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837 Transmission Page Map | |
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Fields that Display by Default | |
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Field on Transmission Page |
Location of Data in EDI |
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Amount |
CLM02 |
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Assigned |
From My Tasks page |
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Document Date |
BHT04 + BHT05 |
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Number of Errors |
Count of errors with a severity greater than 2 |
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Original File Date |
Date supplied by the -m Instream command line parameter |
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Original File Name |
Name supplied by the -m Instream command line parameter |
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Receiver |
Criteria set up by TI administrator |
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Sender |
Criteria set up by TI administrator |
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Status |
From My Tasks page See List of Statuses |
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Submitter Identifier |
2000C - CLM01 if available Otherwise 2000B – CLM01 |
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Fields that you can add with Choose Fields Link | |
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Field on Transmission Page |
Location of Data in EDI |
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AttendingPhysician2ndID |
2310A - REF02 |
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AttendingPhysician2ndIDQual |
2310A - REF01 |
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AttendingPhysicianIDCode |
2310A - NM109 |
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AttendingPhysicianIDCodeQual |
2310A - NM108 |
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Beginning Service Date |
2400 - DTP03 where DTP02 contains “RD8” |
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Billing / Pay-To Provider Specialty Code |
2000A - PRV01 |
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Billing / Pay-To Provider Specialty REF ID |
2000A - PRV03 |
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Billing / Pay-To Provider Specialty REF ID Qualifier |
2000A - PRV03 |
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Billing Provider Secondary ID |
2010AA - REF02 (first instance) |
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Billing Provider Second ID Qualifier |
2010AA - REF01 (first instance) |
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BillingProviderSecondIDRefID |
2010AA - REF02 (second instance) |
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BillingProviderSecondIDRefID Qual |
2010AA - REF01 (second instance) |
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Billing Provider ID |
2010AA - NM109 |
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Billing Provider ID Qualifier |
2010AA - NM108 |
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Claim Charge Amount |
Subscriber or Patient 2300 - CLM02 |
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Claim Date Of Service |
Subscriber or Patient 2300 - Statement Dates DTP03 |
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Claim Frequency Type Code |
Patient - CLM0503 if available Otherwise Subscriber - CLM0503" |
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ClaimSuppInfoIDCode |
Patient - 2400 PWK06 if available Otherwise Subscriber 2400 PWK06 |
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Clearinghouse Claim ID |
Subscriber or Patient 2300 - Claim Identification Number For Clearinghouses and Other Transmission Intermediaries REF02 |
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ClearinghouseClaimNumRefID |
Subscriber 2300 - REF02 where REF01 = D9 |
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Dependent 2nd ID Identifier |
2010CA - REF02 |
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Dependent 2nd ID Qualifier |
2010CA - REF01 |
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Dependent Date of Birth |
2010CA - DMG02 |
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Dependent Identifier |
2010CA - NM109 |
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Dependent Identifier Qualifier |
2010CA - NM108 |
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Dependent Name First |
2010CA - NM104 |
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Dependent Name Last |
2010CA - NM103 |
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Dependent Name Middle |
2010CA - NM105 |
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Dependent Name Suffix |
2010CA - NM107 |
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Ending Service Date |
2400 - DTP03 where DTP02 contains “RD8” |
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Operating Physician Entity Type |
2310B - NM102 |
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Operating Physician Name First |
2310B - NM104 |
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Operating Physician Name Last |
2310B - NM103 |
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Operating Physician Name Middle |
2310B - NM105 |
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Operating Physician Name Suffix |
2310B - NM107 |
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Operating Physician Secondary ID |
837I only 2310B - REF02 |
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Operating Physician Secondary ID Qualifier |
837I only 2310B - REF01 |
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OperatingPhysicianIDCode |
837I only 2310B - NM109 |
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OperatingPhysicianIDCodeQual |
837I only 2310B - NM108 |
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Original Reference Number |
2300 > Original Reference Number REF02 |
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Patient Account Number |
CLM01 |
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Pay To Provider City |
2010AB - N401 |
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Pay To Provider Country Code |
2010AB - N404 |
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Pay To Provider Entity Type |
2010AB - NM102 |
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Pay To Provider Mailing Address 1 |
2010AB - N301 |
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Pay To Provider Mailing Address 2 |
2010AB - N302 |
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Pay To Provider Name First |
2010AB - NM104 |
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Pay To Provider Name Last |
