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
 
Adjusted Repriced Claim Reference Number
Identification number, assigned by a repricing organization, to identify an adjusted claim.
837 - Health Care Claim Institutional
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 Institutional
D | 2400 | REF02 | - | 127
 
Adjustment Amount
Adjustment amount for the associated reason code.
837 - Health Care Claim Institutional
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 Institutional
D | 2320 | RAS04 | - | 380
D | 2430 | RAS04 | - | 380
 
Adjustment Reason Code
Code that indicates the reason for the adjustment.
837 - Health Care Claim Institutional
D | 2320 | RAS03 | C058-01 | 1034
D | 2430 | RAS03 | C058-01 | 1034
 
Admission Date/Hour or Start of Care Date
The date and time of the admission to the facility or the start date for this episode of care.
837 - Health Care Claim Institutional
D | 2300 | DTP03 | - | 1251
 
Admission Source Code
Code indicating the source of this admission.
837 - Health Care Claim Institutional
D | 2300 | CL102 | - | 1314
 
Admission Type Code
Code indicating the priority of this admission.
837 - Health Care Claim Institutional
D | 2300 | CL101 | - | 1315
 
Admitting Diagnosis Code
The diagnosis code describing the patient's diagnosis at the time of admission.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-02 | 1271
 
Amount Qualifier Code
Code to qualify amount.
837 - Health Care Claim Institutional
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 | 2430 | AMT01 | - | 522
D | 2430 | AMT01 | - | 522
 
Assigned Number
Number assigned for differentiation within a transaction set.
837 - Health Care Claim Institutional
D | 2400 | LX01 | - | 554
 
Assignment or Plan Participation Code
An indication, used by a health plan, that the provider does or does not accept assignment of benefits.
837 - Health Care Claim Institutional
D | 2300 | CLM07 | - | 1359
 
Attachment Control Number
Identification number of attachment related to the claim.
837 - Health Care Claim Institutional
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 Institutional
D | 2300 | 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 Institutional
D | 2300 | PWK02 | - | 756
D | 2400 | PWK02 | - | 756
 
Attending Provider First Name
First Name of the provider responsible for the care of the patient.
837 - Health Care Claim Institutional
D | 2310A | NM104 | - | 1036
 
Attending Provider Last Name
Last Name of the provider responsible for the care of the patient.
837 - Health Care Claim Institutional
D | 2310A | NM103 | - | 1035
 
Attending Provider Middle Name or Initial
Middle name or initial of the provider responsible for care of the patient.
837 - Health Care Claim Institutional
D | 2310A | NM105 | - | 1037
 
Attending Provider Name Suffix
Suffix to the name of the provider responsible for the care of the patient.
837 - Health Care Claim Institutional
D | 2310A | NM107 | - | 1039
 
Attending Provider Primary Identifier
Primary identifier for the provider responsible for the care of the patient.
837 - Health Care Claim Institutional
D | 2310A | NM109 | - | 67
 
Attending Provider Secondary Identifier
Additional identifier for the provider responsible for the care of the patient.
837 - Health Care Claim Institutional
D | 2310A | REF02 | - | 127
 
Auto Accident State or Province Code
State or Province where auto accident occurred.
837 - Health Care Claim Institutional
D | 2300 | CLM11 | C024-04 | 156
 
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 Institutional
D | 2300 | CLM08 | - | 1073
D | 2320 | OI03 | - | 1073
 
Billing Note Text
Free-form text providing additional information about the bill or claim being submitted.
837 - Health Care Claim Institutional
D | 2300 | NTE02 | - | 352
 
Billing Provider Address Line
Address line of the billing provider or billing entity address.
837 - Health Care Claim Institutional
D | 2010AA | N301 | - | 166
D | 2010AA | N302 | - | 166
 
Billing Provider City Name
City of the billing provider or billing entity
837 - Health Care Claim Institutional
D | 2010AA | N401 | - | 19
 
Billing Provider Contact Name
Person at billing organization to contact regarding the billing transaction.
837 - Health Care Claim Institutional
D | 2010AA | PER02 | - | 93
 
Billing Provider Country Code
Country code for the provider or billing entity billing for services.
837 - Health Care Claim Institutional
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 Institutional
D | 2010AA | N407 | - | 1715
 
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 Institutional
D | 2010AA | NM109 | - | 67
 
Billing Provider Organizational Name
Organization name of the entity billing for services.
837 - Health Care Claim Institutional
D | 2010AA | NM103 | - | 1035
 
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 Institutional
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 Institutional
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 Institutional
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 Institutional
D | 2010AA | REF02 | - | 127
 
Bundled Line Number
Identification of line item bundled by payer in payment of benefits.
837 - Health Care Claim Institutional
D | 2430 | SVD06 | - | 554
 
Certification Condition Code Applies Indicator
Code indicating whether or not the condition codes apply to the patient or another entity.
837 - Health Care Claim Institutional
D | 2300 | CRC02 | - | 1073
 
Claim Adjustment Group Code
Code identifying the general category of payment adjustment.
837 - Health Care Claim Institutional
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 Institutional
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 Institutional
D | 2300 | CLM21 | - | 1774
 
Claim DRG Amount
Total of Prospective Payment System operating and capital amounts for this claim.
837 - Health Care Claim Institutional
D | 2320 | MIA04 | - | 782
 
Claim Disproportionate Share Amount
Sum of operating capital disproportionate share amounts for this claim.
837 - Health Care Claim Institutional
D | 2320 | MIA06 | - | 782
 
Claim Filing Indicator Code
Code identifying type of claim or expected adjudication process.
837 - Health Care Claim Institutional
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 Institutional
D | 2300 | CLM05 | C023-03 | 1325
 
Claim Identifier
Identifies type of claims in this transaction.
837 - Health Care Claim Institutional
H | | BHT06 | - | 640
 
Claim Indirect Teaching Amount
Total of operating and capital indirect teaching amounts for this claim.
837 - Health Care Claim Institutional
D | 2320 | MIA18 | - | 782
 
Claim MSP Pass-through Amount
Interim cost pass-though amount used to determine Medicare Secondary Payer liability.
837 - Health Care Claim Institutional
D | 2320 | MIA07 | - | 782
 
Claim Note Text
Narrative text providing additional information related to the claim.
837 - Health Care Claim Institutional
D | 2300 | NTE02 | - | 352
 
Claim PPS Capital Amount
Total Prospective Payment System (PPS) capital amount payable for this claim as output by PPS PRICER.
837 - Health Care Claim Institutional
D | 2320 | MIA08 | - | 782
 
