text stringlengths 3.05k 65.3k | source stringlengths 36 118 | doc_id stringlengths 32 32 | chunk_id stringlengths 34 35 |
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Stedi maintains this guide based on public documentation from CGS Medicare. Contact CGS Medicare for official EDI specifications. To report any errors in this guide, please contact us. X12 835 Health Care Claim Payment Advice (X221A1) X12 Release 5010 Revised November 17, 2023 Go to Stedi Network This X12 Transaction S... | /kaggle/input/edi-db-835-837/CGS Medicare 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | c28f9651cbfa9304ff4372b535411616 | c28f9651cbfa9304ff4372b535411616_0 |
the payment. The payer is responsible to provide the bank with the instructions on how to deliver the remittance information, if not required by this implementation guide, do not send. Payer should coordinate this process with their Originating Depository Financial Institution (ODFI). Example RDM BM X XX Max use 1 Opti... | /kaggle/input/edi-db-835-837/CGS Medicare 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | c28f9651cbfa9304ff4372b535411616 | c28f9651cbfa9304ff4372b535411616_1 |
provider under the mandate. Otherwise, one of the other listed codes may be used. NM1-09 67 Rendering Provider Identifier Min 2 Max 80 String (AN) Required Code identifying a party or other code 1 29 25, 8:52 PM CGS Medicare 835 Health Care Claim Payment Advice (X221A1) - Stedi EDI Guides https: www.stedi.com app guide... | /kaggle/input/edi-db-835-837/CGS Medicare 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | c28f9651cbfa9304ff4372b535411616 | c28f9651cbfa9304ff4372b535411616_2 |
Usage notes This segment is used to convey information only. It is not part of the financial balancing of the 835. Required when the value of any specific amount identified by the AMT01 qualifier is non-zero. If not required by this implementation guide, do not send. Example AMT ZM 00000000 Max use 9 Optional AMT-01 52... | /kaggle/input/edi-db-835-837/CGS Medicare 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | c28f9651cbfa9304ff4372b535411616 | c28f9651cbfa9304ff4372b535411616_3 |
GAINWELL TECHNOLOGIES Louisiana Medicaid 837 Health Care Claim-Institutional Companion Guide Based on ASC X12N Version 005010X223A2 CORE v5010 Master Companion Guide Template Issued January 2018 Version 1.6 Revised 1 14 2025 837 Institutional Companion Guide i Revision History See Appendix C. Usage Information Document... | /kaggle/input/edi-db-835-837/837_Institutional_Companion_Guide.pdf | 0d6c8734dc38c90bb4671e7915172318 | 0d6c8734dc38c90bb4671e7915172318_0 |
Code 1 2 Value is XX National Provider Identifier Element Separator 1 837 Institutional Companion Guide 34 TR3 Page Loop ID Reference Name Codes Length Notes Comments NM109 Identification Code National Provider Identification 2 80 Value is the NPI registered with Louisiana Medicaid that corresponds to the Louisiana Med... | /kaggle/input/edi-db-835-837/837_Institutional_Companion_Guide.pdf | 0d6c8734dc38c90bb4671e7915172318 | 0d6c8734dc38c90bb4671e7915172318_1 |
HIPAA Transaction Standard Companion Guide Healthcare Claim Payment Advice ASC X12N 835 Version 005010X221A1 for State of Idaho MMIS Date of Publication: 02 29 2024 Document Number: TL419 Version: 11.0 Idaho MMIS Companion Guide 835 Health Care Claim Payment Advice Last Updated: 02 29 2024 Page ii Revision History Vers... | /kaggle/input/edi-db-835-837/CAQH 5010 835 Companion Guide (1).pdf | 69f62a9d267e4454bc0b0364e4df734f | 69f62a9d267e4454bc0b0364e4df734f_0 |
Centers for Medicare Medicaid Services (CMS) Standard Companion Guide Health Care Claim Institutional (837I) Based on ASC X12N TR3, Version 005010X223A2 Companion Guide Version Number: 8.0, June 2023 CMS 837I Version 005010X223A2 Companion Guide 2022 Copyright, CGS Administrators, LLC. ii Disclosure Statement The Cente... | /kaggle/input/edi-db-835-837/837I_compguide.pdf | 815189f6dea52a5dd9b38b3bba0f5280 | 815189f6dea52a5dd9b38b3bba0f5280_0 |
- 6 Must be an integer (no decimals). 486 2430 DTP03 Line Check Remit Date - 35 Must not be a future date. 10.4.18 Transaction Set Trailer The following table defines the specific details associated with Transaction Set Trailer. Note: A hyphen in the table below means N A. Table 30. Transaction Set Trailer Page Loop ID... | /kaggle/input/edi-db-835-837/837I_compguide.pdf | 815189f6dea52a5dd9b38b3bba0f5280 | 815189f6dea52a5dd9b38b3bba0f5280_1 |
Health Care Claim 837 Companion Guide Version 1.5 Refers to the following Technical Report Type 3 Guides: ASC X12N 837 Institutional (version 005010X223A2) ASC X12N 837 Professional (version 005010X222A1) ASC X12N 837 Dental (version 005010X224A2) Blue Cross Blue Shield of Massachusetts, February 2024 837 BLUE CROSS BL... | /kaggle/input/edi-db-835-837/MPC_092315-4N___837_Companion_Guide.pdf | 54a54504acc20b0a1ae517e4deceb1a3 | 54a54504acc20b0a1ae517e4deceb1a3_0 |
required if the subscriber is the patient Use the patient s identification number that was in effect on the date of service, exactly as it appears on the Blue Cross ID card. You must include the appropriate alpha prefix. Note: We do not issue unique identification numbers to all individual members. When submitting clai... | /kaggle/input/edi-db-835-837/MPC_092315-4N___837_Companion_Guide.pdf | 54a54504acc20b0a1ae517e4deceb1a3 | 54a54504acc20b0a1ae517e4deceb1a3_1 |
