837

Health Care Claim: Dental

Functional Group=HC

This Draft Standard for Trial Use contains the format and establishes the data contents of the Health Care Claim Transaction Set (837) for use within the context of an Electronic Data Interchange (EDI) environment. This transaction set can be used to submit health care claim billing information, encounter information, or both, from providers of health care services to payers, either directly or via intermediary billers and claims clearinghouses. It can also be used to transmit health care claims and billing payment information between payers with different payment responsibilities where coordination of benefits is required or between payers and regulatory agencies to monitor the rendering, billing, and/or payment of health care services within a specific health care/insurance industry segment.For purposes of this standard, providers of health care products or services may include entities such as physicians, hospitals and other medical facilities or suppliers, dentists, and pharmacies, and entities providing medical information to meet regulatory requirements. The payer refers to a third party entity that pays claims or administers the insurance product or benefit or both. For example, a payer may be an insurance company, health maintenance organization (HMO), preferred provider organization (PPO), government agency (Medicare, Medicaid, Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), etc.) or an entity such as a third party administrator (TPA) or third party organization (TPO) that may be contracted by one of those groups. A regulatory agency is an entity responsible, by law or rule, for administering and monitoring a statutory benefits program or a specific health care/insurance industry segment.

Not Defined:

 

Pos

Id

Segment Name

Req

Max Use

Repeat

Notes

Usage

 

 

 

 

 

 

ISA

Interchange Control Header

M

1

 

 

Required

       

 

 

GS

Functional Group Header

M

1

 

 

Required

       

Heading:

 

Pos

Id

Segment Name

Req

Max Use

Repeat

Notes

Usage

 

 

 

 

 

005

ST

Transaction Set Header

M

1

 

 

Required

       

 

010

BHT

Beginning of Hierarchical Transaction

M

1

 

 

Required

       

 

015

REF

Transmission Type Identification

O

1

 

 

Required

       

LOOP ID - 1000A

 

 

1

N1/020L

 

 

 

 

 

 

020

NM1

Submitter Name

O

1

 

N1/020

Required

       

 

045

PER

Submitter Contact Information

O

2

 

 

Required

       

LOOP ID - 1000B

 

 

1

N1/020L

 

 

 

 

 

 

020

NM1

Receiver Name

O

1

 

N1/020

Required

       

Detail:

 

Pos

Id

Segment Name

Req

Max Use

Repeat

Notes

Usage

 

 

 

 

LOOP ID - 2000A

 

 

>1

 

 

 

 

 

 

 

001

HL

Billing/Pay-to Provider Hierarchical Level

M

1

 

 

Required

       

 

003

PRV

Billing/Pay-to Provider Specialty Information

O

1

 

 

Situational

       

 

010

CUR

Foreign Currency Information

O

1

 

 

Situational

       

LOOP ID - 2010AA

 

 

1

N2/015L

 

 

 

 

 

 

015

NM1

Billing Provider Name

O

1

 

N2/015

Required

       

 

020

N2

Additional Billing Provider Name Information

O

1

 

 

Situational

       

 

025

N3

Billing Provider Address

O

1

 

 

Required

       

 

030

N4

Billing Provider City/State/ZIP Code

O

1

 

 

Required

       

 

035

REF

Billing Provider Secondary Identification Number

O

5

 

 

Situational

       

 

035

REF

Claim Submitter Credit/Debit Card Information

O

8

 

 

Situational

       

LOOP ID - 2010AB

 

 

1

N2/015L

 

 

 

 

 

 

015

NM1

Pay-to Provider’s Name

O

1

 

N2/015

Situational

       

 

020

N2

Additional Pay-to Provider Name Information

O

1

 

 

Situational

       

 

025

N3

Pay-to Provider’s Address

O

1

 

 

Required

       

 

030

N4

Pay-to Provider City/State/Zip

O

1

 

 

Required

       

 

035

REF

Pay-to Provider Secondary Identification Number

O

5

 

 

Situational

       

LOOP ID - 2000B

 

 

>1

 

 

 

 

 

 

 

001

HL

Subscriber Hierarchical Level

M

1

 

 

Required

       

 

005

SBR

Subscriber Information

O

1

 

 

Required

       

LOOP ID - 2010BA

 

 

1

N2/015L

 

 

 

 

 

 

015

NM1

Subscriber Name

O

1

 

N2/015

Required

       

 

