
837 - Health Care Claim Professional
H | 1000A | PER03 | - | 365
H | 1000A | PER05 | - | 365
H | 1000A | PER07 | - | 365
D | 2010AA | PER03 | - | 365
D | 2010AA | PER05 | - | 365
D | 2010AA | PER07 | - | 365
D | 2010AD | PER03 | - | 365
D | 2010AD | PER05 | - | 365
D | 2010AD | PER07 | - | 365
D | 2010BA | PER03 | - | 365
D | 2010BA | PER05 | - | 365
D | 2010CA | PER03 | - | 365
D | 2010CA | PER05 | - | 365
D | 2420E | PER03 | - | 365
D | 2420E | PER05 | - | 365
D | 2420E | PER07 | - | 365
 
Compound Indicator
An indication that the drug is part of a multi-ingredient compound.
837 - Health Care Claim Professional
D | 2410 | SV410 | - | 1073
 
Compound Route of Administration Code
Code indicating the route of administration of the complete compound mixture.
837 - Health Care Claim Professional
D | 2410 | SV421 | - | 1736
 
Condition Code
Code(s) used to identify condition(s) relating to this bill or relating to the patient.
837 - Health Care Claim Professional
D | 2300 | CRC03 | - | 1321
D | 2300 | CRC04 | - | 1321
D | 2300 | CRC05 | - | 1321
D | 2300 | CRC06 | - | 1321
D | 2300 | CRC07 | - | 1321
D | 2300 | CRC03 | - | 1321
D | 2300 | CRC04 | - | 1321
D | 2300 | CRC05 | - | 1321
D | 2300 | CRC06 | - | 1321
D | 2300 | CRC07 | - | 1321
D | 2300 | HI01 | C022-02 | 1271
D | 2300 | HI02 | C022-02 | 1271
D | 2300 | HI03 | C022-02 | 1271
D | 2300 | HI04 | C022-02 | 1271
D | 2300 | HI05 | C022-02 | 1271
D | 2300 | HI06 | C022-02 | 1271
D | 2300 | HI07 | C022-02 | 1271
D | 2300 | HI08 | C022-02 | 1271
D | 2300 | HI09 | C022-02 | 1271
D | 2300 | HI10 | C022-02 | 1271
D | 2300 | HI11 | C022-02 | 1271
D | 2300 | HI12 | C022-02 | 1271
D | 2400 | CRC03 | - | 1321
D | 2400 | CRC04 | - | 1321
D | 2400 | CRC05 | - | 1321
D | 2400 | CRC06 | - | 1321
D | 2400 | CRC07 | - | 1321
 
Condition Indicator
Code indicating a condition
837 - Health Care Claim Professional
D | 2300 | CRC03 | - | 1321
D | 2300 | CRC04 | - | 1321
D | 2300 | CRC05 | - | 1321
D | 2400 | CRC03 | - | 1321
D | 2400 | CRC04 | - | 1321
 
Contact Function Code
Code identifying the major duty or responsibility of the person or group named.
837 - Health Care Claim Professional
H | 1000A | PER01 | - | 366
D | 2010AA | PER01 | - | 366
D | 2010AD | PER01 | - | 366
D | 2010BA | PER01 | - | 366
D | 2010CA | PER01 | - | 366
D | 2420E | PER01 | - | 366
 
Contract Amount
Fixed monetary amount pertaining to the contract
837 - Health Care Claim Professional
D | 2300 | CN102 | - | 782
D | 2400 | CN102 | - | 782
 
Contract Code
Code identifying the specific contract, established by the payer.
837 - Health Care Claim Professional
D | 2300 | CN104 | - | 127
D | 2400 | CN104 | - | 127
 
Contract Percentage
Percent of charges payable under the contract
837 - Health Care Claim Professional
D | 2300 | CN103 | - | 332
D | 2400 | CN103 | - | 332
 
Contract Type Code
Code identifying a contract type
837 - Health Care Claim Professional
D | 2300 | CN101 | - | 1166
D | 2400 | CN101 | - | 1166
 
Contract Version Identifier
Identification of additional or supplemental contract provisions, or identification of a particular version or modification of contract.
837 - Health Care Claim Professional
D | 2300 | CN106 | - | 799
D | 2400 | CN106 | - | 799
 
Country Code
Code indicating the geographic location.
837 - Health Care Claim Professional
D | 2300 | CLM11 | C024-05 | 26
 
Coverage Level Code
Code indicating the level of coverage being provided for this insured
837 - Health Care Claim Professional
D | 2410 | SV704 | - | 1207
 
Currency Code
Code for country in whose currency the charges are specified.
837 - Health Care Claim Professional
D | 2000A | CUR02 | - | 100
 
DME Purchase Price
Purchase price of the Durable Medical Equipment.
837 - Health Care Claim Professional
D | 2400 | SV505 | - | 782
 
DME Rental Price
Rental price of the Durable Medical Equipment. Used in conjunction with the Rental Unit Price Indicator.
837 - Health Care Claim Professional
D | 2400 | SV504 | - | 782
 
Date Time Period
Expression of a date, a time, or a range of dates, times, or dates and times.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
D | 2300 | DTP03 | - | 1251
 
Date Time Period Format Qualifier
Code indicating the date format, time format, or date and time format.
837 - Health Care Claim Professional
D | 2000B | PAT05 | - | 1250
D | 2010BA | DMG01 | - | 1250
D | 2000C | PAT05 | - | 1250
D | 2010CA | DMG01 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2300 | DTP02 | - | 1250
D | 2330B | DTP02 | - | 1250
D | 2400 | DTP02 | - | 1250
D | 2400 | DTP02 | - | 1250
D | 2400 | DTP02 | - | 1250
D | 2400 | DTP02 | - | 1250
D | 2400 | DTP02 | - | 1250
D | 2400 | DTP02 | - | 1250
D | 2400 | DTP02 | - | 1250
D | 2400 | DTP02 | - | 1250
D | 2400 | DTP02 | - | 1250
D | 2400 | DTP02 | - | 1250
D | 2430 | DTP02 | - | 1250
 
Date Time Qualifier
Code specifying the type of date or time or both date and time.
837 - Health Care Claim Professional
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2300 | DTP01 | - | 374
D | 2330B | DTP01 | - | 374
D | 2400 | DTP01 | - | 374
D | 2400 | DTP01 | - | 374
D | 2400 | DTP01 | - | 374
D | 2400 | DTP01 | - | 374
D | 2400 | DTP01 | - | 374
D | 2400 | DTP01 | - | 374
D | 2400 | DTP01 | - | 374
D | 2400 | DTP01 | - | 374
D | 2400 | DTP01 | - | 374
D | 2400 | DTP01 | - | 374
D | 2430 | DTP01 | - | 374
 
Delay Reason Code
Code indicating the reason why a request was delayed.
837 - Health Care Claim Professional
D | 2300 | CLM20 | - | 1514
 
Demonstration Project Identifier
Identification number for a Medicare demonstration project.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
 
Description
A free-form description to clarify the related data elements and their content.
837 - Health Care Claim Professional
D | 2400 | SV101 | C003-07 | 352
 
Device Identifier of the Unique Device Identifier
A mandatory, fixed portion of a UDI that identifies the labeler and the specific version of model of a device.
837 - Health Care Claim Professional
D | 2400 | CR806 | - | 127
 
Diagnosis Code
An ICD-9-CM Diagnosis Code identifying a diagnosed medical condition.
837 - Health Care Claim Professional
D | 2300 | HI01 | C022-02 | 1271
D | 2300 | HI02 | C022-02 | 1271
D | 2300 | HI03 | C022-02 | 1271
D | 2300 | HI04 | C022-02 | 1271
D | 2300 | HI05 | C022-02 | 1271
D | 2300 | HI06 | C022-02 | 1271
D | 2300 | HI07 | C022-02 | 1271
D | 2300 | HI08 | C022-02 | 1271
D | 2300 | HI09 | C022-02 | 1271
D | 2300 | HI10 | C022-02 | 1271
D | 2300 | HI11 | C022-02 | 1271
D | 2300 | HI12 | C022-02 | 1271
 
Diagnosis Code Pointer
A pointer to the claim diagnosis code in the order of importance to this service.
837 - Health Care Claim Professional
D | 2400 | SV107 | - | 1328
 
Diagnosis Type Code
Code identifying the type of diagnosis.
837 - Health Care Claim Professional
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI03 | C022-01 | 1270
D | 2300 | HI04 | C022-01 | 1270
D | 2300 | HI05 | C022-01 | 1270
D | 2300 | HI06 | C022-01 | 1270
D | 2300 | HI07 | C022-01 | 1270
D | 2300 | HI08 | C022-01 | 1270
D | 2300 | HI09 | C022-01 | 1270
D | 2300 | HI10 | C022-01 | 1270
D | 2300 | HI11 | C022-01 | 1270
D | 2300 | HI12 | C022-01 | 1270
 