Stedi maintains this guide based on public documentation from Anthem. Contact Anthem for official EDI specifications. To report any errors in this guide, please contact us. X12 835 Health Care Claim Payment Advice (X221A1) X12 Release 5010 Revised March 1, 2024 Go to Stedi Network This X12 Transaction Set contains the ... | /kaggle/input/edi-db-835-837/Anthem 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | c4837cb4c69775f8499ce91c4514ac55 | c4837cb4c69775f8499ce91c4514ac55_0 |
50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 29 25, 8:52 PM Anthem 835 Health Care Claim Payment Advice (X221A1) - Stedi EDI Guides https: www.stedi.com app guides view anthem health-care-claim-paymentadvice-x221a1 ... | /kaggle/input/edi-db-835-837/Anthem 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | c4837cb4c69775f8499ce91c4514ac55 | c4837cb4c69775f8499ce91c4514ac55_1 |
health-care-claim-paymentadvice-x221a1 01HQWPEZE89AKHP7SZ7YAE893C 66 127 NM1 0300 Detail Header Number Loop Claim Payment Information Loop NM1 Service Provider Name To supply the full name of an individual or organizational entity Usage notes This segment provides information about the rendering provider. An identifica... | /kaggle/input/edi-db-835-837/Anthem 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | c4837cb4c69775f8499ce91c4514ac55 | c4837cb4c69775f8499ce91c4514ac55_2 |
CAS-15 782 Adjustment Amount Min 1 Max 15 Decimal number (R) Optional Monetary amount CAS15 is the amount of the adjustment. Usage notes See CAS03. CAS-16 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS16 is the units of service being adjusted. Usage notes See CAS04. CAS-1... | /kaggle/input/edi-db-835-837/Anthem 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | c4837cb4c69775f8499ce91c4514ac55 | c4837cb4c69775f8499ce91c4514ac55_3 |
Stedi maintains this guide based on public documentation from X12 HIPAA. Contact X12 HIPAA for official EDI specifications. To report any errors in this guide, please contact us. X12 835 Health Care Claim Payment Advice (X221A1) X12 Release 5010 Revised May 3, 2024 Go to Stedi Network This X12 Transaction Set contains ... | /kaggle/input/edi-db-835-837/X12 HIPAA 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | 611ccfce5bd3b56fdab044af957c271c | 611ccfce5bd3b56fdab044af957c271c_0 |
specify identifying information Usage notes Required when identification of the payee is dependent upon an identification number beyond that supplied in the N1 segment. If not required by this implementation guide, may be provided at the sender's discretion, but cannot be required by the receiver. Example REF D3 XXXXX ... | /kaggle/input/edi-db-835-837/X12 HIPAA 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | 611ccfce5bd3b56fdab044af957c271c | 611ccfce5bd3b56fdab044af957c271c_1 |
Insured Name NM1 Corrected Patient Insured Name NM1 Service Provider Name NM1 Crossover Carrier Name NM1 Other Subscriber Name Max use 1 Optional NM1-01 98 Entity Identifier Code Identifier (ID) Required Code identifying an organizational entity, a physical location, property or an individual PR Payer NM1-02 1065 Entit... | /kaggle/input/edi-db-835-837/X12 HIPAA 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | 611ccfce5bd3b56fdab044af957c271c | 611ccfce5bd3b56fdab044af957c271c_2 |
app guides view hipaa health-care-claim-paymentadvice-x221a1 01GRYB6DS30MGXWBPFZCM3695E 94 128 A positive number decreases paid units, and a negative value increases paid units. CAS-05 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code identifying the detailed reason the adjustment was made Usage not... | /kaggle/input/edi-db-835-837/X12 HIPAA 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | 611ccfce5bd3b56fdab044af957c271c | 611ccfce5bd3b56fdab044af957c271c_3 |
PM X12 HIPAA 835 Health Care Claim Payment Advice (X221A1) - Stedi EDI Guides https: www.stedi.com app guides view hipaa health-care-claim-paymentadvice-x221a1 01GRYB6DS30MGXWBPFZCM3695E 126 128 Example 8b: Claim submitted with incorrect subscriber name and ID ISA 00 00 ZZ ABCPAYER ZZ ABCPAYER 190827 0212 00501 1915119... | /kaggle/input/edi-db-835-837/X12 HIPAA 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | 611ccfce5bd3b56fdab044af957c271c | 611ccfce5bd3b56fdab044af957c271c_4 |
Stedi maintains this guide based on public documentation from Health Partner Plans. Contact Health Partner Plans for official EDI specifications. To report any errors in this guide, please contact us. X12 835 Health Care Claim Payment Advice (X221A1) X12 Release 5010 Revised February 22, 2024 Go to Stedi Network This X... | /kaggle/input/edi-db-835-837/Health Partner Plans 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | 654752ca5715dec30fa59b0a1628633b | 654752ca5715dec30fa59b0a1628633b_0 |
not send. Example CAS PI XXX 00000000000000 00000000 Max use 99 Optional CAS-01 1033 Claim Adjustment Group Code Identifier (ID) Required Code identifying the general category of payment adjustment Usage notes Evaluate the usage of group codes in CAS01 based on the following order for their applicability to a set of on... | /kaggle/input/edi-db-835-837/Health Partner Plans 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | 654752ca5715dec30fa59b0a1628633b | 654752ca5715dec30fa59b0a1628633b_1 |