025

N3

Subscriber Address

O

1

 

 

Situational

       

 

030

N4

Subscriber City/State/ZIP Code

O

1

 

 

Situational

       

 

032

DMG

Subscriber Demographic Information

O

1

 

 

Situational

       

 

035

REF

Subscriber Secondary Identification

O

4

 

 

Situational

       

 

035

REF

Property and Casualty Claim Number

O

1

 

 

Situational

       

LOOP ID - 2010BB

 

 

1

N2/015L

 

 

 

 

 

 

015

NM1

Payer Name

O

1

 

N2/015

Required

       

 

025

N3

Payer Address

O

1

 

 

Situational

       

 

030

N4

Payer City/State/ZIP Code

O

1

 

 

Situational

       

 

035

REF

Payer Secondary Identification Number

O

3

 

 

Situational

       

LOOP ID - 2010BC

 

 

1

N2/015L

 

 

 

 

 

 

015

NM1

Credit/Debit Card Holder Name

O

1

 

N2/015

Situational

       

 

035

REF

Credit/Debit Card Information

O

3

 

 

Situational

       

LOOP ID - 2300

 

 

100

 

 

 

 

 

 

 

130

CLM

Claim Information

O

1

 

 

Required

       

 

135

DTP

Date - Admission

O

1

 

 

Situational

       

 

135

DTP

Date - Discharge

O

1

 

 

Situational

       

 

135

DTP

Date - Referral

O

1

 

 

Situational

       

 

135

DTP

Date - Accident

O

1

 

 

Situational

       

 

135

DTP

Date - Appliance Placement

O

5

 

 

Situational

       

 

135

DTP

Date - Service

O

1

 

 

Situational

       

 

145

DN1

Orthodontic Total Months of Treatment

O

1

 

 

Situational

       

 

150

DN2

Tooth Status

O

35

 

 

Situational

       

 

155

PWK

Claim Supplemental Information

O

10

 

 

Situational

       

 

175

AMT

Patient Amount Paid

O

1

 

 

Situational

       

 

175

AMT

Credit/Debit Card - Maximum Amount

O

1

 

 

Situational

       

 

180

REF

Predetermination Identification

O

5

 

 

Situational

       

 

180

REF

Service Authorization Exception Code

O

1

 

 

Situational

       

 

180

REF

Original Reference Number (ICN/DCN)

O

1

 

 

Situational

       

 

180

REF

Prior Authorization or Referral Number

O

2

 

 

Situational

       

 

180

REF

Claim Identification Number for Clearinghouses and Other Transmission Intermediaries

O

1

 

 

Situational

       

 

190

NTE

Claim Note

O

20

 

 

Situational

       

LOOP ID - 2310A

 

 

2

N2/250L

 

 

 

 

 

 

250

NM1

Referring Provider Name

O

1

 

N2/250

Situational

       

 

255

PRV

Referring Provider Specialty Information

O

1

 

 

Situational

       

 

271

REF

Referring Provider Secondary Identification

O

5

 

 

Situational

       

LOOP ID - 2310B

 

 

1

N2/250L

 

 

 

 

 

 

250

NM1

Rendering Provider Name

O

1

 

N2/250

Situational

       

 

255

PRV

Rendering Provider Specialty Information

O

1

 

 

Situational

       

 

271

REF

Rendering Provider Secondary Identification

O

5

 

 

Situational

       

LOOP ID - 2310C

 

 

1

N2/250L

 

 

 

 

 

 

250

NM1

Service Facility Location

O

1

 

N2/250

Situational

       

 

271

REF

Service Facility Location Secondary Identification

O

5

 

 

Situational

       

LOOP ID - 2310D

 

 

1

N2/250L

 

 

 

 

 

 

250

NM1

Assistant Surgeon Name

O

1

 

N2/250

Situational

       

 

255

PRV

Assistant Surgeon Specialty Information

O

1

 

 

Situational

       

 

271

REF

Assistant Surgeon Secondary Identification

O

1

 

 

Situational

       

LOOP ID - 2320

 

 

10

N2/290L

 

 

 

 

 

 

290

SBR

Other Subscriber Information

O

1

 

N2/290

Situational

       

 

295

CAS

Claim Adjustment

O

5

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Payer Paid Amount

O

1

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Approved Amount

O

1

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Allowed Amount

O

1

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Patient Responsibility Amount

