X12 837P professional claim: format and example

837P structure

The full X12 837P layout from its OpenEDI definition, the same model ediFabric uses to parse, validate and generate it: 65 loops and 381 segment positions, in file order. Loops are shaded and their segments indented; Max use is how many times a segment or loop may repeat.

Segment / loop	Name	Usage	Max use
`ST`	Transaction Set Header	Required	1
`BHT`	Beginning of Hierarchical Transaction	Required	1
Any order	The loops below can appear in any order	Required	1
Loop 1000A	Submitter Name	Required	1
`NM1`	Submitter Name	Required	1
`PER`	Submitter EDI Contact Information	Required	2
Loop 1000B	Receiver Name	Required	1
`NM1`	Receiver Name	Required	1
Loop 2000A	Billing Provider Hierarchical Level	Required	>1
`HL`	Billing Provider Hierarchical Level	Required	1
`PRV`	Billing Provider Specialty Information	Situational	1
`CUR`	Foreign Currency Information	Situational	1
Any order	The loops below can appear in any order	Required	1
Loop 2010AA	Billing Provider Name	Required	1
`NM1`	Billing Provider Name	Required	1
`N3`	Billing Provider Address	Required	1
`N4`	Billing Provider City State ZIP Code	Required	1
Any order	The loops below can appear in any order	Required	1
`REF`	Billing Provider Tax Identification	Required	1
`REF`	Billing Provider UPIN License Information	Situational	2
`PER`	Billing Provider Contact Information	Situational	2
Loop 2010AB	Pay Address Name	Situational	1
`NM1`	Pay Address Name	Required	1
`N3`	Pay to Address ADDRESS	Required	1
`N4`	Pay Address City State ZIP Code	Required	1
Loop 2010AC	Pay to Plan Name	Situational	1
`NM1`	Pay to Plan Name	Required	1
`N3`	Pay to Plan Address	Required	1
`N4`	Pay to Plan City State ZIP Code	Required	1
Any order	The loops below can appear in any order	Required	1
`REF`	Pay to Plan Secondary Identification	Situational	1
`REF`	Pay to Plan Tax Identification Number	Required	1
Loop 2000B	Subscriber Hierarchical Level	Required	>1
`HL`	Subscriber Hierarchical Level	Required	1
`SBR`	Subscriber Information	Required	1
`PAT`	Patient Information	Situational	1
Any order	The loops below can appear in any order	Required	1
Loop 2010BA	Subscriber Name	Required	1
`NM1`	Subscriber Name	Required	1
`N3`	Subscriber Address	Situational	1
`N4`	Subscriber City State ZIP Code	Situational	1
`DMG`	Subscriber Demographic Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Subscriber Secondary Identification	Situational	1
`REF`	Propertyand Casualty Claim Number	Situational	1
`PER`	Propertyand Casualty Subscriber Contact Information	Situational	1
Loop 2010BB	Payer Name	Required	1
`NM1`	Payer Name	Required	1
`N3`	Payer Address	Situational	1
`N4`	Payer City State ZIP Code	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Payer Secondary Identification	Situational	3
`REF`	Billing Provider Secondary Identification	Situational	2
Loop 2300	Claim Information	Situational	100
`CLM`	Claim Information	Required	1
Any order	The loops below can appear in any order	Situational	1
`DTP`	Date Onsetof Current Illnessor Symptom	Situational	1
`DTP`	Date Initial Treatment Date	Situational	1
`DTP`	Date Last Seen Date	Situational	1
`DTP`	Date Acute Manifestation	Situational	1
`DTP`	Date Accident	Situational	1
`DTP`	Date Last Menstrual Period	Situational	1
`DTP`	Date Last X Date	Situational	1
`DTP`	Date Hearingand Vision Prescription Date	Situational	1
`DTP`	Date Disability Dates	Situational	1
`DTP`	Date Last Worked	Situational	1
`DTP`	Date Authorized Returnto Work	Situational	1
`DTP`	Date Admission	Situational	1
`DTP`	Date Discharge	Situational	1
`DTP`	Date Assumedand Relinquished Care Dates	Situational	2
`DTP`	Propertyand Casualty Dateof First Contact	Situational	1
`DTP`	Date Repricer Received Date	Situational	1