Health Care Claim Payment Advice (X221A1) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-paymentadvice-x221a1 01H16H5SPA8ZB874WBF4EWR25K 68 82 EDI Samples Example 1: Dollars and Data Sent Separately ISA 00 00 ZZ ABCPAYER ZZ ABCPAYER 190827 0212 00501 191511902 0 P GS HP A... | /kaggle/input/edi-db-835-837/Health Partner Plans 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | 654752ca5715dec30fa59b0a1628633b | 654752ca5715dec30fa59b0a1628633b_2 |
HIPAA Transaction Standard Companion Guide 835 Health Care Claim Payment Advice Refers to the Implementation Guides Based on X12 version 005010 Errata Companion Guide Version Number: 1.1 February 2024 Disclaimer Statement The Health Insurance Portability and Accountability Act (HIPAA), sections 160 and 162, require tha... | /kaggle/input/edi-db-835-837/HIPAA SummaCare 835 Companion Guide 5010.pdf | cc2a69e2b30150b39da3b2fb5d2927af | cc2a69e2b30150b39da3b2fb5d2927af_0 |
Stedi maintains this guide based on public documentation from Security Health. Contact Security Health for official EDI specifications. To report any errors in this guide, please contact us. X12 835 Health Care Claim Payment Advice (X221A1) X12 Release 5010 Revised November 20, 2023 Go to Stedi Network This X12 Transac... | /kaggle/input/edi-db-835-837/Security Health 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | 180e8b2afd45878a1de976c4300ef6ab | 180e8b2afd45878a1de976c4300ef6ab_0 |
the remittance. Usage notes When BM is used, the remittance information will be mailed to the attention of this person at the payee's address identified in this 1000B loop. RDM-03 364 Communication Number Min 1 Max 256 String (AN) Optional Complete communications number including country or area code when applicable RD... | /kaggle/input/edi-db-835-837/Security Health 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | 180e8b2afd45878a1de976c4300ef6ab | 180e8b2afd45878a1de976c4300ef6ab_1 |
- Stedi EDI Guides https: www.stedi.com app guides view security-health health-care-claim-paymentadvice-x221a1 01H25KKVA6Q3PW0CJ2PES5TEHE 66 124 Individual middle name or initial Usage notes If this data element is used and contains only one character, it represents the middle initial. NM1-07 1039 Rendering Provider Na... | /kaggle/input/edi-db-835-837/Security Health 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | 180e8b2afd45878a1de976c4300ef6ab | 180e8b2afd45878a1de976c4300ef6ab_2 |
Identification 0K Policy Form Identifying Number REF-02 127 Healthcare Policy Identification Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 29 25, 8:52 PM Security Health 835 Health Care Claim Payment Advice... | /kaggle/input/edi-db-835-837/Security Health 835 Health Care Claim Payment_Advice (X221A1) - Stedi EDI Guides.pdf | 180e8b2afd45878a1de976c4300ef6ab | 180e8b2afd45878a1de976c4300ef6ab_3 |
837 Health Care Claim Companion Guide Professional and Institutional Revised December 2011 Table of Contents Introduction........................................................................................................... 3 Purpose..................................................................................... | /kaggle/input/edi-db-835-837/837 Health Care Claim Companion Guide Rev 12 2011.pdf | 85a8528b1eeb2fb3eeb424b143cdb49f | 85a8528b1eeb2fb3eeb424b143cdb49f_0 |
HIPAA Transaction Standard Companion Guide Healthcare Claim Payment Advice ASC X12N 835 Version 005010X221A1 for State of Idaho MMIS Date of Publication: 02 29 2024 Document Number: TL419 Version: 11.0 Idaho MMIS Companion Guide 835 Health Care Claim Payment Advice Last Updated: 02 29 2024 Page ii Revision History Vers... | /kaggle/input/edi-db-835-837/CAQH 5010 835 Companion Guide.pdf | 69f62a9d267e4454bc0b0364e4df734f | 69f62a9d267e4454bc0b0364e4df734f_0 |
Stedi maintains this guide based on public documentation from CGS Medicare. Contact CGS Medicare for official EDI specifications. To report any errors in this guide, please contact us. X12 837 Health Care Claim: Institutional (X223A3) X12 Release 5010 Revised November 17, 2023 Go to Stedi Network This X12 Transaction S... | /kaggle/input/edi-db-835-837/CGS Medicare 837 Health Care Claim_ Institutional.pdf | 5a3f498a3f1fe3143b5bf3b242ebbf85 | 5a3f498a3f1fe3143b5bf3b242ebbf85_0 |
Segment in This Hierarchical Structure. 1 30 25, 11:54 AM CGS Medicare 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view cgs-medicare health-care-claim-institutional-x223a3 01H25JDXFJR748R6M871MGNNCJ 38 285 SBR 0050 Detail Billing Provider Hierarchical Level Loop Subs... | /kaggle/input/edi-db-835-837/CGS Medicare 837 Health Care Claim_ Institutional.pdf | 5a3f498a3f1fe3143b5bf3b242ebbf85 | 5a3f498a3f1fe3143b5bf3b242ebbf85_1 |
in REF01 is the same in both the Loop ID-2300 REF segment and the Loop ID-2400 REF segment. In that case, the Loop ID-2400 REF applies only to that specific line. Required when an authorization number is assigned by the payer or UMO AND the services on this claim were preauthorized. If not required by this implementati... | /kaggle/input/edi-db-835-837/CGS Medicare 837 Health Care Claim_ Institutional.pdf | 5a3f498a3f1fe3143b5bf3b242ebbf85 | 5a3f498a3f1fe3143b5bf3b242ebbf85_2 |