O

1

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Covered Amount

O

1

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Discount Amount

O

1

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Patient Paid Amount

O

1

 

 

Situational

       

 

305

DMG

Other Insured Demographic Information

O

1

 

 

Situational

       

 

310

OI

Other Insurance Coverage Information

O

1

 

 

Required

       

LOOP ID - 2330A

 

 

1

N2/325L

 

 

 

 

 

 

325

NM1

Other Subscriber Name

O

1

 

N2/325

Required

       

 

332

N3

Other Subscriber Address

O

1

 

 

Situational

       

 

340

N4

Other Subscriber City/State/Zip Code

O

1

 

 

Situational

       

 

355

REF

Other Subscriber Secondary Identification

O

3

 

 

Situational

       

LOOP ID - 2330B

 

 

1

N2/325L

 

 

 

 

 

 

325

NM1

Other Payer Name

O

1

 

N2/325

Required

       

 

345

PER

Other Payer Contact Information

O

2

 

 

Situational

       

 

350

DTP

Claim Paid Date

O

1

 

 

Situational

       

 

355

REF

Other Payer Secondary Identifier

O

3

 

 

Situational

       

 

355

REF

Other Payer Prior Authorization or Referral Number

O

2

 

 

Situational

       

 

355

REF

Other Payer Claim Adjustment Indicator

O

1

 

 

Situational

       

LOOP ID - 2330C

 

 

1

N2/325L

 

 

 

 

 

 

325

NM1

Other Payer Patient Information

O

1

 

N2/325

Situational

       

 

355

REF

Other Payer Patient Identification

O

3

 

 

Situational

       

LOOP ID - 2330D

 

 

1

N2/325L

 

 

 

 

 

 

325

NM1

Other Payer Referring Provider

O

1

 

N2/325

Situational

       

 

355

REF

Other Payer Referring Provider Identification

O

3

 

 

Situational

       

LOOP ID - 2330E

 

 

1

N2/325L

 

 

 

 

 

 

325

NM1

Other Payer Rendering Provider

O

1

 

N2/325

Situational

       

 

355

REF

Other Payer Rendering Provider Identification

O

3

 

 

Situational

       

LOOP ID - 2400

 

 

50

N2/365L

 

 

 

 

 

 

365

LX

Line Counter

O

1

 

N2/365

Required

       

 

380

SV3

Dental Service

O

1

 

 

Required

       

 

382

TOO

Tooth Information

O

32

 

 

Situational

       

 

455

DTP

Date - Service

O

1

 

 

Situational

       

 

455

DTP

Date - Prior Placement

O

1

 

 

Situational

       

 

455

DTP

Date - Appliance Placement

O

1

 

 

Situational

       

 

455

DTP

Date - Replacement

O

1

 

 

Situational

       

 

460

QTY

Anesthesia Quantity

O

5

 

 

Situational

       

 

470

REF

Service Predetermination Identification

O

1

 

 

Situational

       

 

470

REF

Prior Authorization or Referral Number

O

2

 

 

Situational

       

 

470

REF

Line Item Control Number

O

1

 

 

Situational

       

 

475

AMT

Approved Amount

O

1

 

 

Situational

       

 

475

AMT

Sales Tax Amount

O

1

 

 

Situational

       

 

485

NTE

Line Note

O

10

 

 

Situational

       

LOOP ID - 2420A

 

 

1

N2/500L

 

 

 

 

 

 

500

NM1

Rendering Provider Name

O

1

 

N2/500

Situational

       

 

505

PRV

Rendering Provider Specialty Information

O

1

 

 

Situational

       

 

525

REF

Rendering Provider Secondary Identification

O

5

 

 

Situational

       

LOOP ID - 2420B

 

 

1

N2/500L

 

 

 

 

 

 

500

NM1

Other Payer Prior Authorization or Referral Number

O

1

 

N2/500

Situational

       

 

525

REF

Other Payer Prior Authorization or Referral Number

O

2

 

 

Situational

       

LOOP ID - 2420C

 

 

1

N2/500L

 

 

 

 

 

 

500

NM1

Assistant Surgeon Name

O

1

 

N2/500

Situational

       

 

505

PRV

Assistant Surgeon Specialty Information

O

1

 

 

Situational

       

 

525

REF

Assistant Surgeon Secondary Identification

O

1

 

 

Situational

       

LOOP ID - 2430

 

 

25

N2/540L

 