`PWK`	Claim Supplemental Information	Situational	10
`CN1`	Contract Information	Situational	1
`AMT`	Patient Amount Paid	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Service Authorization Exception Code	Situational	1
`REF`	Mandatory Medicare Section4081 Crossover Indicator	Situational	1
`REF`	Mammography Certification Number	Situational	1
`REF`	Referral Number	Situational	1
`REF`	Prior Authorization	Situational	1
`REF`	Payer Claim Control Number	Situational	1
`REF`	Clinical Laboratory Improvement Amendment CLIA Number	Situational	1
`REF`	Repriced Claim Number	Situational	1
`REF`	Adjusted Repriced Claim Number	Situational	1
`REF`	Investigational Device Exemption Number	Situational	1
`REF`	Claim Identifier for Transmission Intermediaries	Situational	1
`REF`	Medical Record Number	Situational	1
`REF`	Demonstration Project Identifier	Situational	1
`REF`	Care Plan Oversight	Situational	1
`K3`	File Information	Situational	10
`NTE`	Claim Note	Situational	1
`CR1`	Ambulance Transport Information	Situational	1
`CR2`	Spinal Manipulation Service Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
`CRC`	Ambulance Certification	Situational	3
`CRC`	Patient Condition Information Vision	Situational	3
`CRC`	Homebound Indicator	Situational	1
`CRC`	EPSDT Referral	Situational	1
Any order	The loops below can appear in any order	Required	1
`HI`	Health Care Diagnosis Code	Required	1
`HI`	Anesthesia Related Procedure	Situational	1
`HI`	Condition Information	Situational	2
`HCP`	Claim Pricing Repricing Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2310A	Referring Provider Name	Situational	2
`NM1`	Referring Provider Name	Required	1
`REF`	Referring Provider Secondary Identification	Situational	3
Loop 2310B	Rendering Provider Name	Situational	1
`NM1`	Rendering Provider Name	Required	1
`PRV`	Rendering Provider Specialty Information	Situational	1
`REF`	Rendering Provider Secondary Identification	Situational	4
Loop 2310C	Service Facility Location Name	Situational	1
`NM1`	Service Facility Location Name	Required	1
`N3`	Service Facility Location Address	Required	1
`N4`	Service Facility Location City State ZIP Code	Required	1
`REF`	Service Facility Location Secondary Identification	Situational	3
`PER`	Service Facility Contact Information	Situational	1
Loop 2310D	Supervising Provider Name	Situational	1
`NM1`	Supervising Provider Name	Required	1
`REF`	Supervising Provider Secondary Identification	Situational	4
Loop 2310E	Ambulance Pick Location	Situational	1
`NM1`	Ambulance Pick Location	Required	1
`N3`	Ambulance Pick Location Address	Required	1
`N4`	Ambulance Pick Location City State Zip Code	Required	1
Loop 2310F	Ambulance Drop Location	Situational	1
`NM1`	Ambulance Drop Location	Required	1
`N3`	Ambulance Drop Location Address	Required	1
`N4`	Ambulance Drop Location City State Zip Code	Required	1
Loop 2320	Other Subscriber Information	Situational	10
`SBR`	Other Subscriber Information	Required	1
`CAS`	Claim Level Adjustments	Situational	5
Any order	The loops below can appear in any order	Situational	1
`AMT`	Coordinationof Benefits COB Payer Paid Amount	Situational	1
`AMT`	Coordinationof Benefits COB Total Non Amount	Situational	1
`AMT`	Remaining Patient Liability	Situational	1
`OI`	Other Insurance Coverage Information	Required	1
`MOA`	Outpatient Adjudication Information	Situational	1
Any order	The loops below can appear in any order	Required	1
Loop 2330A	Other Subscriber Name	Required	1
`NM1`	Other Subscriber Name	Required	1
`N3`	Other Subscriber Address	Situational	1
`N4`	Other Subscriber City State ZIP Code	Situational	1
`REF`	Other Subscriber Secondary Identification	Situational	1
Loop 2330B	Other Payer Name	Required	1
`NM1`	Other Payer Name	Required	1