law, OR For claims which are not covered under HIPAA. 1 30 25, 11:54 AM CGS Medicare 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view cgs-medicare health-care-claim-institutional-x223a3 01H25JDXFJR748R6M871MGNNCJ 104 285 BN International Classification of Diseases Cl... | /kaggle/input/edi-db-835-837/CGS Medicare 837 Health Care Claim_ Institutional.pdf | 5a3f498a3f1fe3143b5bf3b242ebbf85 | 5a3f498a3f1fe3143b5bf3b242ebbf85_3 |
diagnosis onset as it relates to the diagnosis reported in C022-02. A "Y" indicates that the onset occurred prior to admission to the hospital; an "N" indicates that the onset did NOT occur prior to admission to the hospital; a "U" indicates that it is unknown whether the onset occurred prior to admission to the hospit... | /kaggle/input/edi-db-835-837/CGS Medicare 837 Health Care Claim_ Institutional.pdf | 5a3f498a3f1fe3143b5bf3b242ebbf85 | 5a3f498a3f1fe3143b5bf3b242ebbf85_4 |
Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop HI Principal Diagnosis To supply information related to the delivery of health care Usage notes Do not transmit the decimal point for ICD codes. The decimal point is implied. Example HI BK XXXXX N Variants (all may be used) HI Admitting D... | /kaggle/input/edi-db-835-837/CGS Medicare 837 Health Care Claim_ Institutional.pdf | 5a3f498a3f1fe3143b5bf3b242ebbf85 | 5a3f498a3f1fe3143b5bf3b242ebbf85_5 |
Max 1 Optional Variants (all may be used) Attending Provider Name Loop Operating Physician Name Loop Other Operating Physician Name Loop Service Facility Location Name Loop Referring Provider Name Loop NM1 2500 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Claim Information Loop Ren... | /kaggle/input/edi-db-835-837/CGS Medicare 837 Health Care Claim_ Institutional.pdf | 5a3f498a3f1fe3143b5bf3b242ebbf85 | 5a3f498a3f1fe3143b5bf3b242ebbf85_6 |
01H25JDXFJR748R6M871MGNNCJ 219 285 segment using qualifier 2U (Payer Identification Number). OR Follow an early implementation approach in which the HPID or OEID is sent in NM109. PI Payor Identification XV Centers for Medicare and Medicaid Services PlanID NM1-09 67 Other Payer Primary Identifier Min 2 Max 80 String (A... | /kaggle/input/edi-db-835-837/CGS Medicare 837 Health Care Claim_ Institutional.pdf | 5a3f498a3f1fe3143b5bf3b242ebbf85 | 5a3f498a3f1fe3143b5bf3b242ebbf85_7 |
necessary to report one or more non-destination payer Secondary Identifiers, the composite data element in REF04 is used to identify the payer who assigned this identifier. Example REF 1G XXXX 2U XXXXXX Max use 20 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Refere... | /kaggle/input/edi-db-835-837/CGS Medicare 837 Health Care Claim_ Institutional.pdf | 5a3f498a3f1fe3143b5bf3b242ebbf85 | 5a3f498a3f1fe3143b5bf3b242ebbf85_8 |
1 837 Companion Guide Refers to the Implementation Guides based on the HIPAA Transaction ASC X12N. Standards for Electronic Data Interchange X12N 005010x222 Health Care Claim: Professional (837P) and ASC X12N 005010x223 Health Care Claim: Institutional (837I) October 2016 2 Overview The Companion Guide provides Centene... | /kaggle/input/edi-db-835-837/508_Centene_5010_837_Companion_Guide.pdf | 65e053b3ae1844937cfa041f22d74ce3 | 65e053b3ae1844937cfa041f22d74ce3_0 |
837 Institutional Companion Guide Version 38.0 July 2016. 1 Centers for Medicare Medicaid Services (CMS) Logo. _________________________________________________________________ Medicare Encounter Data System Standard Companion Guide Transaction Information Instructions related to the 837 Health Care Claim: Institutiona... | /kaggle/input/edi-db-835-837/Jul2016_CG_837I_5CR_081016.pdf | 5d1ff4d3761d8c9adb94936bf1b8ccf5 | 5d1ff4d3761d8c9adb94936bf1b8ccf5_0 |
Encounter data cannot use this validation as we validate the plan number and submitter ID to ensure the submitter is authorized to submit on the plan s behalf. 2010AA.NM109 billing provider must be "associated" to the submitter (from a trading partner management perspective) in 1000A.NM109. X223.087.2010AA.N301.070 CSC... | /kaggle/input/edi-db-835-837/Jul2016_CG_837I_5CR_081016.pdf | 5d1ff4d3761d8c9adb94936bf1b8ccf5 | 5d1ff4d3761d8c9adb94936bf1b8ccf5_1 |
equal to 1. Scenario: Nightline Hospital admitted a patient at 8 p.m. on 10 23 2012 and the patient was discharged at 2 p.m. on 10 24 2012. Dawn to Dusk Healthcare submitted the encounter with a day count of 2 for admission, although the overnight stay is considered one (1) day. Edit Edit Description Edit Disposition C... | /kaggle/input/edi-db-835-837/Jul2016_CG_837I_5CR_081016.pdf | 5d1ff4d3761d8c9adb94936bf1b8ccf5 | 5d1ff4d3761d8c9adb94936bf1b8ccf5_2 |
Gentle HealthCare submitted a final claim to Monument Medical Health Plan for Mr. G. Barnes, who expired on 9 15 2013. Monument Medical Health submitted and encounter to the EDS with a patient discharge status code of 41 in Loop 2300 CL103, but the Occurrence Code and Date of Death (occurrence code date) were not provi... | /kaggle/input/edi-db-835-837/Jul2016_CG_837I_5CR_081016.pdf | 5d1ff4d3761d8c9adb94936bf1b8ccf5 | 5d1ff4d3761d8c9adb94936bf1b8ccf5_3 |
Stedi maintains this guide based on public documentation from Health Partner Plans. Contact Health Partner Plans for official EDI specifications. To report any errors in this guide, please contact us. X12 837 Health Care Claim: Institutional (X223A3) X12 Release 5010 Revised May 24, 2023 Go to Stedi Network This X12 Tr... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_0 |