Disability From Date
The beginning date the patient, in the provider's opinion, was or will be unable to perform the duties normally associated with his/her work.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
 
Dispense as Written Code (DAW)/Product Selection Code
A code indicating whether or not the drug was dispensed as written.
837 - Health Care Claim Professional
D | 2410 | SV405 | - | 1329
 
Dosage Form Code
Code indicating the form in which the drug is dispensed.
837 - Health Care Claim Professional
D | 2410 | SV414 | - | 1330
 
Drug Quantity Administered/Universal Product Number Unit Count
The quantity of the drug administered, based upon the unit of measure as defined by the National Drug Code or the quantity of units for the Universal Product Number.
837 - Health Care Claim Professional
D | 2410 | CTP04 | - | 380
 
Durable Medical Equipment Duration
Length of time durable medical equipment (DME) is needed.
837 - Health Care Claim Professional
D | 2400 | CR303 | - | 380
 
EPSDT Indicator
An indicator of whether or not Early and Periodic Screening for Diagnosis and Treatment of children services are involved with this detail line.
837 - Health Care Claim Professional
D | 2400 | SV111 | - | 1073
 
Emergency Indicator
An indicator of whether or not emergency care was rendered in response to the sudden and unexpected onset of a medical condition, a severe injury, or an acute exacerbation of a chronic condition which was threatening to life, limb or sight, and which req
837 - Health Care Claim Professional
D | 2400 | SV109 | - | 1073
 
End Stage Renal Disease Payment Amount
Amount of payment under End Stage Renal Disease benefit.
837 - Health Care Claim Professional
D | 2320 | MOA08 | - | 782
 
Entity Identifier Code
Code identifying an organizational entity, a physical location, property or an individual.
837 - Health Care Claim Professional
H | 1000A | NM101 | - | 98
H | 1000B | NM101 | - | 98
D | 2000A | CUR01 | - | 98
D | 2010AA | NM101 | - | 98
D | 2010AB | NM101 | - | 98
D | 2010AC | NM101 | - | 98
D | 2010AD | NM101 | - | 98
D | 2010BA | NM101 | - | 98
D | 2010BB | NM101 | - | 98
D | 2010CA | NM101 | - | 98
D | 2310A | NM101 | - | 98
D | 2310B | NM101 | - | 98
D | 2310C | NM101 | - | 98
D | 2310D | NM101 | - | 98
D | 2310E | NM101 | - | 98
D | 2310F | NM101 | - | 98
D | 2330A | NM101 | - | 98
D | 2330B | NM101 | - | 98
D | 2330C | NM101 | - | 98
D | 2330D | NM101 | - | 98
D | 2330E | NM101 | - | 98
D | 2330G | NM101 | - | 98
D | 2420A | NM101 | - | 98
D | 2420B | NM101 | - | 98
D | 2420C | NM101 | - | 98
D | 2420D | NM101 | - | 98
D | 2420E | NM101 | - | 98
D | 2420F | NM101 | - | 98
D | 2420G | NM101 | - | 98
D | 2420H | NM101 | - | 98
 
Entity Type Qualifier
Code qualifying the type of entity.
837 - Health Care Claim Professional
H | 1000A | NM102 | - | 1065
H | 1000B | NM102 | - | 1065
D | 2010AA | NM102 | - | 1065
D | 2010AB | NM102 | - | 1065
D | 2010AC | NM102 | - | 1065
D | 2010AD | NM102 | - | 1065
D | 2010BA | NM102 | - | 1065
D | 2010BB | NM102 | - | 1065
D | 2010CA | NM102 | - | 1065
D | 2310A | NM102 | - | 1065
D | 2310B | NM102 | - | 1065
D | 2310C | NM102 | - | 1065
D | 2310D | NM102 | - | 1065
D | 2310E | NM102 | - | 1065
D | 2310F | NM102 | - | 1065
D | 2330A | NM102 | - | 1065
D | 2330B | NM102 | - | 1065
D | 2330C | NM102 | - | 1065
D | 2330D | NM102 | - | 1065
D | 2330E | NM102 | - | 1065
D | 2330G | NM102 | - | 1065
D | 2420A | NM102 | - | 1065
D | 2420B | NM102 | - | 1065
D | 2420C | NM102 | - | 1065
D | 2420D | NM102 | - | 1065
D | 2420E | NM102 | - | 1065
D | 2420F | NM102 | - | 1065
D | 2420G | NM102 | - | 1065
D | 2420H | NM102 | - | 1065
 
Exception Code
Exception code generated by the Third Party Organization.
837 - Health Care Claim Professional
D | 2300 | HCP15 | - | 1527
D | 2400 | HCP15 | - | 1527
 
Facility Code Qualifier
Code identifying the type of facility referenced.
837 - Health Care Claim Professional
D | 2300 | CLM05 | C023-02 | 1332
 
Family Planning Indicator
An indicator of whether or not Family Planning Services are involved with this detail line.
837 - Health Care Claim Professional
D | 2400 | SV112 | - | 1073
 
Form Identifier
Letter or number identifying a specific form.
837 - Health Care Claim Professional
D | 2440 | LQ02 | - | 1271
 
HCPCS Payable Amount
Amount due under Medicare HCPCS system.
837 - Health Care Claim Professional
D | 2320 | MOA02 | - | 782
 
Hierarchical Child Code
Code indicating if there are hierarchical child data segments subordinate to the level being described.
837 - Health Care Claim Professional
D | 2000A | HL04 | - | 736
D | 2000B | HL04 | - | 736
D | 2000C | HL04 | - | 736
 
Hierarchical ID Number
A unique number assigned by the sender to identify a particular data segment in a hierarchical structure.
837 - Health Care Claim Professional
D | 2000A | HL01 | - | 628
D | 2000B | HL01 | - | 628
D | 2000C | HL01 | - | 628
 
Hierarchical Level Code
Code defining the characteristic of a level in a hierarchical structure.
837 - Health Care Claim Professional
D | 2000A | HL03 | - | 735
D | 2000B | HL03 | - | 735
D | 2000C | HL03 | - | 735
 
Hierarchical Parent ID Number
Identification number of the next higher hierarchical data segment that the data segment being described is subordinate to.
837 - Health Care Claim Professional
D | 2000B | HL02 | - | 734
D | 2000C | HL02 | - | 734
 
Hierarchical Structure Code
Code indicating the hierarchical application structure of a transaction set that utilizes the HL segment to define the structure of the transaction set
837 - Health Care Claim Professional
H | | BHT01 | - | 1005
 
Homebound Indicator
A code indicating whether a patient is homebound.
837 - Health Care Claim Professional
D | 2300 | CRC03 | - | 1321
 
Identification Code Qualifier
Code designating the system/method of code structure used for Identification Code (67).
837 - Health Care Claim Professional
H | 1000A | NM108 | - | 66
H | 1000B | NM108 | - | 66
D | 2010AA | NM108 | - | 66
D | 2010AC | NM108 | - | 66
D | 2010AD | NM108 | - | 66
D | 2010BA | NM108 | - | 66
D | 2010BB | NM108 | - | 66
D | 2300 | PWK05 | - | 66
D | 2310A | NM108 | - | 66
D | 2310B | NM108 | - | 66
D | 2310C | NM108 | - | 66
D | 2310D | NM108 | - | 66
D | 2330A | NM108 | - | 66
D | 2330B | NM108 | - | 66
D | 2400 | PWK05 | - | 66
D | 2420A | NM108 | - | 66
D | 2420B | NM108 | - | 66
D | 2420C | NM108 | - | 66
D | 2420D | NM108 | - | 66
D | 2420E | NM108 | - | 66
D | 2420F | NM108 | - | 66
 
Immunization Batch Number
The manufacturer's lot number for vaccine used in immunization.
837 - Health Care Claim Professional
D | 2400 | REF02 | - | 127
 
Implant Status Code
Code identifying the status of implant components
837 - Health Care Claim Professional
D | 2400 | CR802 | - | 1404
 
Implant Type Code
Code identifying implant components
837 - Health Care Claim Professional
D | 2400 | CR801 | - | 1403
 
Implementation Guide Version Name
Name of the referenced implementation guide version.
837 - Health Care Claim Professional
H | | ST03 | - | 1705
 
Individual Relationship Code
Code indicating the relationship between two individuals or entities.
837 - Health Care Claim Professional
D | 2000B | SBR02 | - | 1069
D | 2000C | PAT01 | - | 1069
D | 2320 | SBR02 | - | 1069
 
Industry Code
Code indicating a code from a specific industry code list.
837 - Health Care Claim Professional
D | 2300 | HI02 | C022-02 | 1271
 
Initial Treatment Date
Date that the patient initially sought treatment for this condition.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
D | 2400 | DTP03 | - | 1251
 