Claim PPS Capital Outlier Amount
Total Prospective Payment System capital day or cost outlier payable for this claim, excluding operating outlier amount.
837 - Health Care Claim Institutional
D | 2320 | MIA17 | - | 782
 
Code List Qualifier Code
Code identifying a specific industry code list.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI01 | C022-01 | 1270
D | 2300 | HI02 | C022-01 | 1270
D | 2300 | HI03 | 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 | 2300 | HI01 | 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 | 2300 | HI01 | 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 | 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 | 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 | 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 | 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 | 2430 | RAS03 | C058-02 | 1270
D | 2430 | LQ01 | - | 1270
 
Code Qualifier
Code identifying the type of unit or measurement.
837 - Health Care Claim Institutional
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 Institutional
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
 
Communication Number Qualifier
Code identifying the type of communication number.
837 - Health Care Claim Institutional
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
 
Condition Code
Code(s) used to identify condition(s) relating to this bill or relating to the patient.
837 - Health Care Claim Institutional
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
 
Condition Indicator
Code indicating a condition
837 - Health Care Claim Institutional
D | 2300 | CRC03 | - | 1321
D | 2300 | CRC04 | - | 1321
D | 2300 | CRC05 | - | 1321
 
Contact Function Code
Code identifying the major duty or responsibility of the person or group named.
837 - Health Care Claim Institutional
H | 1000A | PER01 | - | 366
D | 2010AA | PER01 | - | 366
D | 2010AD | PER01 | - | 366
D | 2010BA | PER01 | - | 366
D | 2010CA | PER01 | - | 366
 
Contract Amount
Fixed monetary amount pertaining to the contract
837 - Health Care Claim Institutional
D | 2300 | CN102 | - | 782
 
Contract Code
Code identifying the specific contract, established by the payer.
837 - Health Care Claim Institutional
D | 2300 | CN104 | - | 127
 
Contract Percentage
Percent of charges payable under the contract
837 - Health Care Claim Institutional
D | 2300 | CN103 | - | 332
 
Contract Type Code
Code identifying a contract type
837 - Health Care Claim Institutional
D | 2300 | 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 Institutional
D | 2300 | CN106 | - | 799
 
Cost Report Day Count
The number of days that may be claimed as Medicare patient days on a cost report.
837 - Health Care Claim Institutional
D | 2320 | MIA15 | - | 380
 
Country Code
Code indicating the geographic location.
837 - Health Care Claim Institutional
D | 2010AB | N404 | - | 26
D | 2300 | CLM11 | C024-05 | 26
 
Covered Days or Visits Count
Number of days or visits covered by the primary payer or days/visits that would have been covered had Medicare been primary.
837 - Health Care Claim Institutional
D | 2320 | MIA01 | - | 380
 
Currency Code
Code for country in whose currency the charges are specified.
837 - Health Care Claim Institutional
D | 2000A | CUR02 | - | 100
 
Date Time Period
Expression of a date, a time, or a range of dates, times, or dates and times.
837 - Health Care Claim Institutional
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 Institutional
D | 2010BA | DMG01 | - | 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 | HI01 | C022-03 | 1250
D | 2300 | HI01 | C022-03 | 1250
D | 2300 | HI02 | C022-03 | 1250
D | 2300 | HI03 | C022-03 | 1250
D | 2300 | HI04 | C022-03 | 1250
D | 2300 | HI05 | C022-03 | 1250
D | 2300 | HI06 | C022-03 | 1250
D | 2300 | HI07 | C022-03 | 1250
D | 2300 | HI08 | C022-03 | 1250
D | 2300 | HI09 | C022-03 | 1250
D | 2300 | HI10 | C022-03 | 1250
D | 2300 | HI11 | C022-03 | 1250
D | 2300 | HI12 | C022-03 | 1250
D | 2300 | HI01 | C022-03 | 1250
D | 2300 | HI02 | C022-03 | 1250
D | 2300 | HI03 | C022-03 | 1250
D | 2300 | HI04 | C022-03 | 1250
D | 2300 | HI05 | C022-03 | 1250
D | 2300 | HI06 | C022-03 | 1250
D | 2300 | HI07 | C022-03 | 1250
D | 2300 | HI08 | C022-03 | 1250
D | 2300 | HI09 | C022-03 | 1250
D | 2300 | HI10 | C022-03 | 1250
D | 2300 | HI11 | C022-03 | 1250
D | 2300 | HI12 | C022-03 | 1250
D | 2300 | HI01 | C022-03 | 1250
D | 2300 | HI02 | C022-03 | 1250
D | 2300 | HI03 | C022-03 | 1250
D | 2300 | HI04 | C022-03 | 1250
D | 2300 | HI05 | C022-03 | 1250
D | 2300 | HI06 | C022-03 | 1250
D | 2300 | HI07 | C022-03 | 1250
D | 2300 | HI08 | C022-03 | 1250
D | 2300 | HI09 | C022-03 | 1250
D | 2300 | HI10 | C022-03 | 1250
D | 2300 | HI11 | C022-03 | 1250
D | 2300 | HI12 | C022-03 | 1250
D | 2330B | 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 Institutional
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 | 2430 | DTP01 | - | 374
 
Delay Reason Code
Code indicating the reason why a request was delayed.
837 - Health Care Claim Institutional
D | 2300 | CLM20 | - | 1514
 
Demonstration Project Identifier
Identification number for a Medicare demonstration project.
837 - Health Care Claim Institutional
D | 2300 | REF02 | - | 127
 
Description
A free-form description to clarify the related data elements and their content.
837 - Health Care Claim Institutional
D | 2400 | SV202 | 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 Institutional
D | 2300 | CR806 | - | 127
 
Diagnosis Related Group (DRG) Code
Code identifying the Diagnosis Related Group.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-02 | 1271
 
Discharge Time
Time the patient was discharged from the inpatient care.
837 - Health Care Claim Institutional
D | 2300 | DTP03 | - | 1251
 
Drug Quantity Administered
The quantity of the drug administered, based upon the unit of measure as defined by the National Drug Code.
837 - Health Care Claim Institutional
D | 2410 | CTP04 | - | 380
 
End Stage Renal Disease Payment Amount
Amount of payment under End Stage Renal Disease benefit.
837 - Health Care Claim Institutional
D | 2320 | MOA08 | - | 782
 