 

 

 

 

 

540

SVD

Line Adjudication Information

O

1

 

N2/540

Situational

       

 

545

CAS

Service Adjustment

O

99

 

 

Situational

       

 

550

DTP

Line Adjudication Date

O

1

 

 

Required

       

LOOP ID - 2000C

 

 

>1

 

 

 

 

 

 

 

001

HL

Patient Hierarchical Level

O

1

 

 

Situational

       

 

007

PAT

Patient Information

O

1

 

 

Required

       

LOOP ID - 2010CA

 

 

1

N2/015L

 

 

 

 

 

 

015

NM1

Patient Name

O

1

 

N2/015

Required

       

 

025

N3

Patient Address

O

1

 

 

Required

       

 

030

N4

Patient City/State/ZIP Code

O

1

 

 

Required

       

 

032

DMG

Patient Demographic Information

O

1

 

 

Required

       

 

035

REF

Patient Secondary Identification

O

5

 

 

Situational

       

 

035

REF

Property and Casualty Claim Number

O

1

 

 

Situational

       

LOOP ID - 2300

 

 

100

 

 

 

 

 

 

 

130

CLM

Claim Information

O

1

 

 

Required

       

 

135

DTP

Date - Admission

O

1

 

 

Situational

       

 

135

DTP

Date - Discharge

O

1

 

 

Situational

       

 

135

DTP

Date - Referral

O

1

 

 

Situational

       

 

135

DTP

Date - Accident

O

1

 

 

Situational

       

 

135

DTP

Date - Appliance Placement

O

5

 

 

Situational

       

 

135

DTP

Date - Service

O

1

 

 

Situational

       

 

145

DN1

Orthodontic Total Months of Treatment

O

1

 

 

Situational

       

 

150

DN2

Tooth Status

O

35

 

 

Situational

       

 

155

PWK

Claim Supplemental Information

O

10

 

 

Situational

       

 

175

AMT

Patient Amount Paid

O

1

 

 

Situational

       

 

175

AMT

Credit/Debit Card - Maximum Amount

O

1

 

 

Situational

       

 

180

REF

Predetermination Identification

O

5

 

 

Situational

       

 

180

REF

Service Authorization Exception Code

O

1

 

 

Situational

       

 

180

REF

Original Reference Number (ICN/DCN)

O

1

 

 

Situational

       

 

180

REF

Prior Authorization or Referral Number

O

2

 

 

Situational

       

 

180

REF

Claim Identification Number for Clearinghouses and Other Transmission Intermediaries

O

1

 

 

Situational

       

 

190

NTE

Claim Note

O

20

 

 

Situational

       

LOOP ID - 2310A

 

 

2

N2/250L

 

 

 

 

 

 

250

NM1

Referring Provider Name

O

1

 

N2/250

Situational

       

 

255

PRV

Referring Provider Specialty Information

O

1

 

 

Situational

       

 

271

REF

Referring Provider Secondary Identification

O

5

 

 

Situational

       

LOOP ID - 2310B

 

 

1

N2/250L

 

 

 

 

 

 

250

NM1

Rendering Provider Name

O

1

 

N2/250

Situational

       

 

255

PRV

Rendering Provider Specialty Information

O

1

 

 

Situational

       

 

271

REF

Rendering Provider Secondary Identification

O

5

 

 

Situational

       

LOOP ID - 2310C

 

 

1

N2/250L

 

 

 

 

 

 

250

NM1

Service Facility Location

O

1

 

N2/250

Situational

       

 

271

REF

Service Facility Location Secondary Identification

O

5

 

 

Situational

       

LOOP ID - 2310D

 

 

1

N2/250L

 

 

 

 

 

 

250

NM1

Assistant Surgeon Name

O

1

 

N2/250

Situational

       

 

255

PRV

Assistant Surgeon Specialty Information

O

1

 

 

Situational

       

 

271

REF

Assistant Surgeon Secondary Identification

O

1

 

 

Situational

       

LOOP ID - 2320

 

 

10

N2/290L

 

 

 

 

 

 

290

SBR

Other Subscriber Information

O

1

 

N2/290

Situational

       

 

295

CAS

Claim Adjustment

O

5

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Payer Paid Amount

O

1

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Approved Amount

O

1

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Allowed Amount

O

1

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Patient Responsibility Amount

O

1

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Covered Amount

O

1

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Discount Amount

O

1

 