Insurance Type Code
Code identifying the type of insurance.
837 - Health Care Claim Professional
D | 2320 | SBR05 | - | 1336
 
Insured Group or Policy Number
The identification number, control number, or code assigned by the carrier or administrator to identify the group under which the individual is covered.
837 - Health Care Claim Professional
D | 2320 | SBR03 | - | 127
 
Investigational Device Exemption Identifier
Number or reference identifying exemption assigned to an ivestigational device referenced in the claim.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
 
Last Certification Date
The date of the last certification.
837 - Health Care Claim Professional
D | 2400 | DTP03 | - | 1251
 
Last Menstrual Period Date
The date of the last menstrual period (LMP).
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
 
Last Seen Date
Date the patient was last seen by the referring or ordering physician for a claim billed by a provider whose services require physician certification.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
D | 2400 | DTP03 | - | 1251
 
Last Worked Date
Date patient last worked at the patient's current occupation
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
 
Last X-Ray Date
Date patient received last X-Ray.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
D | 2400 | DTP03 | - | 1251
 
Length of Medical Necessity
Number of days the durable medical equipment will be required for medical treatment.
837 - Health Care Claim Professional
D | 2400 | SV503 | - | 380
 
Line Item Charge Amount
Charges related to this service.
837 - Health Care Claim Professional
D | 2400 | SV102 | - | 782
 
Line Item Control Number
Identifier assigned by the submitter/provider to this line item.
837 - Health Care Claim Professional
D | 2400 | REF02 | - | 127
 
Line Note Text
Narrative text providing additional information related to the service line.
837 - Health Care Claim Professional
D | 2400 | NTE02 | - | 352
D | 2400 | NTE02 | - | 352
 
Loop Identifier Code
The loop ID number given on the transaction set diagram is the value for this data element in segments LS and LE.
837 - Health Care Claim Professional
D | 2400 | LS01 | - | 447
D | 2400 | LE01 | - | 447
 
Mammography Certification Number
CMS assigned Certification Number of the certified mammography screening center
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
D | 2400 | REF02 | - | 127
 
Measurement Qualifier
Code identifying a specific product or process characteristic to which a measurement applies
837 - Health Care Claim Professional
D | 2400 | MEA02 | - | 738
 
Measurement Reference Identification Code
Code identifying the broad category to which a measurement applies
837 - Health Care Claim Professional
D | 2400 | MEA01 | - | 737
 
Medical Record Number
A unique number assigned to patient by the provider to assist in retrieval of medical records.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
 
Medicare Assignment Code
An indication, used by Medicare or other government programs, that the provider accepted assignment.
837 - Health Care Claim Professional
D | 2300 | CLM07 | - | 1359
D | 2320 | OI07 | - | 1359
 
Medicare Section 4081 Indicator
Code indicating Medicare Section 4081 applies.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
 
Name
Free-form name.
837 - Health Care Claim Professional
D | 2010BA | PER02 | - | 93
 
National Drug Code, Universal Product Number or Device Identifier of the Unique Device Identifier
The national drug identification number assigned by the Food and Drug Administration (FDA), or the unique product identification number or Device Identifier of the Unique Device Identifier that unambiguously identifies a medical/surgical device.
837 - Health Care Claim Professional
D | 2410 | LIN03 | - | 234
 
Non-Covered Charge Amount
Charges pertaining to the related revenue center code that the primary payer will not cover.
837 - Health Care Claim Professional
D | 2320 | AMT02 | - | 782
 
Non-Payable Professional Component Billed Amount
Amount of non-payable charges included in the bill related to professional services.
837 - Health Care Claim Professional
D | 2320 | MOA09 | - | 782
 
Note Reference Code
Code identifying the functional area or purpose for which the note applies.
837 - Health Care Claim Professional
D | 2300 | NTE01 | - | 363
D | 2400 | NTE01 | - | 363
D | 2400 | NTE01 | - | 363
 
Obstetric Additional Units
Additional anesthesia units reported by anesthesiologist to report additional complexity beyond the normal services reflected by the base units for the reported procedure and anesthesia time.
837 - Health Care Claim Professional
D | 2400 | QTY02 | - | 380
 
Onset of Current Illness or Injury Date
Date of onset of indicated patient condition.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
 
Oral Cavity Area/Tooth Code
Identifies the tooth, quadrant, sextant or arch on which services were performed or will be performed.
837 - Health Care Claim Professional
D | 2400 | TOO02 | - | 1271
 
Ordering Provider Address Line
Address line of the provider ordering services for the patient.
837 - Health Care Claim Professional
D | 2420E | N301 | - | 166
D | 2420E | N302 | - | 166
 
Ordering Provider City Name
City of provider ordering services for the patient
837 - Health Care Claim Professional
D | 2420E | N401 | - | 19
 
Ordering Provider Contact Name
Contact person to whom inquiries should be directed at the provider ordering services for the patient.
837 - Health Care Claim Professional
D | 2420E | PER02 | - | 93
 
Ordering Provider Country Code
Country code of the provider ordering services for the patient.
837 - Health Care Claim Professional
D | 2420E | N404 | - | 26
 
Ordering Provider Country Subdivision Code
Country subdivision code of the provider ordering services for the patient.
837 - Health Care Claim Professional
D | 2420E | N407 | - | 1715
 
Ordering Provider First Name
The first name of the provider who ordered or prescribed this service.
837 - Health Care Claim Professional
D | 2420E | NM104 | - | 1036
 
Ordering Provider Identifier
The identifier assigned by the Payer to the provider who ordered or prescribed this service.
837 - Health Care Claim Professional
D | 2420E | NM109 | - | 67
 
Ordering Provider Last Name
The last name of the provider who ordered or prescribed this service.
837 - Health Care Claim Professional
D | 2420E | NM103 | - | 1035
 
Ordering Provider Middle Name or Initial
Middle name or initial of the provider ordering services for the patient.
837 - Health Care Claim Professional
D | 2420E | NM105 | - | 1037
 
Ordering Provider Name Suffix
Suffix to the name of the provider ordering services for the patient.
837 - Health Care Claim Professional
D | 2420E | NM107 | - | 1039
 
Ordering Provider Postal Zone or ZIP Code
Postal ZIP code of the provider ordering services for the patient.
837 - Health Care Claim Professional
D | 2420E | N403 | - | 116
 
Ordering Provider Secondary Identifier
Additional identifier for the provider ordering services for the patient.
837 - Health Care Claim Professional
D | 2420E | REF02 | - | 127
 
Ordering Provider State or Province Code
The State Postal Code of the provider who ordered/prescribed this service.
837 - Health Care Claim Professional
D | 2420E | N402 | - | 156
 
Originator Application Transaction Identifier
An identification number that identifies a transaction within the originator's applications system.
837 - Health Care Claim Professional
H | | BHT03 | - | 127
 
Other Insured Group Name
Name of the group or plan through which the insurance is provided to the other insured.
837 - Health Care Claim Professional
D | 2320 | SBR04 | - | 93
 
Other Payer Address Line
Address line of the other payer's mailing address.
837 - Health Care Claim Professional
D | 2330B | N301 | - | 166
D | 2330B | N302 | - | 166
 
Other Payer Billing Provider Identifier
The non-destination (COB) payer's identifier for the provider or organization in whose name the bill is submitted and to whom payment should be made.
837 - Health Care Claim Professional
D | 2330G | REF02 | - | 127
 
Other Payer City Name
The city name of the other payer's mailing address.
837 - Health Care Claim Professional
D | 2330B | N401 | - | 19
 
Other Payer Claim Adjustment Indicator
Indicates this claim has been adjusted.
837 - Health Care Claim Professional
D | 2320 | OI08 | - | 1073
 
Other Payer Country Code
Code indicating the geographic location of the other payer.
837 - Health Care Claim Professional
D | 2330B | N404 | - | 26
 
Other Payer Country Subdivision Code
Subdivision code indicating the geographic location of the other payer.
837 - Health Care Claim Professional
D | 2330B | N407 | - | 1715
 
Other Payer Organization Name
Organization name of this non-destination (COB) payer.
837 - Health Care Claim Professional
D | 2330B | NM103 | - | 1035
 
Other Payer Postal Zone or ZIP Code
The ZIP code of the other payer's mailing address.
837 - Health Care Claim Professional
D | 2330B | N403 | - | 116
 
Other Payer Predetermination of Benefits Identifier
The non-destination (COB) payer's identification number assigned to a Predetermination of Benefits.
837 - Health Care Claim Professional
D | 2330B | REF02 | - | 127
 
Other Payer Previous Claim Control Number
A number assigned by another payer to identify a previously adjusted claim. The number may also be identified as an Internal Control Number (ICN), Claim Control Number (CCN) or Document Control Number (DCN).
837 - Health Care Claim Professional
D | 2330B | REF02 | - | 127
 