Entity Identifier Code
Code identifying an organizational entity, a physical location, property or an individual.
837 - Health Care Claim Institutional
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 | 2330F | NM101 | - | 98
D | 2330G | NM101 | - | 98
D | 2330H | NM101 | - | 98
D | 2330I | NM101 | - | 98
D | 2420A | NM101 | - | 98
D | 2420B | NM101 | - | 98
D | 2420C | NM101 | - | 98
D | 2420D | NM101 | - | 98
 
Entity Type Qualifier
Code qualifying the type of entity.
837 - Health Care Claim Institutional
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 | 2330F | NM102 | - | 1065
D | 2330G | NM102 | - | 1065
D | 2330H | NM102 | - | 1065
D | 2330I | NM102 | - | 1065
D | 2420A | NM102 | - | 1065
D | 2420B | NM102 | - | 1065
D | 2420C | NM102 | - | 1065
D | 2420D | NM102 | - | 1065
 
Exception Code
Exception code generated by the Third Party Organization.
837 - Health Care Claim Institutional
D | 2300 | HCP15 | - | 1527
D | 2400 | HCP15 | - | 1527
 
External Cause of Injury Code
Code identifying the cause of the injury.
837 - Health Care Claim Institutional
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
 
Facility Code Qualifier
Code identifying the type of facility referenced.
837 - Health Care Claim Institutional
D | 2300 | CLM05 | C023-02 | 1332
 
Facility Tax Amount
The amount of facility tax or surcharge applicable to the reported service.
837 - Health Care Claim Institutional
D | 2400 | AMT02 | - | 782
 
Facility Type Code
Code identifying the type of facility where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format.
837 - Health Care Claim Institutional
D | 2300 | CLM05 | C023-01 | 1331
 
HCPCS Payable Amount
Amount due under Medicare HCPCS system.
837 - Health Care Claim Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
H | | BHT01 | - | 1005
 
Identification Code Qualifier
Code designating the system/method of code structure used for Identification Code (67).
837 - Health Care Claim Institutional
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 | 2310E | NM108 | - | 66
D | 2310F | 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
 
Implant Status Code
Code identifying the status of implant components
837 - Health Care Claim Institutional
D | 2300 | CR802 | - | 1404
 
Implant Type Code
Code identifying implant components
837 - Health Care Claim Institutional
D | 2300 | CR801 | - | 1403
 
Individual Relationship Code
Code indicating the relationship between two individuals or entities.
837 - Health Care Claim Institutional
D | 2000B | SBR02 | - | 1069
D | 2000C | PAT01 | - | 1069
D | 2320 | SBR02 | - | 1069
 
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 Institutional
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 Institutional
D | 2400 | REF02 | - | 127
 
Lifetime Psychiatric Days Count
Number of lifetime psychiatric days used for this claim.
837 - Health Care Claim Institutional
D | 2320 | MIA03 | - | 380
 
Line Item Charge Amount
Charges related to this service.
837 - Health Care Claim Institutional
D | 2400 | SV203 | - | 782
 
Line Item Control Number
Identifier assigned by the submitter/provider to this line item.
837 - Health Care Claim Institutional
D | 2400 | REF02 | - | 127
 
Line Item Denied Charge or Non-Covered Charge Amount
Line item charges denied or not covered.
837 - Health Care Claim Institutional
D | 2400 | SV207 | - | 782
 
Line Note Text
Narrative text providing additional information related to the service line.
837 - Health Care Claim Institutional
D | 2400 | NTE02 | - | 352
 
Mammography Certification Number
CMS assigned Certification Number of the certified mammography screening center
837 - Health Care Claim Institutional
D | 2300 | REF02 | - | 127
D | 2400 | REF02 | - | 127
 
Medical Record Number
A unique number assigned to patient by the provider to assist in retrieval of medical records.
837 - Health Care Claim Institutional
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 Institutional
D | 2320 | OI07 | - | 1359
 
Name
Free-form name.
837 - Health Care Claim Institutional
D | 2010BA | PER02 | - | 93
 
National Drug Code 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 Institutional
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 Institutional
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 Institutional
D | 2320 | MIA19 | - | 782
D | 2320 | MOA09 | - | 782
 
Note Reference Code
Code identifying the functional area or purpose for which the note applies.
837 - Health Care Claim Institutional
D | 2300 | NTE01 | - | 363
D | 2300 | NTE01 | - | 363
D | 2400 | NTE01 | - | 363
 
Occurrence Code
A code defining a significant event relating to this bill that may affect payer processing.
837 - Health Care Claim Institutional
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
 
Occurrence Code Date
Date associated with the Occurrence Code reported in this composite element.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-04 | 1251
D | 2300 | HI02 | C022-04 | 1251
D | 2300 | HI03 | C022-04 | 1251
D | 2300 | HI04 | C022-04 | 1251
D | 2300 | HI05 | C022-04 | 1251
D | 2300 | HI06 | C022-04 | 1251
D | 2300 | HI07 | C022-04 | 1251
D | 2300 | HI08 | C022-04 | 1251
D | 2300 | HI09 | C022-04 | 1251
D | 2300 | HI10 | C022-04 | 1251
D | 2300 | HI11 | C022-04 | 1251
D | 2300 | HI12 | C022-04 | 1251
 
Occurrence Span Code
A code that identifies an event that relates to payment of the claim. This event occurs over a span of days.
837 - Health Care Claim Institutional
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
 
Occurrence Span Code Date
Date associated with the Occurrence Span Code reported in this composite element.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-04 | 1251
D | 2300 | HI02 | C022-04 | 1251
D | 2300 | HI03 | C022-04 | 1251
D | 2300 | HI04 | C022-04 | 1251
D | 2300 | HI05 | C022-04 | 1251
D | 2300 | HI06 | C022-04 | 1251
D | 2300 | HI07 | C022-04 | 1251
D | 2300 | HI08 | C022-04 | 1251
D | 2300 | HI09 | C022-04 | 1251
D | 2300 | HI10 | C022-04 | 1251
D | 2300 | HI11 | C022-04 | 1251
D | 2300 | HI12 | C022-04 | 1251
 
Old Capital Amount
The amount for old capital for this claim.
837 - Health Care Claim Institutional
D | 2320 | MIA12 | - | 782
 
Operating Physician First Name
First name of the physician performing the principle procedure.
837 - Health Care Claim Institutional
D | 2310B | NM104 | - | 1036
D | 2420A | NM104 | - | 1036
 
Operating Physician Last Name
Last name of the physician performing the principle procedure.
837 - Health Care Claim Institutional
D | 2310B | NM103 | - | 1035
D | 2420A | NM103 | - | 1035
 
Operating Physician Middle Name or Initial
Middle name or initial of the physician performing the principal procedure.
837 - Health Care Claim Institutional
D | 2310B | NM105 | - | 1037
D | 2420A | NM105 | - | 1037
 