 

Situational

       

 

300

AMT

Coordination of Benefits (COB) Patient Paid Amount

O

1

 

 

Situational

       

 

305

DMG

Other Insured Demographic Information

O

1

 

 

Situational

       

 

310

OI

Other Insurance Coverage Information

O

1

 

 

Required

       

LOOP ID - 2330A

 

 

1

N2/325L

 

 

 

 

 

 

325

NM1

Other Subscriber Name

O

1

 

N2/325

Required

       

 

332

N3

Other Subscriber Address

O

1

 

 

Situational

       

 

340

N4

Other Subscriber City/State/Zip Code

O

1

 

 

Situational

       

 

355

REF

Other Subscriber Secondary Identification

O

3

 

 

Situational

       

LOOP ID - 2330B

 

 

1

N2/325L

 

 

 

 

 

 

325

NM1

Other Payer Name

O

1

 

N2/325

Required

       

 

345

PER

Other Payer Contact Information

O

2

 

 

Situational

       

 

350

DTP

Claim Paid Date

O

1

 

 

Situational

       

 

355

REF

Other Payer Secondary Identifier

O

3

 

 

Situational

       

 

355

REF

Other Payer Prior Authorization or Referral Number

O

2

 

 

Situational

       

 

355

REF

Other Payer Claim Adjustment Indicator

O

1

 

 

Situational

       

LOOP ID - 2330C

 

 

1

N2/325L

 

 

 

 

 

 

325

NM1

Other Payer Patient Information

O

1

 

N2/325

Situational

       

 

355

REF

Other Payer Patient Identification

O

3

 

 

Situational

       

LOOP ID - 2330D

 

 

1

N2/325L

 

 

 

 

 

 

325

NM1

Other Payer Referring Provider

O

1

 

N2/325

Situational

       

 

355

REF

Other Payer Referring Provider Identification

O

3

 

 

Situational

       

LOOP ID - 2330E

 

 

1

N2/325L

 

 

 

 

 

 

325

NM1

Other Payer Rendering Provider

O

1

 

N2/325

Situational

       

 

355

REF

Other Payer Rendering Provider Identification

O

3

 

 

Situational

       

LOOP ID - 2400

 

 

50

N2/365L

 

 

 

 

 

 

365

LX

Line Counter

O

1

 

N2/365

Required

       

 

380

SV3

Dental Service

O

1

 

 

Required

       

 

382

TOO

Tooth Information

O

32

 

 

Situational

       

 

455

DTP

Date - Service

O

1

 

 

Situational

       

 

455

DTP

Date - Prior Placement

O

1

 

 

Situational

       

 

455

DTP

Date - Appliance Placement

O

1

 

 

Situational

       

 

455

DTP

Date - Replacement

O

1

 

 

Situational

       

 

460

QTY

Anesthesia Quantity

O

5

 

 

Situational

       

 

470

REF

Service Predetermination Identification

O

1

 

 

Situational

       

 

470

REF

Prior Authorization or Referral Number

O

2

 

 

Situational

       

 

470

REF

Line Item Control Number

O

1

 

 

Situational

       

 

475

AMT

Approved Amount

O

1

 

 

Situational

       

 

475

AMT

Sales Tax Amount

O

1

 

 

Situational

       

 

485

NTE

Line Note

O

10

 

 

Situational

       

LOOP ID - 2420A

 

 

1

N2/500L

 

 

 

 

 

 

500

NM1

Rendering Provider Name

O

1

 

N2/500

Situational

       

 

505

PRV

Rendering Provider Specialty Information

O

1

 

 

Situational

       

 

525

REF

Rendering Provider Secondary Identification

O

5

 

 

Situational

       

LOOP ID - 2420B

 

 

1

N2/500L

 

 

 

 

 

 

500

NM1

Other Payer Prior Authorization or Referral Number

O

1

 

N2/500

Situational

       

 

525

REF

Other Payer Prior Authorization or Referral Number

O

2

 

 

Situational

       

LOOP ID - 2420C

 

 

1

N2/500L

 

 

 

 

 

 

500

NM1

Assistant Surgeon Name

O

1

 

N2/500

Situational

       

 

505

PRV

Assistant Surgeon Specialty Information

O

1

 

 

Situational

       

 

525

REF

Assistant Surgeon Secondary Identification

O

1

 

 

Situational

       

LOOP ID - 2430

 