Other Payer Primary Identifier
An identification number for the other payer.
837 - Health Care Claim Professional
D | 2330B | NM109 | - | 67
 
Other Payer Prior Authorization Number
The non-destination (COB) payer's prior authorization number.
837 - Health Care Claim Professional
D | 2330B | REF02 | - | 127
 
Other Payer Referral Number
The non-destination (COB) payer's referral number.
837 - Health Care Claim Professional
D | 2330B | REF02 | - | 127
 
Other Payer Referring Provider Identifier
The non-destination (COB) payer's referring provider identifier.
837 - Health Care Claim Professional
D | 2330C | REF02 | - | 127
 
Other Payer Rendering Provider Identifier
The non-destination (COB) payer's rendering provider identifier.
837 - Health Care Claim Professional
D | 2330D | REF02 | - | 127
 
Other Payer Responsibility Sequence Code
Code indicating the order in which benefits will be adjudicated when multiple payers are involved.
837 - Health Care Claim Professional
D | 2320 | SBR01 | - | 1138
D | 2400 | REF04 | C040-02 | 127
D | 2400 | REF04 | C040-02 | 127
D | 2400 | REF04 | C040-02 | 127
D | 2420A | REF04 | C040-02 | 127
D | 2420B | REF04 | C040-02 | 127
D | 2420C | REF04 | C040-02 | 127
D | 2420E | REF04 | C040-02 | 127
D | 2420F | REF04 | C040-02 | 127
D | 2430 | SVD01 | - | 1138
 
Other Payer Secondary Identifier
Additional identifier for the other payer organization
837 - Health Care Claim Professional
D | 2330B | REF02 | - | 127
 
Other Payer Service Location Secondary Identifier
The non-destination payer's service location secondary identifier.
837 - Health Care Claim Professional
D | 2330E | REF02 | - | 127
 
Other Payer State or Province Code
The state or province code of the other payer's mailing address.
837 - Health Care Claim Professional
D | 2330B | N402 | - | 156
 
Other Payer Voided Claim Indicator
Indicates the claim has been voided.
837 - Health Care Claim Professional
D | 2320 | OI10 | - | 1073
 
Other Payer's Claim Control Number
A number assigned by the other payer to identify a claim. The number is usually referred to as an Internal Control Number (ICN), Claim Control Number (CCN) or a Document Control Number (DCN).
837 - Health Care Claim Professional
D | 2330B | REF02 | - | 127
 
Other Subscriber Address Line
Address line of the Other Subscriber's mailing address.
837 - Health Care Claim Professional
D | 2330A | N301 | - | 166
D | 2330A | N302 | - | 166
 
Other Subscriber City Name
The city name of the Other Subscriber.
837 - Health Care Claim Professional
D | 2330A | N401 | - | 19
 
Other Subscriber Country Code
The country code of the Other Subscriber's mailing address.
837 - Health Care Claim Professional
D | 2330A | N404 | - | 26
 
Other Subscriber Country Subdivision Code
The country subdivision code of the Other Subscriber's mailing address.
837 - Health Care Claim Professional
D | 2330A | N407 | - | 1715
 
Other Subscriber First Name
The first name of the Other Subscriber.
837 - Health Care Claim Professional
D | 2330A | NM104 | - | 1036
 
Other Subscriber Identifier
An identification number, assigned by the third party payer, to identify the Other Subscriber.
837 - Health Care Claim Professional
D | 2330A | NM109 | - | 67
 
Other Subscriber Last Name or Organization Name
The last name or organization name of the Other Subscriber.
837 - Health Care Claim Professional
D | 2330A | NM103 | - | 1035
 
Other Subscriber Middle Name or Initial
This is the middle name or initial of the Other Subscriber.
837 - Health Care Claim Professional
D | 2330A | NM105 | - | 1037
 
Other Subscriber Name Suffix
The suffix to the name of the Other Subscriber.
837 - Health Care Claim Professional
D | 2330A | NM107 | - | 1039
 
Other Subscriber Postal Zone or ZIP Code
The Postal ZIP code of the Other Subscriber's mailing address.
837 - Health Care Claim Professional
D | 2330A | N403 | - | 116
 
Other Subscriber Social Security Number
Identifier assigned to the other subscriber by the Social Security Administration.
837 - Health Care Claim Professional
D | 2330A | REF02 | - | 127
 
Other Subscriber State or Province Code
The state code of the Other Subscriber's mailing address.
837 - Health Care Claim Professional
D | 2330A | N402 | - | 156
 
Paid Service Unit Count
Units of service paid by the payer for coordination of benefits.
837 - Health Care Claim Professional
D | 2430 | SVD05 | - | 380
 
Patient Address Line
Address line of the street mailing address of the patient.
837 - Health Care Claim Professional
D | 2010CA | N301 | - | 166
D | 2010CA | N302 | - | 166
 
Patient Amount Paid
The amount the provider has received from the patient (or insured) toward payment of this claim.
837 - Health Care Claim Professional
D | 2300 | AMT02 | - | 782
 
Patient Birth Date
Date of birth of the patient.
837 - Health Care Claim Professional
D | 2010CA | DMG02 | - | 1251
 
Patient City Name
The city name of the patient.
837 - Health Care Claim Professional
D | 2010CA | N401 | - | 19
 
Patient Condition Code
Code indicating the condition of the patient.
837 - Health Care Claim Professional
D | 2300 | CR208 | - | 1342
 
Patient Condition Description
Free-form description of the patient's condition.
837 - Health Care Claim Professional
D | 2300 | CR210 | - | 352
D | 2300 | CR211 | - | 352
 
Patient Country Code
The country code of the patient.
837 - Health Care Claim Professional
D | 2010CA | N404 | - | 26
 
Patient Country Subdivision Code
The country subdivision code of the patient.
837 - Health Care Claim Professional
D | 2010CA | N407 | - | 1715
 
Patient Death Date
Date of the patient's death.
837 - Health Care Claim Professional
D | 2000B | PAT06 | - | 1251
D | 2000C | PAT06 | - | 1251
 
Patient First Name
The first name of the individual to whom the services were provided.
837 - Health Care Claim Professional
D | 2010CA | NM104 | - | 1036
 
Patient Gender Code
A code indicating the sex of the patient.
837 - Health Care Claim Professional
D | 2010CA | DMG03 | - | 1068
 
Patient Last Name
The last name of the individual to whom the services were provided.
837 - Health Care Claim Professional
D | 2010CA | NM103 | - | 1035
 
Patient Middle Name or Initial
The middle name or initial of the individual to whom the services were provided.
837 - Health Care Claim Professional
D | 2010CA | NM105 | - | 1037
 
Patient Name Suffix
Suffix to the name of the individual to whom the services were provided.
837 - Health Care Claim Professional
D | 2010CA | NM107 | - | 1039
 
Patient Postal Zone or ZIP Code
The ZIP Code of the patient.
837 - Health Care Claim Professional
D | 2010CA | N403 | - | 116
 
Patient Signature Source Code
Code indication how the patient/subscriber authorization signatures were obtained and how they are being retained by the provider.
837 - Health Care Claim Professional
D | 2300 | CLM10 | - | 1351
 
Patient State or Province Code
The State Postal Code of the patient.
837 - Health Care Claim Professional
D | 2010CA | N402 | - | 156
 
Patient Weight
Weight of the patient at time of treatment or transport.
837 - Health Care Claim Professional
D | 2000B | PAT08 | - | 81
D | 2000C | PAT08 | - | 81
D | 2300 | CR102 | - | 81
D | 2400 | CR102 | - | 81
 
Pay-To Address Line
Address line of the provider to receive payment.
837 - Health Care Claim Professional
D | 2010AB | N301 | - | 166
D | 2010AB | N302 | - | 166
 
Pay-To Plan Address Line
Street address of the Pay-To Plan.
837 - Health Care Claim Professional
D | 2010AC | N301 | - | 166
D | 2010AC | N302 | - | 166
 
Pay-To Plan City Name
City name of the Pay-To Plan.
837 - Health Care Claim Professional
D | 2010AC | N401 | - | 19
 
Pay-To Plan Organizational Name
Organization name of the health plan that is seeking reimbursement (Pay-To Plan).
837 - Health Care Claim Professional
D | 2010AC | NM103 | - | 1035
 
Pay-To Plan Postal Zone or ZIP Code
Postal zone or ZIP code of the Pay-To Plan.
837 - Health Care Claim Professional
D | 2010AC | N403 | - | 116
 
Pay-To Plan Primary Identifier
Identification number for the Pay-To Plan.
837 - Health Care Claim Professional
D | 2010AC | NM109 | - | 67
 
Pay-To Plan State or Province Code
State or province code of the Pay-to Plan.
837 - Health Care Claim Professional
D | 2010AC | N402 | - | 156
 