Operating Physician Name Suffix
Suffix to the name of the physician performing the principal procedure.
837 - Health Care Claim Institutional
D | 2310B | NM107 | - | 1039
D | 2420A | NM107 | - | 1039
 
Operating Physician Primary Identifier
Primary identifier of the physician performing the principle procedure.
837 - Health Care Claim Institutional
D | 2310B | NM109 | - | 67
D | 2420A | NM109 | - | 67
 
Operating Physician Secondary Identifier
Additional identifier for the physician performing the principal procedure.
837 - Health Care Claim Institutional
D | 2310B | REF02 | - | 127
D | 2420A | REF02 | - | 127
 
Originator Application Transaction Identifier
An identification number that identifies a transaction within the originator's applications system.
837 - Health Care Claim Institutional
H | | BHT03 | - | 127
 
Other Diagnosis
Other diagnosis for this claim.
837 - Health Care Claim Institutional
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
 
Other Insured Group Name
Name of the group or plan through which the insurance is provided to the other insured.
837 - Health Care Claim Institutional
D | 2320 | SBR04 | - | 93
 
Other Operating Physician First Name
First Name of the individual performing a secondary surgical procedure or assisting the Operating Physician.
837 - Health Care Claim Institutional
D | 2310C | NM104 | - | 1036
D | 2420B | NM104 | - | 1036
 
Other Operating Physician Identifier
National identifier for the individual performing a secondary surgical procedure or assisting the Operating Physician.
837 - Health Care Claim Institutional
D | 2310C | NM109 | - | 67
D | 2420B | NM109 | - | 67
 
Other Operating Physician Last Name
Last Name of the individual performing a secondary surgical procedure or assisting the Operating Physician.
837 - Health Care Claim Institutional
D | 2310C | NM103 | - | 1035
D | 2420B | NM103 | - | 1035
 
Other Operating Physician Middle Name or Initial
Middle name or initial of the individual performing a secondary surgical procedure or assisting the Operating Physician.
837 - Health Care Claim Institutional
D | 2310C | NM105 | - | 1037
D | 2420B | NM105 | - | 1037
 
Other Operating Physician Name Suffix
Suffix to the name of the individual performing a secondary surgical procedure or assisting the Operating Physician.
837 - Health Care Claim Institutional
D | 2310C | NM107 | - | 1039
D | 2420B | NM107 | - | 1039
 
Other Payer Address Line
Address line of the other payer's mailing address.
837 - Health Care Claim Institutional
D | 2330B | N301 | - | 166
D | 2330B | N302 | - | 166
 
Other Payer Attending Provider Secondary Identifier
The non-destination (COB) payer's attending provider identification.
837 - Health Care Claim Institutional
D | 2330C | REF02 | - | 127
 
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 Institutional
D | 2330I | REF02 | - | 127
 
Other Payer City Name
The city name of the other payer's mailing address.
837 - Health Care Claim Institutional
D | 2330B | N401 | - | 19
 
Other Payer Claim Adjustment Indicator
Indicates this claim has been adjusted.
837 - Health Care Claim Institutional
D | 2320 | OI08 | - | 1073
 
Other Payer Country Code
Code indicating the geographic location of the other payer.
837 - Health Care Claim Institutional
D | 2330B | N404 | - | 26
 
Other Payer Country Subdivision Code
Subdivision code indicating the geographic location of the other payer.
837 - Health Care Claim Institutional
D | 2330B | N407 | - | 1715
 
Other Payer Operating Provider Secondary Identifier
The non-destination (COB) payer's operating provider identification.
837 - Health Care Claim Institutional
D | 2330D | REF02 | - | 127
 
Other Payer Organization Name
Organization name of this non-destination (COB) payer.
837 - Health Care Claim Institutional
D | 2330B | NM103 | - | 1035
 
Other Payer Other Operating Physician Secondary Identifier
The non-destination (COB) payer's identifier for the individual performing a secondary surgical procedure or assisting the Operating Physician.
837 - Health Care Claim Institutional
D | 2330E | REF02 | - | 127
 
Other Payer Postal Zone or ZIP Code
The ZIP code of the other payer's mailing address.
837 - Health Care Claim Institutional
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 Institutional
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 Institutional
D | 2330B | REF02 | - | 127
 
Other Payer Primary Identifier
An identification number for the other payer.
837 - Health Care Claim Institutional
D | 2330B | NM109 | - | 67
 
Other Payer Prior Authorization Number
The non-destination (COB) payer's prior authorization number.
837 - Health Care Claim Institutional
D | 2330B | REF02 | - | 127
 
Other Payer Referral Number
The non-destination (COB) payer's referral number.
837 - Health Care Claim Institutional
D | 2330B | REF02 | - | 127
 
Other Payer Referring Provider Identifier
The non-destination (COB) payer's referring provider identifier.
837 - Health Care Claim Institutional
D | 2330H | REF02 | - | 127
 
Other Payer Rendering Provider Secondary Identifier
The non-destination (COB) payer's rendering provider identifier.
837 - Health Care Claim Institutional
D | 2330G | 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 Institutional
D | 2320 | SBR01 | - | 1138
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 | 2420D | REF04 | C040-02 | 127
D | 2430 | SVD01 | - | 1138
 
Other Payer Secondary Identifier
Additional identifier for the other payer organization
837 - Health Care Claim Institutional
D | 2330B | REF02 | - | 127
 
Other Payer Service Location Secondary Identifier
The non-destination payer's service location secondary identifier.
837 - Health Care Claim Institutional
D | 2330F | REF02 | - | 127
 
Other Payer State or Province Code
The state or province code of the other payer's mailing address.
837 - Health Care Claim Institutional
D | 2330B | N402 | - | 156
 
Other Payer Voided Claim Indicator
Indicates the claim has been voided.
837 - Health Care Claim Institutional
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 Institutional
D | 2330B | REF02 | - | 127
 
Other Provider Secondary Identifier
Additional identification number of the other provider as defined by the payer organization.
837 - Health Care Claim Institutional
D | 2310C | REF02 | - | 127
D | 2420B | REF02 | - | 127
 
Other Subscriber Address Line
Address line of the Other Subscriber's mailing address.
837 - Health Care Claim Institutional
D | 2330A | N301 | - | 166
D | 2330A | N302 | - | 166
 
Other Subscriber City Name
The city name of the Other Subscriber.
837 - Health Care Claim Institutional
D | 2330A | N401 | - | 19
 