2010AB - NM103 |
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Pay To Provider Name Middle |
2010AB - NM105 |
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Pay To Provider Name Suffix |
2010AB - NM107 |
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Pay To Provider State |
2010AB - N402 |
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Pay To Provider Zip |
2010AB - N403 |
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Pay To Provider Secondary ID |
2010AB - REF02 (first instance) |
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PaytoProvider2ndIDRefID |
2010AB - REF02 (second instance) |
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Pay To Provider Secondary ID Qualifier |
2010AB - REF01 (first instance) |
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PaytoProvider2ndIDRefIDQual |
2010AB - REF01 (second instance) |
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PaytoProviderID |
2010AB - NM109 |
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PaytoProviderIDQual |
2010AB - NM108 |
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Provider City |
2010AA - N401 |
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Provider Contact 1 Email |
2010AA - PER04/06/08 when PER03/05/07 = EM |
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Provider Contact 1 FAX |
2010AA - PER04/06/08 when PER03/05/07 = FX |
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Provider Contact 1 Name |
2010AA - PER02 |
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Provider Contact 1 Phone |
2010AA - PER04/06/08 when PER03/05/07 = TE |
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Provider Contact 2 Email |
2010AA - PER04/06/08 when PER03/05/07 = EM |
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Provider Contact 2 FAX |
2010AA - PER04/06/08 when PER03/05/07 = FX |
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Provider Contact 2 Name |
2010AA - PER02 |
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Provider Contact 2 Phone |
2010AA - PER04/06/08 when PER03/05/07 = TE |
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Provider Country Code |
2010AA - N404 |
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Provider Entity Type |
2010AA - NM102 |
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Provider Identifier |
2010AA - NM109 |
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Provider Identifier Qualifier |
2010AA - NM108 |
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Provider Mailing Address 1 |
2010AA - N301 |
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Provider Mailing Address 2 |
2010AA - N302 |
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Provider Name First |
2010AA - NM104 |
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Provider Name Last |
2010AA - NM103 |
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Provider Name Middle |
2010AA - NM105 |
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Provider Name Suffix |
2010AA - NM107 |
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Provider State |
2010AA - N402 |
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Provider Zip |
2010AA - N403 |
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Receiver Identifier |
1000B - NM109 |
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Receiver Identifier Qualifier |
1000B - NM108 |
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Receiver Name Last |
1000B - NM103 |
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Rendering Provider Name Last |
837D and 837P 2310B - NM103 |
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Rendering Provider Secondary ID |
837D and 837P 2310B - REF02 |
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Rendering Provider Secondary ID Qualifier |
837D and 837P 2310B - REF01 |
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Rendering Provider Specialty Code |
837D and 837P 2310B - PRV01 |
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Rendering Provider Specialty Ref ID |
837D and 837P 2310B - PRV03 |
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Rendering Provider Specialty Ref ID Qualifier |
837D and 837P 2310B - PRV02 |
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RenderingProvider2ndID |
837D and 837P 2310B - REF02 |
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RenderingProvider2ndIDQual |
837D and 837P 2310B - REF01 |
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SubmitterIdentifier837I |
1000A - NM109 |
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Submitter Contact 1 Email |
1000A - PER04/06/08 when PER03/05/07 = EM |
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Submitter Contact 1 FAX |
1000A - PER04/06/08 when PER03/05/07 = FX |
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Submitter Contact 1 Name |
1000A - PER02 |
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Submitter Contact 1 Phone |
1000A - PER04/06/08 when PER03/05/07 = TE |
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Submitter Contact 2 Email |
1000A - PER04/06/08 when PER03/05/07 = EM |
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Submitter Contact 2 FAX |
1000A - PER04/06/08 when PER03/05/07 = FX |
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Submitter Contact 2 Name |
1000A - PER02 |
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Submitter Contact 2 Phone |
1000A - PER04/06/08 when PER03/05/07 = TE |
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Submitter Identifier Qualifier |
1000A - NM108 |
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Submitter Name First |
1000A - NM104 |
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Submitter Name Last |
1000A - NM103 |
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Submitter Name Middle |
1000A - NM105 |
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Subscriber 2nd ID Identifier |
2010BA - REF02 |
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Subscriber 2nd ID Qualifier |
2010BA - REF01 |
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Subscriber Date of Birth |
2010BA - DMG02 |
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Subscriber Identifier |
2010BA - NM109 |
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Subscriber Identifier Qualifier |
2010BA - NM108 |
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Subscriber Name First |
2010BA - NM104 |
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Subscriber Name Last |
2010BA - NM103 |
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Subscriber Name Middle |
2010BA - NM105 |
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Subscriber Name Suffix |
2010BA - NM107 |
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Transaction Date |
BHT04 + BHT05 |