Pay-To Plan Tax Identification Number
Tax identification number of the plan to whom payment should be made.
837 - Health Care Claim Professional
D | 2010AC | REF02 | - | 127
 
Pay-to Address City Name
City name of the entity to receive payment.
837 - Health Care Claim Professional
D | 2010AB | N401 | - | 19
 
Pay-to Address Country Code
Country code of the entity to receive payment (for example, ZIP code).
837 - Health Care Claim Professional
D | 2010AB | N404 | - | 26
 
Pay-to Address Country Subdivision Code
Country subdivision code of the entity to receive payment (for example, ZIP code).
837 - Health Care Claim Professional
D | 2010AB | N407 | - | 1715
 
Pay-to Address Postal Zone or ZIP Code
Postal code of the entity to receive payment (for example, ZIP code).
837 - Health Care Claim Professional
D | 2010AB | N403 | - | 116
 
Pay-to Address State Code
State or sub-country code of the entity to receive payment.
837 - Health Care Claim Professional
D | 2010AB | N402 | - | 156
 
Pay-to Factoring Agent Address Line
The address line of the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | N301 | - | 166
D | 2010AD | N302 | - | 166
 
Pay-to Factoring Agent City Name
The city of the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | N401 | - | 19
 
Pay-to Factoring Agent Contact Name
The contact name for the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | PER02 | - | 93
 
Pay-to Factoring Agent Country Code
The country code of the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | N404 | - | 26
 
Pay-to Factoring Agent Country Subdivision Code
The country subdivision code of the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | N407 | - | 1715
 
Pay-to Factoring Agent First Name
The first name of the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | NM104 | - | 1036
 
Pay-to Factoring Agent Last or Organization Name
The last name or organization name of the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | NM103 | - | 1035
 
Pay-to Factoring Agent Middle Name or Initial
The middle name or initial of the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | NM105 | - | 1037
 
Pay-to Factoring Agent Name Suffix
The name suffix of the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | NM107 | - | 1039
 
Pay-to Factoring Agent Postal Zone or ZIP Code
The Postal Zone or ZIP code of the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | N403 | - | 116
 
Pay-to Factoring Agent Primary Identifier
The primary identifier for the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | NM109 | - | 67
 
Pay-to Factoring Agent Secondary Identifier
The secondary identifier for the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | REF02 | - | 127
 
Pay-to Factoring Agent State or Province Code
The State or Province code of the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | N402 | - | 156
 
Pay-to Factoring Agent Tax Identification Number
The tax identification number of the entity who purchased the financial obligation.
837 - Health Care Claim Professional
D | 2010AD | REF02 | - | 127
 
Pay-to Plan Country Code
Country code of the Pay-To Plan.
837 - Health Care Claim Professional
D | 2010AC | N404 | - | 26
 
Pay-to Plan Country Subdivision Code
Country subdivision code of the Pay-To Plan.
837 - Health Care Claim Professional
D | 2010AC | N407 | - | 1715
 
Pay-to Plan Secondary Identifier
Additional identifier for the Pay-To Plan.
837 - Health Care Claim Professional
D | 2010AC | REF02 | - | 127
 
Payer Address Line
Address line of the Payer's claim mailing address for this particular payer organization identification and claim office.
837 - Health Care Claim Professional
D | 2010BB | N301 | - | 166
D | 2010BB | N302 | - | 166
 
Payer City Name
The City Name of the Payer's claim mailing address for this particular payer ID and claim office.
837 - Health Care Claim Professional
D | 2010BB | N401 | - | 19
 
Payer Claim Control Number
A number assigned by the payer to identify a claim. The number is usually referred to as an Internal Control Number (ICN), Claim Control Number (CCN) or a Document Control Number (DCN).
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
 
Payer Country
The country code for the payer when the payer's country is not the United States of America.
837 - Health Care Claim Professional
D | 2010BB | N404 | - | 26
 
Payer Country Subdivision
The state, province or other subdivision identification of the payer's address when the payer's country is not the United States of America, including its territories, or Canada.
837 - Health Care Claim Professional
D | 2010BB | N407 | - | 1715
 
Payer Identifier
Number identifying the payer organization.
837 - Health Care Claim Professional
D | 2010BB | NM109 | - | 67
 
Payer Name
Name identifying the payer organization.
837 - Health Care Claim Professional
D | 2010BB | NM103 | - | 1035
 
Payer Paid Amount
The amount paid by the payer on this claim.
837 - Health Care Claim Professional
D | 2320 | AMT02 | - | 782
 
Payer Postal Zone or ZIP Code
The ZIP Code of the Payer's claim mailing address for this particular payer organization identification and claim office.
837 - Health Care Claim Professional
D | 2010BB | N403 | - | 116
 
Payer Responsibility Sequence Code
Code indicating the order in which benefits for this payer will be adjudicated when multiple payers are involved.
837 - Health Care Claim Professional
D | 2000B | SBR01 | - | 1138
 
Payer Secondary Identifier
Additional identifier for the payer.
837 - Health Care Claim Professional
D | 2010BB | REF02 | - | 127
 
Payer State or Province Code
State Postal Code of the Payer's claim mailing address for this particular payer organization identification and claim office.
837 - Health Care Claim Professional
D | 2010BB | N402 | - | 156
 
Payment Effective Date
The effective date of the payment.
837 - Health Care Claim Professional
D | 2330B | DTP03 | - | 1251
D | 2430 | DTP03 | - | 1251
 
Percent Sales Tax Amount
The amount of sales tax applied to the drug purchase.
837 - Health Care Claim Professional
D | 2410 | SV424 | - | 782
 
Percent Sales Tax Rate
The percentage rate used to calculate the sales tax applied to the drug purchase.
837 - Health Care Claim Professional
D | 2410 | SV423 | - | 954
 
Place of Service Code
The code that identifies where the service was performed.
837 - Health Care Claim Professional
D | 2300 | CLM05 | C023-01 | 1331
D | 2400 | SV105 | - | 1331
 
Policy Compliance Code
The code that specifies policy compliance.
837 - Health Care Claim Professional
D | 2300 | HCP14 | - | 1526
D | 2400 | HCP14 | - | 1526
 
Postage Claimed Amount
Cost of postage used to provide service or to process associated paper work.
837 - Health Care Claim Professional
D | 2400 | AMT02 | - | 782
 
Predetermination of Benefits Code
Code indicating that the associated claim is a predetermination of benefits request rather than a claim or encounter.
837 - Health Care Claim Professional
D | 2300 | CLM19 | - | 1383
 
Predetermination of Benefits Identifier
Identifier assigned to a Predetermination of Benefits.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
D | 2400 | REF02 | - | 127
 
Pregnancy Indicator
A yes/no code indicating whether a patient is pregnant.
837 - Health Care Claim Professional
D | 2000B | PAT09 | - | 1073
D | 2000C | PAT09 | - | 1073
 
Prescription Date
The date the prescription was issued by the referring physician.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
D | 2400 | DTP03 | - | 1251
 
Prescription Fill Number
The indication of which refill applies to the prescription when more than one is prescribed.
837 - Health Care Claim Professional
D | 2410 | SV403 | - | 127
 
Prescription Number
The unique identification number assigned by the pharmacy or supplier to the prescription.
837 - Health Care Claim Professional
D | 2410 | SV401 | - | 127
 
Prescription or Link Sequence Number
The unique identification number assigned by the pharmacy or supplier to the prescription or compound drug ingredient.
837 - Health Care Claim Professional
D | 2410 | REF02 | - | 127
 
Pricing Methodology
Pricing methodology at which the claim or line item has been priced or repriced.
837 - Health Care Claim Professional
D | 2300 | HCP01 | - | 1473
D | 2400 | HCP01 | - | 1473
 
Prior Authorization Number
A number, code or other value that indicates the services provided on this claim have been authorized by the payee or other service organization.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
D | 2400 | REF02 | - | 127
 
Prior Authorization Type Code
Code indicating the type of prior authorization or medical certification that has occurred.
837 - Health Care Claim Professional
D | 2410 | SV418 | - | 1357
 
Procedure Code
Code identifying the procedure, product or service.
837 - Health Care Claim Professional
D | 2400 | SV101 | C003-02 | 234
D | 2400 | SV501 | C003-02 | 234
D | 2430 | SVD03 | C003-02 | 234
 
Procedure Identifier
Code identifying the type of procedure code.
837 - Health Care Claim Professional
D | 2400 | SV501 | C003-01 | 235
 