`N3`	Other Payer Address	Situational	1
`N4`	Other Payer City State ZIP Code	Situational	1
`DTP`	Claim Checkor Remittance Date	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Other Payer Secondary Identifier	Situational	2
`REF`	Other Payer Prior Authorization Number	Situational	1
`REF`	Other Payer Referral Number	Situational	1
`REF`	Other Payer Claim Adjustment Indicator	Situational	1
`REF`	Other Payer Claim Control Number	Situational	1
Loop 2330C	Other Payer Referring Provider	Situational	2
`NM1`	Other Payer Referring Provider	Required	1
`REF`	Other Payer Referring Provider Secondary Identification	Required	3
Loop 2330D	Other Payer Rendering Provider	Situational	1
`NM1`	Other Payer Rendering Provider	Required	1
`REF`	Other Payer Rendering Provider Secondary Identification	Required	3
Loop 2330E	Other Payer Service Facility Location	Situational	1
`NM1`	Other Payer Service Facility Location	Required	1
`REF`	Other Payer Service Facility Location Secondary Identification	Required	3
Loop 2330F	Other Payer Supervising Provider	Situational	1
`NM1`	Other Payer Supervising Provider	Required	1
`REF`	Other Payer Supervising Provider Secondary Identification	Required	3
Loop 2330G	Other Payer Billing Provider	Situational	1
`NM1`	Other Payer Billing Provider	Required	1
`REF`	Other Payer Billing Provider Secondary Identification	Required	2
Loop 2400	Service Line Number	Required	50
`LX`	Service Line Number	Required	1
`SV1`	Professional Service	Required	1
`SV5`	Durable Medical Equipment Service	Situational	1
Any order	The loops below can appear in any order	Situational	1
`PWK`	Line Supplemental Information	Situational	10
`PWK`	Durable Medical Equipment Certificateof Medical Necessity Indicator	Situational	1
`CR1`	Ambulance Transport Information	Situational	1
`CR3`	Durable Medical Equipment Certification	Situational	1
Any order	The loops below can appear in any order	Situational	1
`CRC`	Ambulance Certification	Situational	3
`CRC`	Hospice Employee Indicator	Situational	1
`CRC`	Condition Indicator Durable Medical Equipment	Situational	1
Any order	The loops below can appear in any order	Required	1
`DTP`	Date Service Date	Required	1
`DTP`	Date Prescription Date	Situational	1
`DTP`	DATE Certification Revision Recertification Date	Situational	1
`DTP`	Date Begin Therapy Date	Situational	1
`DTP`	Date Last Certification Date	Situational	1
`DTP`	Date Last Seen Date	Situational	1
`DTP`	Date Test Date	Situational	2
`DTP`	Date Shipped Date	Situational	1
`DTP`	Date Last X Date	Situational	1
`DTP`	Date Initial Treatment Date	Situational	1
Any order	The loops below can appear in any order	Situational	1
`QTY`	Ambulance Patient Count	Situational	1
`QTY`	Obstetric Anesthesia Additional Units	Situational	1
`MEA`	Test Result	Situational	5
`CN1`	Contract Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Repriced Line Item Reference Number	Situational	1
`REF`	Adjusted Repriced Line Item Reference Number	Situational	1
`REF`	Prior Authorization	Situational	5
`REF`	Line Item Control Number	Situational	1
`REF`	Mammography Certification Number	Situational	1
`REF`	Clinical Laboratory Improvement Amendment CLIA Number	Situational	1
`REF`	Referring Clinical Laboratory Improvement Amendment CLIA Facility Identification	Situational	1
`REF`	Immunization Batch Number	Situational	1
`REF`	Referral Number	Situational	5
Any order	The loops below can appear in any order	Situational	1
`AMT`	Sales Tax Amount	Situational	1
`AMT`	Postage Claimed Amount	Situational	1
`K3`	File Information	Situational	10
Any order	The loops below can appear in any order	Situational	1
`NTE`	Line Note	Situational	1
`NTE`	Third Party Organization Notes	Situational	1
`PS1`	Purchased Service Information	Situational	1