579 2 Non-Person Entity NM1-03 1035 Billing Provider Organizational Name Min 1 Max 60 String (AN) Required Individual last name or organizational name NM1-08 66 Identification Code Qualifier Identifier (ID) Optional Code designating the system method of code structure used for Identification Code (67) XX Centers for Me... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_1 |
format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. Usage notes Selection of the appropriate qualifier is designated by the NUBC Billing Manual. D8 Date Expressed in Format CCYYMMDD DT Date and Time Expressed in Format CCYYMMDDHHMM DTP-03 1251 Admission Dat... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_2 |
codes. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BG Condition C022-02 1271 Condition Code Min 1 Max 30 String (AN) Required Cod... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_3 |
their associated dates, amounts and quantities Usage notes Required when it is necessary to report an additional occurrence code and the preceding HI data elements have been used to report other occurrence codes. If not required by this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualif... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_4 |
this implementation guide, do not send. Max use 1 Optional C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. BBQ International Classification of Diseases Clinical Modification (ICD-10-PCS) Other... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_5 |
specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4Y... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_6 |
Amount Min 1 Max 15 Decimal number (R) Required Monetary amount CAS03 is the amount of adjustment. CAS-04 380 Adjustment Quantity Min 1 Max 15 Decimal number (R) Optional Numeric value of quantity CAS04 is the units of service being adjusted. CAS-05 1034 Adjustment Reason Code Min 1 Max 5 Identifier (ID) Optional Code ... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_7 |
health plan. LU Location Number REF-02 127 Other Payer Other Operating Physician Secondary Identifier String (AN) Required Min 1 Max 50 Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_8 |
Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 292 579 2420A Operating Physician Name Loop Max 1 Optional Variants (all may be used) Other Operating Physician Name Loop Rendering Provider Name Loop Referring Provider Name Loop NM1 5000 ... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_9 |
to match the claim to the payment information returned in the 835 transaction. The two recommended identifiers are either the Patient Account Number or the Claim Number in the billing submitter's patient management system. The developers of this implementation guide strongly recommend that submitters use unique numbers... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_10 |
Information HI Patient's Reason For Visit HI Principal Diagnosis HI Principal Procedure Information HI Treatment Code Information HI Value Information Max use 2 Optional HI-01 C022 Health Care Code Information To send health care codes and their associated dates, amounts and quantities Max use 1 Required C022-01 1270 C... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_11 |
represents the beginning value in a range of codes. C022-03 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or date and time format C022-03 is the date format that will appear in C022-04. D8 Date Expressed in Format CCYYMMDD C022-04 1251 Occurrence Code Date... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_12 |
to report other diagnoses. If not required by this implementation guide, do not send. C022-01 1270 Code List Qualifier Code Identifier (ID) Required Code identifying a specific industry code list C022-01 qualifies C022-02, C022-04, C022-05, C022-06 and C022-08. ABF International Classification of Diseases Clinical Modi... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_13 |
C022-06 and C022-08. TC Treatment Codes C022-02 1271 Treatment Code Min 1 Max 30 String (AN) Required Code indicating a code from a specific industry code list If C022-08 is used, then C022-02 represents the beginning value in a range of codes. 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_14 |
Other Subscriber Information To record information specific to the primary insured and the insurance carrier for that insured Usage notes Required when other payers are known to potentially be involved in paying on this claim. If not required by this implementation guide, do not send. All information contained in Loop ... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_15 |
guides view health-partner-plans health-care-claim-institutional-x223a3 01H16H3T6ZSQSBCEV8FBKSZ4YX 507 579 1 Person 1 30 25, 11:52 AM Health Partner Plans 837 Health Care Claim: Institutional (X223A3) - Stedi EDI Guides https: www.stedi.com app guides view health-partner-plans health-care-claim-institutional-x223a3 01H... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_16 |
Usage notes This information is specific to the destination payer reported in Loop ID-2010BB. HCP-09 235 Product or Service ID Qualifier Identifier (ID) Optional Code identifying the type source of the descriptive number used in Product Service ID (234) ER Jurisdiction Specific Procedure and Supply Codes This code set ... | /kaggle/input/edi-db-835-837/Health Partner Plans 837 Health Care Claim_ Institutional.pdf | 4552e0b5e4bc9bebee7acbe3f3f1e672 | 4552e0b5e4bc9bebee7acbe3f3f1e672_17 |