Procedure Modifier
This identifies special circumstances related to the performance of the service.
837 - Health Care Claim Professional
D | 2400 | SV101 | C003-03 | 1339
D | 2400 | SV101 | C003-04 | 1339
D | 2400 | SV101 | C003-05 | 1339
D | 2400 | SV101 | C003-06 | 1339
D | 2400 | SV101 | C003-09 | 1339
D | 2400 | SV101 | C003-10 | 1339
D | 2400 | SV101 | C003-11 | 1339
D | 2400 | SV101 | C003-12 | 1339
D | 2430 | SVD03 | C003-03 | 1339
D | 2430 | SVD03 | C003-04 | 1339
D | 2430 | SVD03 | C003-05 | 1339
D | 2430 | SVD03 | C003-06 | 1339
D | 2430 | SVD03 | C003-09 | 1339
D | 2430 | SVD03 | C003-10 | 1339
D | 2430 | SVD03 | C003-11 | 1339
D | 2430 | SVD03 | C003-12 | 1339
 
Product Process Characteristic Code
Code identifying the general class of a product or process characteristic.
837 - Health Care Claim Professional
D | 2410 | SV705 | - | 750
 
Product or Service ID Qualifier
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
837 - Health Care Claim Professional
D | 2400 | SV101 | C003-01 | 235
D | 2400 | HCP09 | - | 235
D | 2410 | LIN02 | - | 235
D | 2430 | SVD03 | C003-01 | 235
 
Professional Service Code
Code identifying pharmacist intervention when a conflict code has been identified.
837 - Health Care Claim Professional
D | 2410 | SV707 | C059-02 | 1739
 
Property & Casualty Claim Number
Identification number for property & casualty claim associated with the services identified on the bill.
837 - Health Care Claim Professional
D | 2010BA | REF02 | - | 127
D | 2010CA | REF02 | - | 127
 
Property & Casualty Patient Contact Name
Name of the person to whom inquiries about the claim should be directed.
837 - Health Care Claim Professional
D | 2010CA | PER02 | - | 93
 
Property & Casualty Patient Identifier
Identification number of the patient on a Property & Casualty claim.
837 - Health Care Claim Professional
D | 2010CA | REF02 | - | 127
 
Provider Agreement Code
Code indicating the type of agreement under which the provider is submitting this claim.
837 - Health Care Claim Professional
D | 2300 | CLM16 | - | 1360
 
Provider Code
Code identifying the type of provider.
837 - Health Care Claim Professional
D | 2000A | PRV01 | - | 1221
D | 2310B | PRV01 | - | 1221
D | 2420A | PRV01 | - | 1221
 
Provider Taxonomy Code
Code designating the provider type, classification, and specialization.
837 - Health Care Claim Professional
D | 2000A | PRV03 | - | 127
D | 2310B | PRV03 | - | 127
D | 2420A | PRV03 | - | 127
 
Provider or Supplier Signature Indicator
An indicater that the provider of service reported on this claim acknowledges the performance of the service and authorizes payment, and that a signature is on file in the provider's office.
837 - Health Care Claim Professional
D | 2300 | CLM06 | - | 1073
 
Provider's Assigned Claim Identifier
The identifier generated by the provider for the purposes of reassociation to their claim accounts receivable.
837 - Health Care Claim Professional
D | 2300 | CLM01 | - | 1028
 
Purchased Service Charge Amount
The charge for the purchased service.
837 - Health Care Claim Professional
D | 2400 | AMT02 | - | 782
 
Purchased Service Provider Identifier
The provider number of the entity from which service was purchased.
837 - Health Care Claim Professional
D | 2420B | NM109 | - | 67
 
Purchased Service Provider Secondary Identifier
Additional identifier for the provider of purchased services.
837 - Health Care Claim Professional
D | 2420B | REF02 | - | 127
 
Quantity Qualifier
Code specifying the type of quantity.
837 - Health Care Claim Professional
D | 2400 | QTY01 | - | 673
D | 2400 | QTY01 | - | 673
 
Question Number/Letter
Identifies the question or letter number.
837 - Health Care Claim Professional
D | 2440 | FRM01 | - | 350
 
Question Response
A yes/no question response.
837 - Health Care Claim Professional
D | 2440 | FRM02 | - | 1073
D | 2440 | FRM03 | - | 127
D | 2440 | FRM04 | - | 373
D | 2440 | FRM05 | - | 332
 
Reason for Service Code
Code identifying the type of utilization conflict detected.
837 - Health Care Claim Professional
D | 2410 | SV707 | C059-01 | 1738
 
Receiver Name
Name of organization receiving the transaction.
837 - Health Care Claim Professional
H | 1000B | NM103 | - | 1035
 
Receiver Primary Identifier
Primary identification number for the receiver of the transaction.
837 - Health Care Claim Professional
H | 1000B | NM109 | - | 67
 
Reference Identification Qualifier
Code qualifying the reference identification.
837 - Health Care Claim Professional
D | 2000A | PRV02 | - | 128
D | 2010AA | REF01 | - | 128
D | 2010AC | REF01 | - | 128
D | 2010AC | REF01 | - | 128
D | 2010AD | REF01 | - | 128
D | 2010AD | REF01 | - | 128
D | 2010BA | REF01 | - | 128
D | 2010BA | REF01 | - | 128
D | 2010BB | REF01 | - | 128
D | 2010BB | REF01 | - | 128
D | 2010CA | REF01 | - | 128
D | 2010CA | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2300 | REF01 | - | 128
D | 2310A | REF01 | - | 128
D | 2310B | PRV02 | - | 128
D | 2310B | REF01 | - | 128
D | 2310C | REF01 | - | 128
D | 2330A | REF01 | - | 128
D | 2330B | REF01 | - | 128
D | 2330B | REF01 | - | 128
D | 2330B | REF01 | - | 128
D | 2330B | REF01 | - | 128
D | 2330B | REF01 | - | 128
D | 2330B | REF01 | - | 128
D | 2330C | REF01 | - | 128
D | 2330D | REF01 | - | 128
D | 2330E | REF01 | - | 128
D | 2330G | REF01 | - | 128
D | 2400 | REF01 | - | 128
D | 2400 | REF04 | C040-01 | 128
D | 2400 | REF01 | - | 128
D | 2400 | REF01 | - | 128
D | 2400 | REF01 | - | 128
D | 2400 | REF04 | C040-01 | 128
D | 2400 | REF01 | - | 128
D | 2400 | REF01 | - | 128
D | 2400 | REF01 | - | 128
D | 2400 | REF01 | - | 128
D | 2400 | REF01 | - | 128
D | 2400 | REF01 | - | 128
D | 2400 | REF04 | C040-01 | 128
D | 2410 | REF01 | - | 128
D | 2420A | PRV02 | - | 128
D | 2420A | REF01 | - | 128
D | 2420A | REF04 | C040-01 | 128
D | 2420B | REF01 | - | 128
D | 2420B | REF04 | C040-01 | 128
D | 2420C | REF01 | - | 128
D | 2420C | REF04 | C040-01 | 128
D | 2420E | REF01 | - | 128
D | 2420E | REF04 | C040-01 | 128
D | 2420F | REF01 | - | 128
D | 2420F | REF04 | C040-01 | 128
 
Referral Number
Referral authorization number.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
D | 2400 | REF02 | - | 127
 
Referring CLIA Number
Referring Clinical Laboratory Improvement Amendment (CLIA) facility identification.
837 - Health Care Claim Professional
D | 2400 | REF02 | - | 127
 
Referring Provider First Name
The first name of provider who referred the patient to the provider of service on this claim.
837 - Health Care Claim Professional
D | 2310A | NM104 | - | 1036
D | 2420F | NM104 | - | 1036
 
Referring Provider Identifier
The identification number for the referring physician.
837 - Health Care Claim Professional
D | 2310A | NM109 | - | 67
D | 2420F | NM109 | - | 67
 
Referring Provider Last Name
The Last Name of Provider who referred the patient to the provider of service on this claim.
837 - Health Care Claim Professional
D | 2310A | NM103 | - | 1035
D | 2420F | NM103 | - | 1035
 
Referring Provider Middle Name or Initial
Middle name or initial of the provider who is referring patient for care.
837 - Health Care Claim Professional
D | 2310A | NM105 | - | 1037
D | 2420F | NM105 | - | 1037
 
Referring Provider Name Suffix
Suffix to the name of the provider referring the patient for care.
837 - Health Care Claim Professional
D | 2310A | NM107 | - | 1039
D | 2420F | NM107 | - | 1039
 
Referring Provider Secondary Identifier
Additional identification number for the provider referring the patient for service.
837 - Health Care Claim Professional
D | 2310A | REF02 | - | 127
D | 2420F | REF02 | - | 127
 
Reimbursement Rate
Rate used when payment is based upon a percentage of applicable charges.
837 - Health Care Claim Professional
D | 2320 | MOA01 | - | 954
 
Reject Reason Code
Code assigned by issuer to identify reason for rejection.
837 - Health Care Claim Professional
D | 2300 | HCP13 | - | 901
D | 2400 | HCP13 | - | 901
 