Other Subscriber Country Code
The country code of the Other Subscriber's mailing address.
837 - Health Care Claim Institutional
D | 2330A | N404 | - | 26
 
Other Subscriber Country Subdivision Code
The country subdivision code of the Other Subscriber's mailing address.
837 - Health Care Claim Institutional
D | 2330A | N407 | - | 1715
 
Other Subscriber First Name
The first name of the Other Subscriber.
837 - Health Care Claim Institutional
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 Institutional
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 Institutional
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 Institutional
D | 2330A | NM105 | - | 1037
 
Other Subscriber Name Suffix
The suffix to the name of the Other Subscriber.
837 - Health Care Claim Institutional
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 Institutional
D | 2330A | N403 | - | 116
 
Other Subscriber Social Security Number
Identifier assigned to the other subscriber by the Social Security Administration.
837 - Health Care Claim Institutional
D | 2330A | REF02 | - | 127
 
Other Subscriber State or Province Code
The state code of the Other Subscriber's mailing address.
837 - Health Care Claim Institutional
D | 2330A | N402 | - | 156
 
PPS-Capital DSH DRG Amount
PPS-capital disproportionate share amount for this claim as output by PPS-PRICER.
837 - Health Care Claim Institutional
D | 2320 | MIA11 | - | 782
 
PPS-Capital Exception Amount
A per discharge payment exception paid to the hospital. It is a flat-rate add-on to the PPS payment.
837 - Health Care Claim Institutional
D | 2320 | MIA24 | - | 782
 
PPS-Capital FSP DRG Amount
PPS-capital federal portion for this claim as output by PPS-PRICER.
837 - Health Care Claim Institutional
D | 2320 | MIA09 | - | 782
 
PPS-Capital HSP DRG Amount
Hospital-Specific portion for PPS-capital for this claim as output by PPS-PRICER.
837 - Health Care Claim Institutional
D | 2320 | MIA10 | - | 782
 
PPS-Capital IME amount
PPS-capital indirect medical expenses for this claim as output by PPS-PRICER.
837 - Health Care Claim Institutional
D | 2320 | MIA13 | - | 782
 
PPS-Operating Federal Specific DRG Amount
Sum of federal operating portion of the DRG amount this claim as output by PPS-PRICER.
837 - Health Care Claim Institutional
D | 2320 | MIA16 | - | 782
 
PPS-Operating Hospital Specific DRG Amount
Sum of hospital specific operating portion of DRG amount for this claim as output by PPS-PRICER.
837 - Health Care Claim Institutional
D | 2320 | MIA14 | - | 782
 
Paid Service Unit Count
Units of service paid by the payer for coordination of benefits.
837 - Health Care Claim Institutional
D | 2430 | SVD05 | - | 380
 
Patient Address Line
Address line of the street mailing address of the patient.
837 - Health Care Claim Institutional
D | 2010CA | N301 | - | 166
D | 2010CA | N302 | - | 166
 
Patient Birth Date
Date of birth of the patient.
837 - Health Care Claim Institutional
D | 2010CA | DMG02 | - | 1251
 
Patient City Name
The city name of the patient.
837 - Health Care Claim Institutional
D | 2010CA | N401 | - | 19
 
Patient Country Code
The country code of the patient.
837 - Health Care Claim Institutional
D | 2010CA | N404 | - | 26
 
Patient Country Subdivision Code
The country subdivision code of the patient.
837 - Health Care Claim Institutional
D | 2010CA | N407 | - | 1715
 
Patient First Name
The first name of the individual to whom the services were provided.
837 - Health Care Claim Institutional
D | 2010CA | NM104 | - | 1036
 
Patient Gender Code
A code indicating the sex of the patient.
837 - Health Care Claim Institutional
D | 2010CA | DMG03 | - | 1068
 
Patient Last Name
The last name of the individual to whom the services were provided.
837 - Health Care Claim Institutional
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 Institutional
D | 2010CA | NM105 | - | 1037
 
Patient Name Suffix
Suffix to the name of the individual to whom the services were provided.
837 - Health Care Claim Institutional
D | 2010CA | NM107 | - | 1039
 
Patient Postal Zone or ZIP Code
The ZIP Code of the patient.
837 - Health Care Claim Institutional
D | 2010CA | N403 | - | 116
 
Patient Reason For Visit
The diagnosis code describing the patient's reason for visit at the time of outpatient registration.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-02 | 1271
D | 2300 | HI02 | C022-02 | 1271
D | 2300 | HI03 | C022-02 | 1271
 
Patient State or Province Code
The State Postal Code of the patient.
837 - Health Care Claim Institutional
D | 2010CA | N402 | - | 156
 
Patient Status Code
A code indicating the patient's status at the date of admission, outpatient service, or start of care.
837 - Health Care Claim Institutional
D | 2300 | CL103 | - | 1352
 
Pay-To Address Line
Address line of the provider to receive payment.
837 - Health Care Claim Institutional
D | 2010AB | N301 | - | 166
D | 2010AB | N302 | - | 166
 
Pay-To Plan Address Line
Street address of the Pay-To Plan.
837 - Health Care Claim Institutional
D | 2010AC | N301 | - | 166
D | 2010AC | N302 | - | 166
 
Pay-To Plan City Name
City name of the Pay-To Plan.
837 - Health Care Claim Institutional
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 Institutional
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 Institutional
D | 2010AC | N403 | - | 116
 
Pay-To Plan Primary Identifier
Identification number for the Pay-To Plan.
837 - Health Care Claim Institutional
D | 2010AC | NM109 | - | 67
 
Pay-To Plan State or Province Code
State or province code of the Pay-to Plan.
837 - Health Care Claim Institutional
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 Institutional
D | 2010AC | REF02 | - | 127
 
Pay-to Address City Name
City name of the entity to receive payment.
837 - Health Care Claim Institutional
D | 2010AB | N401 | - | 19
 
Pay-to Address Country Subdivision Code
Country subdivision code of the entity to receive payment (for example, ZIP code).
837 - Health Care Claim Institutional
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 Institutional
D | 2010AB | N403 | - | 116
 
Pay-to Address State Code
State or sub-country code of the entity to receive payment.
837 - Health Care Claim Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
D | 2010AD | REF02 | - | 127
 
Pay-to Plan Country Code
Country code of the Pay-To Plan.
837 - Health Care Claim Institutional
D | 2010AC | N404 | - | 26
 
Pay-to Plan Country Subdivision Code
Country subdivision code of the Pay-To Plan.
837 - Health Care Claim Institutional
D | 2010AC | N407 | - | 1715
 