Stedi maintains this guide based on public documentation from Home State Health. Contact Home State Health for official EDI specifications. To report any errors in this guide, please contact us. X12 837 Health Care Claim: Professional (X222A2) X12 Release 5010 Revised November 17, 2023 Go to Stedi Network This X12 Tran... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_0 |
Code identifying the type of communication number EM Electronic Mail EX Telephone Extension FX Facsimile TE Telephone PER-08 364 Communication Number Min 1 Max 256 String (AN) Optional Complete communications number including country or area code when applicable 1 30 25, 11:52 AM Home State Health 837 Health Care Claim... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_1 |
Hierarchical Level Loop Subscriber Hierarchical Level Loop Payer Name Loop NM1 Payer Name To supply the full name of an individual or organizational entity Usage notes This is the destination payer. For the purposes of this implementation the term payer is synonymous with several other terms, such as, repricer and thir... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_2 |
- Repricer Received Date Max use 1 Optional DTP-01 374 Date Time Qualifier Identifier (ID) Required Code specifying type of date or time, or both date and time 431 Onset of Current Symptoms or Illness DTP-02 1250 Date Time Period Format Qualifier Identifier (ID) Required Code indicating the date format, time format, or... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_3 |
notes Use the codes listed in CRC03. CRC-05 1321 Condition Indicator Min 2 Max 3 Identifier (ID) Optional Code indicating a condition Usage notes Use the codes listed in CRC03. 1 30 25, 11:52 AM Home State Health 837 Health Care Claim: Professional (X222A2) - Stedi EDI Guides https: www.stedi.com app guides view home-s... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_4 |
NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send. Example REF LU X Max use 4 Optional REF-01 128 Reference Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification 0B State License Number 1G Provider UPIN Number U... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_5 |
guide, do not send. Example N4 XXX XX XXXXXXXX XX Only one of Other Subscriber State or Province Code (N4-02) or Country Subdivision Code (N4-07) may be present If Country Subdivision Code (N4-07) is present, then Country Code (N4-04) is required Max use 1 Optional N4-01 19 Other Subscriber City Name Min 2 Max 30 Strin... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_6 |
Testing Results 1 30 25, 11:52 AM Home State Health 837 Health Care Claim: Professional (X222A2) - Stedi EDI Guides https: www.stedi.com app guides view home-state-health health-care-claim-professional-x222a2 01H25M3DFZT8BN5QV8WP430GEQ 250 665 BS Baseline BT Blanket Test Results CB Chiropractic Justification CK Consent... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_7 |
9F Referral Number REF-02 127 Referral Number Min 1 Max 50 String (AN) Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier REF-04 C040 Reference Identifier To identify one or more reference numbers or identification numbers as specified by... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_8 |
or identification numbers as specified by the Reference Qualifier - REF04 contains data relating to the value cited in REF02. Usage notes Required when the identifier reported in REF02 of this segment is for a non-destination payer. Max use 1 Optional 1 30 25, 11:53 AM Home State Health 837 Health Care Claim: Professio... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_9 |
there are hierarchical child data segments subordinate to the level being described HL04 indicates whether or not there are subordinate (or child) HL segments related to the current HL segment. 1 30 25, 11:53 AM Home State Health 837 Health Care Claim: Professional (X222A2) - Stedi EDI Guides https: www.stedi.com app g... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_10 |
- Disability Dates DTP Date - Discharge DTP Date - Hearing and Vision Prescription Date DTP Date - Initial Treatment Date DTP Date - Last Menstrual Period DTP Date - Last Seen Date DTP Date - Last X-ray Date DTP Date - Onset of Current Illness or Symptom DTP Date - Property and Casualty Date of First Contact DTP Date -... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_11 |
to clarify the related data elements and their content CR211 is an additional description of the patient's condition. 1 30 25, 11:53 AM Home State Health 837 Health Care Claim: Professional (X222A2) - Stedi EDI Guides https: www.stedi.com app guides view home-state-health health-care-claim-professional-x222a2 01H25M3DF... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_12 |
mandated NPI Implementation Date when NM109 in this loop is not used and an identification number other than the NPI is necessary for the receiver to identify the provider. If not required by this implementation guide, do not send. Example REF G2 XX Max use 3 Optional REF-01 128 Reference Identification Qualifier Ident... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_13 |