Related Causes Code
Code identifying an accompanying cause of an illness, injury, or an accident.
837 - Health Care Claim Professional
D | 2300 | CLM11 | C024-01 | 1362
D | 2300 | CLM11 | C024-02 | 1362
 
Related Hospitalization Admission Date
The date the patient was admitted for inpatient care related to current service.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
 
Related Hospitalization Discharge Date
The date the patient was discharged from the inpatient care referenced in the applicable hospitalization or hospice date.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
 
Release of Information Code
Code indicating whether the provider has on file a signed statement permitting the release of medical data to other organizations.
837 - Health Care Claim Professional
D | 2300 | CLM09 | - | 1363
 
Relinquished Care Date
Date the provider ceased post-operative care.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
 
Remaining Patient Liability
In the judgement of the provider, the amount that remained to be paid after adjudication by this Other Payer.
837 - Health Care Claim Professional
D | 2320 | AMT02 | - | 782
D | 2430 | AMT02 | - | 782
 
Remark Code
Code indicating a code from a specific industry code list, such as the Health Care Claim Status Code list.
837 - Health Care Claim Professional
D | 2320 | RAS03 | C058-03 | 1271
D | 2320 | RAS03 | C058-04 | 1271
D | 2320 | RAS03 | C058-05 | 1271
D | 2320 | RAS03 | C058-06 | 1271
D | 2320 | RAS03 | C058-07 | 1271
D | 2320 | LQ02 | - | 1271
D | 2430 | RAS03 | C058-03 | 1271
D | 2430 | RAS03 | C058-04 | 1271
D | 2430 | RAS03 | C058-05 | 1271
D | 2430 | RAS03 | C058-06 | 1271
D | 2430 | RAS03 | C058-07 | 1271
D | 2430 | III02 | - | 1271
D | 2430 | LQ02 | - | 1271
 
Rendering Provider First Name
The first name of the provider who performed the service.
837 - Health Care Claim Professional
D | 2310B | NM104 | - | 1036
D | 2420A | NM104 | - | 1036
 
Rendering Provider Identifier
The identifier assigned by the Payer to the provider who performed the service.
837 - Health Care Claim Professional
D | 2310B | NM109 | - | 67
D | 2420A | NM109 | - | 67
 
Rendering Provider Last Name
The last name of the provider who performed the service.
837 - Health Care Claim Professional
D | 2310B | NM103 | - | 1035
D | 2420A | NM103 | - | 1035
 
Rendering Provider Middle Name or Initial
Middle name or initial of the provider who has provided the services to the patient.
837 - Health Care Claim Professional
D | 2310B | NM105 | - | 1037
D | 2420A | NM105 | - | 1037
 
Rendering Provider Name Suffix
Name suffix of the provider who has provided the services to the patient.
837 - Health Care Claim Professional
D | 2310B | NM107 | - | 1039
D | 2420A | NM107 | - | 1039
 
Rendering Provider Secondary Identifier
Additional identifier for the provider providing care to the patient.
837 - Health Care Claim Professional
D | 2310B | REF02 | - | 127
D | 2420A | REF02 | - | 127
 
Rental Unit Price Indicator
Frequency at which the rental equipment is billed. Used in conjunction with the DME Rental Price.
837 - Health Care Claim Professional
D | 2400 | SV506 | - | 594
 
Repriced Allowed Amount
The maximum amount determined by the repricer as being allowable under the provisions of the contract prior to the determination of the actual payment.
837 - Health Care Claim Professional
D | 2300 | HCP02 | - | 782
D | 2400 | HCP02 | - | 782
 
Repriced Approved Ambulatory Patient Group (APG) Amount
Amount of payment by the repricer for the referenced Ambulatory Patient Group.
837 - Health Care Claim Professional
D | 2400 | HCP07 | - | 782
 
Repriced Approved Ambulatory Patient Group (APG) Code
Identifier for Ambulatory Patient Group assigned to the claim by the repricer.
837 - Health Care Claim Professional
D | 2400 | HCP06 | - | 127
 
Repriced Approved Procedure Code
The procedure code that describes the services as approved by the repricer.
837 - Health Care Claim Professional
D | 2400 | HCP10 | - | 234
 
Repriced Approved Service Unit Count
Number of service units approved by pricing or repricing entity.
837 - Health Care Claim Professional
D | 2400 | HCP12 | - | 380
 
Repriced Claim Reference Number
Identification number, assigned by a repricing organization, to identify the claim.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
 
Repriced Line Item Reference Number
Identification number of a line item repriced by a third party or prior payer.
837 - Health Care Claim Professional
D | 2400 | REF02 | - | 127
 
Repriced Savings Amount
The amount of savings related to Third Party Organization claims.
837 - Health Care Claim Professional
D | 2300 | HCP03 | - | 782
D | 2400 | HCP03 | - | 782
 
Repricer Received Date
Date the claim was received by the repricer organization.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251
 
Repricing Organization Identifier
Reference or identification number of the repricing organization.
837 - Health Care Claim Professional
D | 2300 | HCP04 | - | 127
D | 2400 | HCP04 | - | 127
 
Repricing Per Diem or Flat Rate Amount
Amount used to determine the flat rate or per diem price by the repricing organization.
837 - Health Care Claim Professional
D | 2300 | HCP05 | - | 118
D | 2400 | HCP05 | - | 118
 
Result of Service Code
Code identifying action taken by a pharmacist in response to a conflict.
837 - Health Care Claim Professional
D | 2410 | SV707 | C059-03 | 1740
 
Round Trip Purpose Description
Free-form description of the purpose of the ambulance transport round trip.
837 - Health Care Claim Professional
D | 2300 | CR109 | - | 352
D | 2400 | CR109 | - | 352
 
Service Allowed Amount
The amount the payer deems payable for this service, prior to considering patient responsibility.
837 - Health Care Claim Professional
D | 2430 | AMT02 | - | 782
 
Service Date
Date of service, such as the start date of the service, the end date of the service, or the single day date of the service.
837 - Health Care Claim Professional
D | 2400 | DTP03 | - | 1251
 
Service Line Paid Amount
Amount paid by the indicated payer for a service line
837 - Health Care Claim Professional
D | 2430 | SVD02 | - | 782
 
Service Location Address Line
Address line of the service location address.
837 - Health Care Claim Professional
D | 2310C | N301 | - | 166
D | 2310C | N302 | - | 166
D | 2420C | N301 | - | 166
D | 2420C | N302 | - | 166
 
Service Location City Name
City of the service location.
837 - Health Care Claim Professional
D | 2310C | N401 | - | 19
D | 2420C | N401 | - | 19
 
Service Location Country Code
Country code for the service location.
837 - Health Care Claim Professional
D | 2310C | N404 | - | 26
D | 2420C | N404 | - | 26
 
Service Location Country Subdivision Code
Country Subdivision code for the service location.
837 - Health Care Claim Professional
D | 2310C | N407 | - | 1715
D | 2420C | N407 | - | 1715
 
Service Location Name
Name of the service location.
837 - Health Care Claim Professional
D | 2310C | NM103 | - | 1035
D | 2420C | NM103 | - | 1035
 
Service Location Postal Zone or ZIP Code
Postal zone code or ZIP code for the service location.
837 - Health Care Claim Professional
D | 2310C | N403 | - | 116
D | 2420C | N403 | - | 116
 
Service Location Primary Identifier
The primary identification number for the service location.
837 - Health Care Claim Professional
D | 2310C | NM109 | - | 67
D | 2420C | NM109 | - | 67
 
Service Location Secondary Identifier
Secondary identification number for the service location.
837 - Health Care Claim Professional
D | 2310C | REF02 | - | 127
D | 2420C | REF02 | - | 127
 
Service Location State or Province Code
State or province for the service location.
837 - Health Care Claim Professional
D | 2310C | N402 | - | 156
D | 2420C | N402 | - | 156
 
Service Unit Count
The quantity of units, times, days, visits, services, or treatments for the service described by the HCPCS codes, revenue code or procedure code.
837 - Health Care Claim Professional
D | 2400 | SV104 | - | 380
 
Shipped Date
Date product shipped.
837 - Health Care Claim Professional
D | 2400 | DTP03 | - | 1251
 
Special Program Indicator
A code indicating the Special Program under which the services rendered to the patient were performed.
837 - Health Care Claim Professional
D | 2300 | CLM12 | - | 1366
 
State Care Tax
Tax reported for State purposes (not Sales Tax).
837 - Health Care Claim Professional
D | 2400 | AMT02 | - | 782
 
State of Claim Jurisdiction
Jurisdictional state that defines the rules, regulations, statutes, or guidelines under which the electronic claim/bill is being submitted.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
 
Stretcher Purpose Description
Free-form description of the purpose of the use of a stretcher during ambulance service.
837 - Health Care Claim Professional
D | 2300 | CR110 | - | 352
D | 2400 | CR110 | - | 352
 