Pay-to Plan Secondary Identifier
Additional identifier for the Pay-To Plan.
837 - Health Care Claim Institutional
D | 2010AC | REF02 | - | 127
 
Payer Additional Identifier
Additional identifier for the payer.
837 - Health Care Claim Institutional
D | 2010BB | 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 Institutional
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 Institutional
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 Institutional
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 Institutional
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 Institutional
D | 2010BB | N407 | - | 1715
 
Payer Identifier
Number identifying the payer organization.
837 - Health Care Claim Institutional
D | 2010BB | NM109 | - | 67
 
Payer Name
Name identifying the payer organization.
837 - Health Care Claim Institutional
D | 2010BB | NM103 | - | 1035
 
Payer Paid Amount
The amount paid by the payer on this claim.
837 - Health Care Claim Institutional
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 Institutional
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 Institutional
D | 2000B | SBR01 | - | 1138
 
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 Institutional
D | 2010BB | N402 | - | 156
 
Payment Effective Date
The effective date of the payment.
837 - Health Care Claim Institutional
D | 2330B | DTP03 | - | 1251
D | 2430 | DTP03 | - | 1251
 
Peer Review Authorization Number
Authorization number provided by a review organization after review completed.
837 - Health Care Claim Institutional
D | 2300 | REF02 | - | 127
 
Policy Compliance Code
The code that specifies policy compliance.
837 - Health Care Claim Institutional
D | 2300 | HCP14 | - | 1526
D | 2400 | HCP14 | - | 1526
 
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 Institutional
D | 2300 | CLM19 | - | 1383
 
Predetermination of Benefits Identifier
Identifier assigned to a Predetermination of Benefits.
837 - Health Care Claim Institutional
D | 2300 | REF02 | - | 127
D | 2400 | REF02 | - | 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 Institutional
D | 2410 | REF02 | - | 127
 
Present on Admission Indicator
Code which provides an indication as to whether the diagnosis was present at the time of admission.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-09 | 1271
D | 2300 | HI01 | C022-09 | 1271
D | 2300 | HI02 | C022-09 | 1271
D | 2300 | HI03 | C022-09 | 1271
D | 2300 | HI04 | C022-09 | 1271
D | 2300 | HI05 | C022-09 | 1271
D | 2300 | HI06 | C022-09 | 1271
D | 2300 | HI07 | C022-09 | 1271
D | 2300 | HI08 | C022-09 | 1271
D | 2300 | HI09 | C022-09 | 1271
D | 2300 | HI10 | C022-09 | 1271
D | 2300 | HI11 | C022-09 | 1271
D | 2300 | HI12 | C022-09 | 1271
D | 2300 | HI01 | C022-09 | 1271
D | 2300 | HI02 | C022-09 | 1271
D | 2300 | HI03 | C022-09 | 1271
D | 2300 | HI04 | C022-09 | 1271
D | 2300 | HI05 | C022-09 | 1271
D | 2300 | HI06 | C022-09 | 1271
D | 2300 | HI07 | C022-09 | 1271
D | 2300 | HI08 | C022-09 | 1271
D | 2300 | HI09 | C022-09 | 1271
D | 2300 | HI10 | C022-09 | 1271
D | 2300 | HI11 | C022-09 | 1271
D | 2300 | HI12 | C022-09 | 1271
 
Pricing Methodology
Pricing methodology at which the claim or line item has been priced or repriced.
837 - Health Care Claim Institutional
D | 2300 | HCP01 | - | 1473
D | 2400 | HCP01 | - | 1473
 
Principal Diagnosis Code
The diagnosis code describing the condition established, after study, to be chiefly responsible for occasioning the admission of the patient for care.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-02 | 1271
 
Principal Procedure Code
Code identifying the principal procedure, product or service.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-02 | 1271
 
Principal Procedure Date
Date on which the Principal Procedure was performed.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-04 | 1251
 
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 Institutional
D | 2300 | REF02 | - | 127
 
Procedure Code
Code identifying the procedure, product or service.
837 - Health Care Claim Institutional
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 | SV202 | C003-02 | 234
D | 2430 | SVD03 | C003-02 | 234
 
Procedure Date
Date when the health care procedure was performed.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-04 | 1251
D | 2300 | HI02 | C022-04 | 1251
D | 2300 | HI03 | C022-04 | 1251
D | 2300 | HI04 | C022-04 | 1251
D | 2300 | HI05 | C022-04 | 1251
D | 2300 | HI06 | C022-04 | 1251
D | 2300 | HI07 | C022-04 | 1251
D | 2300 | HI08 | C022-04 | 1251
D | 2300 | HI09 | C022-04 | 1251
D | 2300 | HI10 | C022-04 | 1251
D | 2300 | HI11 | C022-04 | 1251
D | 2300 | HI12 | C022-04 | 1251
 
Procedure Modifier
This identifies special circumstances related to the performance of the service.
837 - Health Care Claim Institutional
D | 2400 | SV202 | C003-03 | 1339
D | 2400 | SV202 | C003-04 | 1339
D | 2400 | SV202 | C003-05 | 1339
D | 2400 | SV202 | C003-06 | 1339
D | 2400 | SV202 | C003-09 | 1339
D | 2400 | SV202 | C003-10 | 1339
D | 2400 | SV202 | C003-11 | 1339
D | 2400 | SV202 | 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 or Service ID Qualifier
Code identifying the type/source of the descriptive number used in Product/Service ID (234).
837 - Health Care Claim Institutional
D | 2400 | SV202 | C003-01 | 235
D | 2400 | HCP09 | - | 235
D | 2410 | LIN02 | - | 235
D | 2430 | SVD03 | C003-01 | 235
 
Property & Casualty Claim Number
Identification number for property & casualty claim associated with the services identified on the bill.
837 - Health Care Claim Institutional
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 Institutional
D | 2010CA | PER02 | - | 93
 
Property & Casualty Patient Identifier
Identification number of the patient on a Property & Casualty claim.
837 - Health Care Claim Institutional
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 Institutional
D | 2300 | CLM16 | - | 1360
 
Provider Code
Code identifying the type of provider.
837 - Health Care Claim Institutional
D | 2000A | PRV01 | - | 1221
D | 2310A | PRV01 | - | 1221
 
Provider Taxonomy Code
Code designating the provider type, classification, and specialization.
837 - Health Care Claim Institutional
D | 2000A | PRV03 | - | 127
D | 2310A | PRV03 | - | 127
 
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 Institutional
D | 2300 | CLM01 | - | 1028
 