as specified by the Reference Identification Qualifier MOA04 is the Claim Payment Remark Code. See Code Source 411. MOA-05 127 Claim Payment Remark Code Min 1 Max 50 String (AN) Optional Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier 1 30 25, ... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_14 |
1073 EPSDT Indicator Identifier (ID) Optional Code indicating a Yes or No condition or response SV111 is early and periodic screen for diagnosis and treatment of children (EPSDT) involvement; a "Y" value indicates EPSDT involvement; an "N" value indicates no EPSDT involvement. Usage notes For this implementation, the l... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_15 |
when mandated by state or federal law or regulations to report an Immunization Batch Number. If not required by this implementation guide, do not send. Example REF BT X Variants (all may be used) REF Adjusted Repriced Line Item Reference Number REF Clinical Laboratory Improvement Amendment (CLIA) Number REF Line Item C... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_16 |
XXX Only one of Laboratory or Facility State or Province Code (N4-02) or Country Subdivision Code (N4-07) may be present If Country Subdivision Code (N4-07) is present, then Country Code (N4-04) is required Max use 1 Required N4-01 19 Laboratory or Facility City Name Min 2 Max 30 String (AN) Required Free-form text for... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_17 |
health-care-claim-professional-x222a2 01H25M3DFZT8BN5QV8WP430GEQ 642 665 DTP 5500 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchical Level Loop Patient Hierarchical Level Loop Claim Information Loop Service Line Number Loop Line Adjudication Information Loop DTP Line Check or Remittance Date To spe... | /kaggle/input/edi-db-835-837/Home State Health 837 Health Care Claim_ Professional.pdf | 27b51894711aa342918686b13db178cd | 27b51894711aa342918686b13db178cd_18 |
835 Transaction Companion Guide ANSI x12 Version 005010X221A1 General Guidelines August 201 5 CDPHP 835 TRANSACTION COMPANION GUIDE 2 Table of Contents Disclosure..................................................................................................................................... 3 Preface.................. | /kaggle/input/edi-db-835-837/835_companion_guide.pdf | 978359a285f20df034bb060dcb8e3304 | 978359a285f20df034bb060dcb8e3304_0 |
Page 1 of 18 Standard Companion Guide Refers to the Implementation Guide Based on X12 Version 005010X222A1 Health Care Claim Professional (837P) Companion Guide Version Number 6.2 March 8, 2023 Page 2 of 18 CHANGE LOG Version Release Date Changes 1.0 12 10 2010 Initial draft release 2.0 03 24 2014 ICD-10 effective date... | /kaggle/input/edi-db-835-837/EDI-837P-CG-005010X222A1.pdf | 1cad7d28e6149a1dbd60806e0461b980 | 1cad7d28e6149a1dbd60806e0461b980_0 |
Page 1 of 12 Standard Companion Guide Refers to the Implementation Guide Based on X12 Version 005010X221A1 Health Care Claim Payment Advice (835) Companion Guide Version Number 4.1 3 27 2024 Page 2 of 12 CHANGE LOG Version Release Date Changes 1.0 12 10 2010 Created 835 Companion Guide based on version 5010. 2.0 09 25 ... | /kaggle/input/edi-db-835-837/EDI-835-Companion-Guide-005010X221A1.pdf | ed861059f7c9d03e09383db0b383d447 | ed861059f7c9d03e09383db0b383d447_0 |
837 Health Care Claim Companion Guides Version 2.8 January, 2024 i 837 Health Care Claim Companion Guides Version 2.8 January, 2024 For use with ASC X12N 837 Health Care Professional and Institutional Transactions Set Implementation Guides and Addenda (Version HIPAA 5010) www.carelonbehavioralhealth.com 837 Health Care... | /kaggle/input/edi-db-835-837/837-health-care-claim-companion-guide.pdf | da20cac9edf74c6f8186b9d9268d0aab | da20cac9edf74c6f8186b9d9268d0aab_0 |
NM101 Entity ID Code R 40 Receiver 837 Health Care Claim Companion Guides Version 2.8 January, 2024 43 Seg Data Element Name Usage Comments Expected Value NM102 Entity Type Qualifier R Use 2 Non-Person Entity NM103 Receiver Name R Use CARELON BEHAVIORAL HEALTH, INC. NM109 Receiver Primary Identifier R This element cont... | /kaggle/input/edi-db-835-837/837-health-care-claim-companion-guide.pdf | da20cac9edf74c6f8186b9d9268d0aab | da20cac9edf74c6f8186b9d9268d0aab_1 |
835 - Companion Guide June 28, 2022 005010X221A1 835 1 835 Health Care Claim Payment Advice Companion Guide Refers to ASC X12 835 Technical Report Type 3 Guide HIPAA V5010X221A1 Version: 1.1 Publication: June 28, 2022 Author: Delta Dental 835 - Companion Guide June 28, 2022 005010X221A1 835 2 Disclosure Statement This ... | /kaggle/input/edi-db-835-837/companion-guide-835.pdf | 797bef7c9f95e3cc46e3501cfa4c1f9c | 797bef7c9f95e3cc46e3501cfa4c1f9c_0 |
State of Washington 837 Professional Healthcare Claim Companion Guide Prepared by: CNSI August 2012 WAMMIS-CG-837P-CLAIMS-5010-01-01 Disclaimer This companion guide contains data clarifications derived from specific business rules that apply exclusively to Washington State Medicaid processing for Washington State HCA. ... | /kaggle/input/edi-db-835-837/837-Professional-CG-2012.pdf | ed32b4253a0d4f41fd4ddee945072c87 | ed32b4253a0d4f41fd4ddee945072c87_0 |
State of Washington 837 Professional and Institutional Encounter Data Companion Guide Prepared by: CNSI WAMMIS-CG837ENC-5010-01-12 November 2023 Disclaimer This companion guide contains data clarifications derived from specific business rules that apply exclusively to Washington State Medicaid processing for Washington... | /kaggle/input/edi-db-835-837/837-Encounters-CG.pdf | 4362743e4e6fd23da15bccd26a737619 | 4362743e4e6fd23da15bccd26a737619_0 |
