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Thanks to the tilde, it’s relatively easy to recognize segments. Every segment begins with a segment identifier code. Here are the most common codes: PRV = Provider; SBR = Subscriber; HL = Hierarchy; NM1 = Name Taxonomy (PRV) 837P – Professional Claims The taxonomy should be populated in Loops 2000A and 2310B PRV segment for all applicable claims that you are filing. PRV Loop 2000A Billing/Pay-to Provider PRV01 = Provider Code BI – Billing Provider Specialty Information PT – … 5. Only loops, segments, and data elements valid for the HIPAA Technical Report will be translated. Submitting data, not valid based on the Technical Report, will cause files to be rejected.

CMS1450: FL81 = Billing provider qualifier and taxonomy. Segment: PRV Billing Provider Specialty Information Loop: 2000A Billing Provider Hierarchical Level Level: Detail Usage: Situational by Implementation Guide Business Rule: AH requires submission of the following data elements for this segment. To submit the rending provider taxonomy code, please use the PRV segment in either loop 2310B or 2420A: Pos Id Segment Name Req Max Use Repeat Notes Usage ISA Interchange Control Header M 1 Required 837_P_Medical_v2.1.ecs 8 Ver 2.1 505 PRV Rendering Provider 3.0 Segment Usage – 837 Professional The following matrix lists all segments available for submission with the 5010 version of the 837P IG. Additionally, it includes a CSC Usage column that identifies segments that are required, situational, 837 Transactions and Code Sets . Other Electronic Transactions You Might Use . Healthcare Claims Status / Response . Standard Transaction Form: X12-276/277 - Health Care Claim Status Request and Response .

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PRV. PRV01. receiving a fully completed Provider/Group Access Information for 837 All Trading Partners are required to submit compliant 837 functional segments. All non- PRV. 3. Reference Identification Appropriate taxonomy code.

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IBC/KHPE Business Rules referenced in the Segment Usage Detail represent the following situations; The element is required by the Implementation Guide and required by IBC/KHPE.

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HIPAA 5010 837 transaction sets used are: 837 Q1 for professionals, 837 Q2 for dental practices, and 837 Q3 for institutions. Providers sent the proper 837 transaction set to payers. (See an example 837 Q1 below.) This transaction set can be used to submit healthcare claim billing information, encounter information, or both.

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Identification 10 Billing Provider Name The billing entity does not have to be a health care provider, however the NPI submitted must be known to SD Medicaid and also listed as a billing entity for the Rendering Provider. Must be a street address. NM108 NM109 837_P_Medical_v2.1.ecs 5 Ver 2.1 837 Health Care Claim: Professional-Medical Functional Group=HC 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 837 Institutional: Segment Usage Detail The 837 Institutional Data Element Segment identifies the specific data content required by IBC/KHPE. IBC/KHPE Business Rules referenced in the Segment Usage Detail represent the following situations; The element is required by the Implementation Guide and required by IBC/KHPE. PRV segment Denotes code is a Health Care Provider Taxonomy Code Health Care Provider Taxonomy Code Denotes taxonomy is for the provider BILLING the service PRV*BI*PXC*282NR1301X ~ The following are the Loops that are most commonly transmitted in the EDI 837 P message. 1.