 

25

N2/540L

 

 

 

 

 

 

540

SVD

Line Adjudication Information

O

1

 

N2/540

Situational

       

 

545

CAS

Service Adjustment

O

99

 

 

Situational

       

 

550

DTP

Line Adjudication Date

O

1

 

 

Required

       

 

555

SE

Transaction Set Trailer

M

1

 

 

Required

       

Not Defined:

 

Pos

Id

Segment Name

Req

Max Use

Repeat

Notes

Usage

 

 

 

 

 

 

GE

Functional Group Trailer

M

1

 

 

Required

       

 

 

IEA

Interchange Control Trailer

M

1

 

 

Required

       

Notes:

1/020L

Loop 1000 contains submitter and receiver information. If any intermediary receivers change or add data in any way, then they add an occurrence to the loop as a form of identification. The added loop occurrence must be the last occurrence of the loop.

1/020

Loop 1000 contains submitter and receiver information. If any intermediary receivers change or add data in any way, then they add an occurrence to the loop as a form of identification. The added loop occurrence must be the last occurrence of the loop.

1/020L

Loop 1000 contains submitter and receiver information. If any intermediary receivers change or add data in any way, then they add an occurrence to the loop as a form of identification. The added loop occurrence must be the last occurrence of the loop.

1/020

Loop 1000 contains submitter and receiver information. If any intermediary receivers change or add data in any way, then they add an occurrence to the loop as a form of identification. The added loop occurrence must be the last occurrence of the loop.

2/015L

Loop 2010 contains information about entities that apply to all claims in loop 2300. For example, these entities may include billing provider, pay-to provider, insurer, primary administrator, contract holder, or claimant.

2/015

Loop 2010 contains information about entities that apply to all claims in loop 2300. For example, these entities may include billing provider, pay-to provider, insurer, primary administrator, contract holder, or claimant.

2/015L

Loop 2010 contains information about entities that apply to all claims in loop 2300. For example, these entities may include billing provider, pay-to provider, insurer, primary administrator, contract holder, or claimant.

2/015

Loop 2010 contains information about entities that apply to all claims in loop 2300. For example, these entities may include billing provider, pay-to provider, insurer, primary administrator, contract holder, or claimant.

2/015L

Loop 2010 contains information about entities that apply to all claims in loop 2300. For example, these entities may include billing provider, pay-to provider, insurer, primary administrator, contract holder, or claimant.

2/015

Loop 2010 contains information about entities that apply to all claims in loop 2300. For example, these entities may include billing provider, pay-to provider, insurer, primary administrator, contract holder, or claimant.

2/015L

Loop 2010 contains information about entities that apply to all claims in loop 2300. For example, these entities may include billing provider, pay-to provider, insurer, primary administrator, contract holder, or claimant.

2/015

Loop 2010 contains information about entities that apply to all claims in loop 2300. For example, these entities may include billing provider, pay-to provider, insurer, primary administrator, contract holder, or claimant.

2/015L

Loop 2010 contains information about entities that apply to all claims in loop 2300. For example, these entities may include billing provider, pay-to provider, insurer, primary administrator, contract holder, or claimant.

2/015

Loop 2010 contains information about entities that apply to all claims in loop 2300. For example, these entities may include billing provider, pay-to provider, insurer, primary administrator, contract holder, or claimant.

2/250L

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250L

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250L

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250L

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250

Loop 2310 contains information about the rendering, referring, or attending provider.

2/290L

Loop 2320 contains insurance information about: paying and other Insurance Carriers for that Subscriber, Subscriber of the Other Insurance Carriers, School or Employer Information for that Subscriber.

2/290

Loop 2320 contains insurance information about: paying and other Insurance Carriers for that Subscriber, Subscriber of the Other Insurance Carriers, School or Employer Information for that Subscriber.

2/325L

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325L

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325L

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325L

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325L

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/365L

Loop 2400 contains Service Line information.

2/365

Loop 2400 contains Service Line information.

2/500L

Loop 2420 contains information about the rendering, referring, or attending provider on a service line level. These segments override the information in the claim - level segments if the entity identifier codes in each NM1 segment are the same.

2/500

Loop 2420 contains information about the rendering, referring, or attending provider on a service line level. These segments override the information in the claim - level segments if the entity identifier codes in each NM1 segment are the same.