Stedi maintains this guide based on public documentation from Texas Medicaid Healthcare Partnerships (TMHP). Contact Texas Medicaid Healthcare Partnerships (TMHP) for official EDI specifications. To report any errors in this guide, please contact us. X12 837 837 Health Care Claim: Professional (X222 A2 A1) X12 Release ... | /kaggle/input/edi-db-835-837/Texas Medicaid and Healthcare Partnerships.pdf | 4a37daee5032a47fe649756aa1604f37 | 4a37daee5032a47fe649756aa1604f37_0 |
364 Communication Number Min 1 Max 256 String (AN) Optional Complete communications number including country or area code when applicable PER-07 365 Communication Number Qualifier Identifier (ID) Optional Code identifying the type of communication number EM Electronic Mail EX Telephone Extension FX Facsimile TE Telepho... | /kaggle/input/edi-db-835-837/Texas Medicaid and Healthcare Partnerships.pdf | 4a37daee5032a47fe649756aa1604f37 | 4a37daee5032a47fe649756aa1604f37_1 |
Identification Qualifier Identifier (ID) Required Code qualifying the Reference Identification SY Social Security Number The Social Security Number must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid. REF-02 127 Subsc... | /kaggle/input/edi-db-835-837/Texas Medicaid and Healthcare Partnerships.pdf | 4a37daee5032a47fe649756aa1604f37 | 4a37daee5032a47fe649756aa1604f37_2 |
Required Code indicating the date format, time format, or date and time format DTP02 is the date or time or period format that will appear in DTP03. D8 Date Expressed in Format CCYYMMDD DTP-03 1251 Last X-Ray Date Min 1 Max 35 String (AN) Required Expression of a date, a time, or range of dates, times or dates and time... | /kaggle/input/edi-db-835-837/Texas Medicaid and Healthcare Partnerships.pdf | 4a37daee5032a47fe649756aa1604f37 | 4a37daee5032a47fe649756aa1604f37_3 |
do not apply. Usage notes The response answers the question: Was an EPSDT referral given to the patient? N No If no, then choose "NU" in CRC03 indicating no referral given. Y Yes CRC-03 1321 Condition Indicator Identifier (ID) Required Code indicating a condition Usage notes The codes for CRC03 also can be used for CRC... | /kaggle/input/edi-db-835-837/Texas Medicaid and Healthcare Partnerships.pdf | 4a37daee5032a47fe649756aa1604f37 | 4a37daee5032a47fe649756aa1604f37_4 |
do not send. The PRV segment in Loop ID-2310 applies to the entire claim unless overridden on the service line level by the presence of a PRV segment with the same value in PRV01. Example PRV PE PXC XXXXXX Max use 1 Optional PRV-01 1221 Provider Code Identifier (ID) Required Code identifying the type of provider PE Per... | /kaggle/input/edi-db-835-837/Texas Medicaid and Healthcare Partnerships.pdf | 4a37daee5032a47fe649756aa1604f37 | 4a37daee5032a47fe649756aa1604f37_5 |
Social Security Number (SSN) is also available on an IHS CHS claim, put the SSN in REF02. When sending the Social Security Number as the Member ID, it must be a string of exactly nine numbers with no separators. For example, sending "111002222" would be valid, while sending "111-00-2222" would be invalid. NM1-09 67 Oth... | /kaggle/input/edi-db-835-837/Texas Medicaid and Healthcare Partnerships.pdf | 4a37daee5032a47fe649756aa1604f37 | 4a37daee5032a47fe649756aa1604f37_6 |
AM Texas Medicaid Healthcare Partnerships (TMHP) 837 837 Health Care Claim: Professional (X222 A2 A1) - Stedi EDI Guides https: www.stedi.com app guides view tmhp 837-health-care-claim-professional-x222a2a1 01HMBZ8Y6XYRFK1ZR16EKD50N6 208 552 PWK 4200 Detail Billing Provider Hierarchical Level Loop Subscriber Hierarchic... | /kaggle/input/edi-db-835-837/Texas Medicaid and Healthcare Partnerships.pdf | 4a37daee5032a47fe649756aa1604f37 | 4a37daee5032a47fe649756aa1604f37_7 |
Required Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier REF-04 C040 Reference Identifier To identify one or more reference numbers or identification numbers as specified by the Reference Qualifier - REF04 contains data relating to the value ci... | /kaggle/input/edi-db-835-837/Texas Medicaid and Healthcare Partnerships.pdf | 4a37daee5032a47fe649756aa1604f37 | 4a37daee5032a47fe649756aa1604f37_8 |
organizational name NM1-04 1036 Supervising Provider First Name Min 1 Max 35 String (AN) Optional Individual first name NM1-05 1037 Supervising Provider Middle Name or Initial Min 1 Max 25 String (AN) Optional Individual middle name or initial NM1-07 1039 Supervising Provider Name Suffix Min 1 Max 10 String (AN) Option... | /kaggle/input/edi-db-835-837/Texas Medicaid and Healthcare Partnerships.pdf | 4a37daee5032a47fe649756aa1604f37 | 4a37daee5032a47fe649756aa1604f37_9 |
codified form. FRM-02 1073 Question Response Identifier (ID) Optional Code indicating a Yes or No condition or response FRM02, FRM03, FRM04 and FRM05 are responses which only have meaning in reference to the question identified in FRM01. N No W Not Applicable Y Yes FRM-03 127 Question Response Min 1 Max 50 String (AN) ... | /kaggle/input/edi-db-835-837/Texas Medicaid and Healthcare Partnerships.pdf | 4a37daee5032a47fe649756aa1604f37 | 4a37daee5032a47fe649756aa1604f37_10 |
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