Receiver Name
Name of organization receiving the transaction.
837 - Health Care Claim Institutional
H | 1000B | NM103 | - | 1035
 
Receiver Primary Identifier
Primary identification number for the receiver of the transaction.
837 - Health Care Claim Institutional
H | 1000B | NM109 | - | 67
 
Reference Identification Qualifier
Code qualifying the reference identification.
837 - Health Care Claim Institutional
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 | 2310A | PRV02 | - | 128
D | 2310A | REF01 | - | 128
D | 2310B | REF01 | - | 128
D | 2310C | REF01 | - | 128
D | 2310D | REF01 | - | 128
D | 2310E | REF01 | - | 128
D | 2310F | 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 | 2330F | REF01 | - | 128
D | 2330G | REF01 | - | 128
D | 2330H | REF01 | - | 128
D | 2330I | 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 | 2410 | REF01 | - | 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 | 2420D | REF01 | - | 128
D | 2420D | REF04 | C040-01 | 128
 
Referral Number
Referral authorization number.
837 - Health Care Claim Institutional
D | 2300 | 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 Institutional
D | 2310F | NM104 | - | 1036
D | 2420D | NM104 | - | 1036
 
Referring Provider Identifier
The identification number for the referring physician.
837 - Health Care Claim Institutional
D | 2310F | NM109 | - | 67
D | 2420D | 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 Institutional
D | 2310F | NM103 | - | 1035
D | 2420D | 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 Institutional
D | 2310F | NM105 | - | 1037
D | 2420D | NM105 | - | 1037
 
Referring Provider Name Suffix
Suffix to the name of the provider referring the patient for care.
837 - Health Care Claim Institutional
D | 2310F | NM107 | - | 1039
D | 2420D | NM107 | - | 1039
 
Referring Provider Secondary Identifier
Additional identification number for the provider referring the patient for service.
837 - Health Care Claim Institutional
D | 2310F | REF02 | - | 127
D | 2420D | REF02 | - | 127
 
Reimbursement Rate
Rate used when payment is based upon a percentage of applicable charges.
837 - Health Care Claim Institutional
D | 2320 | MOA01 | - | 954
 
Reject Reason Code
Code assigned by issuer to identify reason for rejection.
837 - Health Care Claim Institutional
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 Institutional
D | 2300 | CLM11 | C024-01 | 1362
 
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 Institutional
D | 2300 | CLM09 | - | 1363
 
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 Institutional
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 Institutional
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 | LQ02 | - | 1271
 
Rendering Provider First Name
The first name of the provider who performed the service.
837 - Health Care Claim Institutional
D | 2310D | NM104 | - | 1036
D | 2420C | NM104 | - | 1036
 
Rendering Provider Identifier
The identifier assigned by the Payer to the provider who performed the service.
837 - Health Care Claim Institutional
D | 2310D | NM109 | - | 67
D | 2420C | NM109 | - | 67
 
Rendering Provider Last Name
The last name of the provider who performed the service.
837 - Health Care Claim Institutional
D | 2310D | NM103 | - | 1035
D | 2420C | 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 Institutional
D | 2310D | NM105 | - | 1037
D | 2420C | NM105 | - | 1037
 
Rendering Provider Name Suffix
Name suffix of the provider who has provided the services to the patient.
837 - Health Care Claim Institutional
D | 2310D | NM107 | - | 1039
D | 2420C | NM107 | - | 1039
 
Rendering Provider Secondary Identifier
Additional identifier for the provider providing care to the patient.
837 - Health Care Claim Institutional
D | 2310D | REF02 | - | 127
D | 2420C | REF02 | - | 127
 
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 Institutional
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 Institutional
D | 2300 | HCP07 | - | 782
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 Institutional
D | 2300 | HCP06 | - | 127
D | 2400 | HCP06 | - | 127
 
Repriced Approved Procedure Code
The procedure code that describes the services as approved by the repricer.
837 - Health Care Claim Institutional
D | 2400 | HCP10 | - | 234
 
Repriced Approved Revenue Code
UB92 revenue code approved by the repricer for payment on the claim.
837 - Health Care Claim Institutional
D | 2400 | HCP08 | - | 234
 
Repriced Approved Service Unit Count
Number of service units approved by pricing or repricing entity.
837 - Health Care Claim Institutional
D | 2300 | HCP12 | - | 380
D | 2400 | HCP12 | - | 380
 
Repriced Claim Reference Number
Identification number, assigned by a repricing organization, to identify the claim.
837 - Health Care Claim Institutional
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 Institutional
D | 2400 | REF02 | - | 127
 
Repriced Savings Amount
The amount of savings related to Third Party Organization claims.
837 - Health Care Claim Institutional
D | 2300 | HCP03 | - | 782
D | 2400 | HCP03 | - | 782
 
Repricer Received Date
Date the claim was received by the repricer organization.
837 - Health Care Claim Institutional
D | 2300 | DTP03 | - | 1251
 
Repricing Organization Identifier
Reference or identification number of the repricing organization.
837 - Health Care Claim Institutional
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 Institutional
D | 2300 | HCP05 | - | 118
D | 2400 | HCP05 | - | 118
 
Service Allowed Amount
The amount the payer deems payable for this service, prior to considering patient responsibility.
837 - Health Care Claim Institutional
D | 2430 | AMT02 | - | 782
 
Service Line Paid Amount
Amount paid by the indicated payer for a service line
837 - Health Care Claim Institutional
D | 2430 | SVD02 | - | 782
 
Service Line Revenue Code
UB92 Revenue Code pertaining to the service line.
837 - Health Care Claim Institutional
D | 2400 | SV201 | - | 234
D | 2430 | SVD04 | - | 234
 
Service Location Address Line
Address line of the service location address.
837 - Health Care Claim Institutional
D | 2310E | N301 | - | 166
D | 2310E | N302 | - | 166
 
Service Location City Name
City of the service location.
837 - Health Care Claim Institutional
D | 2310E | N401 | - | 19
 
Service Location Country Code
Country code for the service location.
837 - Health Care Claim Institutional
D | 2310E | N404 | - | 26
 
Service Location Country Subdivision Code
Country Subdivision code for the service location.
837 - Health Care Claim Institutional
D | 2310E | N407 | - | 1715
 
Service Location Name
Name of the service location.
837 - Health Care Claim Institutional
D | 2310E | NM103 | - | 1035
 
Service Location Postal Zone or ZIP Code
Postal zone code or ZIP code for the service location.
837 - Health Care Claim Institutional
D | 2310E | N403 | - | 116
 