Submission Clarification Code
Code indicating that the pharmacist is clarifying the submission.
837 - Health Care Claim Professional
D | 2410 | SV419 | - | 1734
 
Submitted Drug Sales Tax Code
Code indicating the basis for percentage sales tax.
837 - Health Care Claim Professional
D | 2410 | SV422 | - | 1737
 
Submitter Contact Name
Name of the person at the submitter organization to whom inquiries about the transaction should be directed.
837 - Health Care Claim Professional
H | 1000A | PER02 | - | 93
 
Submitter First Name
The first name of the person submitting the transaction or receiving the transaction, as identified by the preceding identification code.
837 - Health Care Claim Professional
H | 1000A | NM104 | - | 1036
 
Submitter Identifier
Code or number identifying the entity submitting the claim.
837 - Health Care Claim Professional
H | 1000A | NM109 | - | 67
 
Submitter Last or Organization Name
The last name or the organizational name of the entity submitting the transaction
837 - Health Care Claim Professional
H | 1000A | NM103 | - | 1035
 
Submitter Middle Name or Initial
The middle name or initial of the person submitting the transaction.
837 - Health Care Claim Professional
H | 1000A | NM105 | - | 1037
 
Subscriber Address Line
Address line of the current mailing address of the insured individual or subscriber to the coverage.
837 - Health Care Claim Professional
D | 2010BA | N301 | - | 166
D | 2010BA | N302 | - | 166
 
Subscriber Birth Date
The date of birth of the subscriber to the indicated coverage or policy.
837 - Health Care Claim Professional
D | 2010BA | DMG02 | - | 1251
 
Subscriber City Name
The City Name of the insured individual or subscriber to the coverage.
837 - Health Care Claim Professional
D | 2010BA | N401 | - | 19
 
Subscriber Country Code
The code identifying the country of the insured or subscriber address.
837 - Health Care Claim Professional
D | 2010BA | N404 | - | 26
 
Subscriber Country Subdivision Code
The country subdivision code of the insured or subscriber address.
837 - Health Care Claim Professional
D | 2010BA | N407 | - | 1715
 
Subscriber First Name
The first name of the insured individual or subscriber to the coverage.
837 - Health Care Claim Professional
D | 2010BA | NM104 | - | 1036
 
Subscriber Gender Code
Code indicating the sex of the subscriber to the indicated coverage or policy.
837 - Health Care Claim Professional
D | 2010BA | DMG03 | - | 1068
 
Subscriber Group Name
Name of the group through which the coverage is provided to the subscriber.
837 - Health Care Claim Professional
D | 2000B | SBR04 | - | 93
 
Subscriber Group or Policy Number
The identifier assigned by the health plan or administrator to identify the group through which the coverage is provided to the subscriber.
837 - Health Care Claim Professional
D | 2000B | SBR03 | - | 127
 
Subscriber Last Name or Organization Name
The last name or organization name of the subscriber to the coverage.
837 - Health Care Claim Professional
D | 2010BA | NM103 | - | 1035
 
Subscriber Middle Name or Initial
The middle name or initial of the subscriber to the indicated coverage or policy.
837 - Health Care Claim Professional
D | 2010BA | NM105 | - | 1037
 
Subscriber Name Suffix
Suffix of the insured individual or subscriber to the coverage.
837 - Health Care Claim Professional
D | 2010BA | NM107 | - | 1039
 
Subscriber Postal Zone or ZIP Code
The ZIP Code of the insured individual or subscriber to the coverage.
837 - Health Care Claim Professional
D | 2010BA | N403 | - | 116
 
Subscriber Primary Identifier
Primary identification number of the subscriber to the coverage.
837 - Health Care Claim Professional
D | 2010BA | NM109 | - | 67
 
Subscriber Social Security Number
This is the number assigned to the subscriber by the Social Security Administration.
837 - Health Care Claim Professional
D | 2010BA | REF02 | - | 127
 
Subscriber State or Province Code
The State Postal Code of the insured individual or subscriber to the coverage.
837 - Health Care Claim Professional
D | 2010BA | N402 | - | 156
 
Supervising Provider First Name
The First Name of the Provider who supervised the rendering of a service on this claim.
837 - Health Care Claim Professional
D | 2310D | NM104 | - | 1036
D | 2420D | NM104 | - | 1036
 
Supervising Provider Identifier
The Identification Number for the Supervising Provider.
837 - Health Care Claim Professional
D | 2310D | NM109 | - | 67
D | 2420D | NM109 | - | 67
 
Supervising Provider Last Name
The Last Name of the Provider who supervised the rendering of a service on this claim.
837 - Health Care Claim Professional
D | 2310D | NM103 | - | 1035
D | 2420D | NM103 | - | 1035
 
Supervising Provider Middle Name or Initial
Middle name or initial of the provider supervising care rendered to the patient.
837 - Health Care Claim Professional
D | 2310D | NM105 | - | 1037
D | 2420D | NM105 | - | 1037
 
Supervising Provider Name Suffix
Suffix to the name of the provider supervising care rendered to the patient.
837 - Health Care Claim Professional
D | 2310D | NM107 | - | 1039
D | 2420D | NM107 | - | 1039
 
Temporary Solution for a Statutory/Regulatory Requirement
The unexpected data requirement of a legislative authority.
837 - Health Care Claim Professional
D | 2300 | K301 | - | 449
D | 2400 | K301 | - | 449
 
Terms Discount Percentage
Discount percentage available to the payer for payment within a specific time period.
837 - Health Care Claim Professional
D | 2300 | CN105 | - | 338
D | 2400 | CN105 | - | 338
 
Test Performed Date
The date the patient was tested for Hemoglobin, Hematocrit or Serum Creatinine.
837 - Health Care Claim Professional
D | 2400 | DTP03 | - | 1251
 
Test Results
The results of Hemoglobin, Hematocrit or Creatinine tests, Epoetin Starting Dosage, or the Patient's Height.
837 - Health Care Claim Professional
D | 2400 | MEA03 | - | 739
 
Tooth Surface Code
The surface(s) of the tooth on which services were performed or will be performed.
837 - Health Care Claim Professional
D | 2400 | TOO03 | C005-01 | 1369
D | 2400 | TOO03 | C005-02 | 1369
D | 2400 | TOO03 | C005-03 | 1369
D | 2400 | TOO03 | C005-04 | 1369
D | 2400 | TOO03 | C005-05 | 1369
 
Total Claim Charge Amount
The sum of all charges included within this claim.
837 - Health Care Claim Professional
D | 2300 | CLM02 | - | 782
 
Transaction Segment Count
A tally of all segments between the ST and the SE segments including the ST and SE segments.
837 - Health Care Claim Professional
D | | SE01 | - | 96
 
Transaction Set Control Number
The unique identification number within a transaction set.
837 - Health Care Claim Professional
H | | ST02 | - | 329
D | | SE02 | - | 329
 
Transaction Set Creation Date
Identifies the date the submitter created the transaction.
837 - Health Care Claim Professional
H | | BHT04 | - | 373
 
Transaction Set Creation Time
Time file is created for transmission.
837 - Health Care Claim Professional
H | | BHT05 | - | 337
 
Transaction Set Identifier Code
Code uniquely identifying a Transaction Set.
837 - Health Care Claim Professional
H | | ST01 | - | 143
 
Transaction Set Purpose Code
Code identifying purpose of transaction set.
837 - Health Care Claim Professional
H | | BHT02 | - | 353
 
Transport Distance
Distance traveled during the ambulance transport.
837 - Health Care Claim Professional
D | 2300 | CR106 | - | 380
D | 2400 | CR106 | - | 380
 
Unit Dose Code
Code indicating the type of unit dose dispensing done.
837 - Health Care Claim Professional
D | 2410 | SV411 | - | 1370
 
Unit or Basis for Measurement Code
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken.
837 - Health Care Claim Professional
D | 2000B | PAT07 | - | 355
D | 2000C | PAT07 | - | 355
D | 2300 | CR101 | - | 355
D | 2300 | CR105 | - | 355
D | 2400 | SV103 | - | 355
D | 2400 | SV502 | - | 355
D | 2400 | CR101 | - | 355
D | 2400 | CR105 | - | 355
D | 2400 | CR302 | - | 355
D | 2400 | HCP11 | - | 355
 
Usual and Customary Charge
The usual and customary charge amount of the drug prescribed.
837 - Health Care Claim Professional
D | 2400 | AMT02 | - | 782
 
Value Added Network Trace Number
Unique Identification number for a transaction assigned by a Value Added Network, Clearinghouse, or other transmission entity.
837 - Health Care Claim Professional
D | 2300 | REF02 | - | 127
 
Work Return Date
Date patient was or is able to return to the patient's normal occupation or to a similar or substitute occupation.
837 - Health Care Claim Professional
D | 2300 | DTP03 | - | 1251