2/500L

Loop 2420 contains information about the rendering, referring, or attending provider on a service line level. These segments override the information in the claim - level segments if the entity identifier codes in each NM1 segment are the same.

2/500

Loop 2420 contains information about the rendering, referring, or attending provider on a service line level. These segments override the information in the claim - level segments if the entity identifier codes in each NM1 segment are the same.

2/500L

Loop 2420 contains information about the rendering, referring, or attending provider on a service line level. These segments override the information in the claim - level segments if the entity identifier codes in each NM1 segment are the same.

2/500

Loop 2420 contains information about the rendering, referring, or attending provider on a service line level. These segments override the information in the claim - level segments if the entity identifier codes in each NM1 segment are the same.

2/540L

SVD01 identifies the payer which adjudicated the corresponding service line and must match DE 67 in the NM109 position 325 for the payer.

2/540

SVD01 identifies the payer which adjudicated the corresponding service line and must match DE 67 in the NM109 position 325 for the payer.

2/015L

Loop 2010 contains information about entities that apply to all claims in loop 2300. For example, these entities may include billing provider, pay-to provider, insurer, primary administrator, contract holder, or claimant.

2/015

Loop 2010 contains information about entities that apply to all claims in loop 2300. For example, these entities may include billing provider, pay-to provider, insurer, primary administrator, contract holder, or claimant.

2/250L

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250L

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250L

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250L

Loop 2310 contains information about the rendering, referring, or attending provider.

2/250

Loop 2310 contains information about the rendering, referring, or attending provider.

2/290L

Loop 2320 contains insurance information about: paying and other Insurance Carriers for that Subscriber, Subscriber of the Other Insurance Carriers, School or Employer Information for that Subscriber.

2/290

Loop 2320 contains insurance information about: paying and other Insurance Carriers for that Subscriber, Subscriber of the Other Insurance Carriers, School or Employer Information for that Subscriber.

2/325L

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325L

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325L

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325L

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325L

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/325

Segments NM1-N4 contain name and address information of the insurance carriers referenced in loop 2320.

2/365L

Loop 2400 contains Service Line information.

2/365

Loop 2400 contains Service Line information.

2/500L

Loop 2420 contains information about the rendering, referring, or attending provider on a service line level. These segments override the information in the claim - level segments if the entity identifier codes in each NM1 segment are the same.

2/500

Loop 2420 contains information about the rendering, referring, or attending provider on a service line level. These segments override the information in the claim - level segments if the entity identifier codes in each NM1 segment are the same.

2/500L

Loop 2420 contains information about the rendering, referring, or attending provider on a service line level. These segments override the information in the claim - level segments if the entity identifier codes in each NM1 segment are the same.

2/500

Loop 2420 contains information about the rendering, referring, or attending provider on a service line level. These segments override the information in the claim - level segments if the entity identifier codes in each NM1 segment are the same.

2/500L

Loop 2420 contains information about the rendering, referring, or attending provider on a service line level. These segments override the information in the claim - level segments if the entity identifier codes in each NM1 segment are the same.

2/500

Loop 2420 contains information about the rendering, referring, or attending provider on a service line level. These segments override the information in the claim - level segments if the entity identifier codes in each NM1 segment are the same.

2/540L

SVD01 identifies the payer which adjudicated the corresponding service line and must match DE 67 in the NM109 position 325 for the payer.

2/540

SVD01 identifies the payer which adjudicated the corresponding service line and must match DE 67 in the NM109 position 325 for the payer.


1. The 837 transaction is designed to transmit one or more claims for each billing provider. The hierarchy of the looping structure is as follows: billing provider, subscriber, patient, claim level, and claim service line level. Billing providers who sort claims using this hierarchy use the 837 more efficiently because information that applies to all lower levels in the hierarchy does not have to be repeated within the transaction.
2. The developers of this implementation guide also recommend this standard for submitting similar data within a prepaid managed care context. Referred to as “capitated encounters,” this data usually does not result in a payment, though it is possible to submit a mixed claim that includes both prepaid and request for payment services. This standard allows for the submission of data from providers of health care products and services to a Managed Care Organization or other payer. This standard may be used by payers to share data with plan sponsors, employers, regulatory entities, and Community Health Information Networks.
3. This standard also can be used as a transaction set in support of the Coordination of Benefits (COB) claims process. Additional looped segments can be used within both the claim and service line levels to transfer each payer’s adjudication information to subsequent payers.


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