Service Location Primary Identifier
The primary identification number for the service location.
837 - Health Care Claim Institutional
D | 2310E | NM109 | - | 67
 
Service Location Secondary Identifier
Secondary identification number for the service location.
837 - Health Care Claim Institutional
D | 2310E | REF02 | - | 127
 
Service Location State or Province Code
State or province for the service location.
837 - Health Care Claim Institutional
D | 2310E | N402 | - | 156
 
Service Tax Amount
The amount of service tax or surcharge applicable to the reported service.
837 - Health Care Claim Institutional
D | 2400 | AMT02 | - | 782
 
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 Institutional
D | 2400 | SV205 | - | 380
 
Service/Assessment Date
Date on which patient assessment or other required assessment was performed or the date of service, such as the start date of the service, the end date of the service, or the single date of the service.
837 - Health Care Claim Institutional
D | 2400 | DTP03 | - | 1251
 
State Care Tax
Tax reported for State purposes (not Sales Tax).
837 - Health Care Claim Institutional
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 Institutional
D | 2300 | REF02 | - | 127
 
Statement From and Through Date
The start and end date of the period covered on the claim.
837 - Health Care Claim Institutional
D | 2300 | DTP03 | - | 1251
 
Submitter Contact Name
Name of the person at the submitter organization to whom inquiries about the transaction should be directed.
837 - Health Care Claim Institutional
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 Institutional
H | 1000A | NM104 | - | 1036
 
Submitter Identifier
Code or number identifying the entity submitting the claim.
837 - Health Care Claim Institutional
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 Institutional
H | 1000A | NM103 | - | 1035
 
Submitter Middle Name or Initial
The middle name or initial of the person submitting the transaction.
837 - Health Care Claim Institutional
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 Institutional
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 Institutional
D | 2010BA | DMG02 | - | 1251
 
Subscriber City Name
The City Name of the insured individual or subscriber to the coverage.
837 - Health Care Claim Institutional
D | 2010BA | N401 | - | 19
 
Subscriber Country Code
The code identifying the country of the insured or subscriber address.
837 - Health Care Claim Institutional
D | 2010BA | N404 | - | 26
 
Subscriber Country Subdivision Code
The country subdivision code of the insured or subscriber address.
837 - Health Care Claim Institutional
D | 2010BA | N407 | - | 1715
 
Subscriber First Name
The first name of the insured individual or subscriber to the coverage.
837 - Health Care Claim Institutional
D | 2010BA | NM104 | - | 1036
 
Subscriber Gender Code
Code indicating the sex of the subscriber to the indicated coverage or policy.
837 - Health Care Claim Institutional
D | 2010BA | DMG03 | - | 1068
 
Subscriber Group Name
Name of the group through which the coverage is provided to the subscriber.
837 - Health Care Claim Institutional
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 Institutional
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 Institutional
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 Institutional
D | 2010BA | NM105 | - | 1037
 
Subscriber Name Suffix
Suffix of the insured individual or subscriber to the coverage.
837 - Health Care Claim Institutional
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 Institutional
D | 2010BA | N403 | - | 116
 
Subscriber Primary Identifier
Primary identification number of the subscriber to the coverage.
837 - Health Care Claim Institutional
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 Institutional
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 Institutional
D | 2010BA | N402 | - | 156
 
Temporary Solution for a Statutory/Regulatory Requirement
The unexpected data requirement of a legislative authority.
837 - Health Care Claim Institutional
D | 2300 | K301 | - | 449
 
Terms Discount Percentage
Discount percentage available to the payer for payment within a specific time period.
837 - Health Care Claim Institutional
D | 2300 | CN105 | - | 338
 
Total Claim Charge Amount
The sum of all charges included within this claim.
837 - Health Care Claim Institutional
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 Institutional
D | | SE01 | - | 96
 
Transaction Set Control Number
The unique identification number within a transaction set.
837 - Health Care Claim Institutional
H | | ST02 | - | 329
D | | SE02 | - | 329
 
Transaction Set Creation Date
Identifies the date the submitter created the transaction.
837 - Health Care Claim Institutional
H | | BHT04 | - | 373
 
Transaction Set Creation Time
Time file is created for transmission.
837 - Health Care Claim Institutional
H | | BHT05 | - | 337
 
Transaction Set Identifier Code
Code uniquely identifying a Transaction Set.
837 - Health Care Claim Institutional
H | | ST01 | - | 143
 
Transaction Set Purpose Code
Code identifying purpose of transaction set.
837 - Health Care Claim Institutional
H | | BHT02 | - | 353
 
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 Institutional
D | 2300 | HCP11 | - | 355
D | 2400 | SV204 | - | 355
D | 2400 | HCP11 | - | 355
 
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 Institutional
D | 2300 | REF02 | - | 127
 
Value Code
A code that identifies data of a monetary nature that is necessary for processing this claim as required by the payer organization.
837 - Health Care Claim Institutional
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
 
Value Code - Monetary Amount
Non-Monetary value associated with the value code reported in this composite element.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-05 | 782
D | 2300 | HI02 | C022-05 | 782
D | 2300 | HI03 | C022-05 | 782
D | 2300 | HI04 | C022-05 | 782
D | 2300 | HI05 | C022-05 | 782
D | 2300 | HI06 | C022-05 | 782
D | 2300 | HI07 | C022-05 | 782
D | 2300 | HI08 | C022-05 | 782
D | 2300 | HI09 | C022-05 | 782
D | 2300 | HI10 | C022-05 | 782
D | 2300 | HI11 | C022-05 | 782
D | 2300 | HI12 | C022-05 | 782
 
Value Code - Non-monetary Value
Non-Monetary value associated with the value code reported in this composite element.
837 - Health Care Claim Institutional
D | 2300 | HI01 | C022-10 | 1271
D | 2300 | HI02 | C022-10 | 1271
D | 2300 | HI03 | C022-10 | 1271
D | 2300 | HI04 | C022-10 | 1271
D | 2300 | HI05 | C022-10 | 1271
D | 2300 | HI06 | C022-10 | 1271
D | 2300 | HI07 | C022-10 | 1271
D | 2300 | HI08 | C022-10 | 1271
D | 2300 | HI09 | C022-10 | 1271
D | 2300 | HI10 | C022-10 | 1271
D | 2300 | HI11 | C022-10 | 1271
D | 2300 | HI12 | C022-10 | 1271
 
Version, Release, or Industry Identifier
Code indicating the version, release, sub-release and industry identification of the EDI standard being used.
837 - Health Care Claim Institutional
H | | ST03 | - | 1705