`HCP`	Line Pricing Repricing Information	Situational	1
Loop 2410	Drug Identification	Situational	1
`LIN`	Drug Identification	Required	1
`CTP`	Drug Quantity	Required	1
`REF`	Prescriptionor Compound Drug Association Number	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2420A	Rendering Provider Name	Situational	1
`NM1`	Rendering Provider Name	Required	1
`PRV`	Rendering Provider Specialty Information	Situational	1
`REF`	Rendering Provider Secondary Identification	Situational	20
Loop 2420B	Purchased Service Provider Name	Situational	1
`NM1`	Purchased Service Provider Name	Required	1
`REF`	Purchased Service Provider Secondary Identification	Situational	20
Loop 2420C	Service Facility Location	Situational	1
`NM1`	Service Facility Location	Required	1
`N3`	Service Facility Location Address	Required	1
`N4`	Service Facility Location City State ZIP Code	Required	1
`REF`	Service Facility Location Secondary Identification	Situational	3
Loop 2420D	Supervising Provider Name	Situational	1
`NM1`	Supervising Provider Name	Required	1
`REF`	Supervising Provider Secondary Identification	Situational	20
Loop 2420E	Ordering Provider Name	Situational	1
`NM1`	Ordering Provider Name	Required	1
`N3`	Ordering Provider Address	Situational	1
`N4`	Ordering Provider City State ZIP Code	Situational	1
`REF`	Ordering Provider Secondary Identification	Situational	20
`PER`	Ordering Provider Contact Information	Situational	1
Loop 2420F	Referring Provider Name	Situational	2
`NM1`	Referring Provider Name	Required	1
`REF`	Referring Provider Secondary Identification	Situational	20
Loop 2420G	Ambulance Pick Location	Situational	1
`NM1`	Ambulance Pick Location	Required	1
`N3`	Ambulance Pick Location Address	Required	1
`N4`	Ambulance Pick Location City State Zip Code	Required	1
Loop 2420H	Ambulance Drop Location	Situational	1
`NM1`	Ambulance Drop Location	Required	1
`N3`	Ambulance Drop Location Address	Required	1
`N4`	Ambulance Drop Location City State Zip Code	Required	1
Loop 2430	Line Adjudication Information	Situational	15
`SVD`	Line Adjudication Information	Required	1
`CAS`	Line Adjustment	Situational	5
`DTP`	Line Checkor Remittance Date	Required	1
`AMT`	Remaining Patient Liability	Situational	1
Loop 2440	Form Identification Code	Situational	>1
`LQ`	Form Identification Code	Required	1
`FRM`	Supporting Documentation	Required	99
Loop 2000C	Patient Hierarchical Level	Situational	>1
`HL`	Patient Hierarchical Level	Required	1
`PAT`	Patient Information	Required	1
Loop 2010CA	Patient Name	Required	1
`NM1`	Patient Name	Required	1
`N3`	Patient Address	Required	1
`N4`	Patient City State ZIP Code	Required	1
`DMG`	Patient Demographic Information	Required	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Propertyand Casualty Claim Number	Situational	1
`REF`	Propertyand Casualty Patient Identifier	Situational	1
`PER`	Propertyand Casualty Patient Contact Information	Situational	1
Loop 2300	Claim Information	Required	100
`CLM`	Claim Information	Required	1
Any order	The loops below can appear in any order	Situational	1
`DTP`	Date Onsetof Current Illnessor Symptom	Situational	1
`DTP`	Date Initial Treatment Date	Situational	1
`DTP`	Date Last Seen Date	Situational	1
`DTP`	Date Acute Manifestation	Situational	1
`DTP`	Date Accident	Situational	1
`DTP`	Date Last Menstrual Period	Situational	1
`DTP`	Date Last X Date	Situational	1
`DTP`	Date Hearingand Vision Prescription Date	Situational	1
`DTP`	Date Disability Dates	Situational	1
`DTP`	Date Last Worked	Situational	1
`DTP`	Date Authorized Returnto Work	Situational	1
`DTP`	Date Admission	Situational	1
`DTP`	Date Discharge	Situational	1
`DTP`	Date Assumedand Relinquished Care Dates	Situational	2
`DTP`	Propertyand Casualty Dateof First Contact	Situational	1
`DTP`	Date Repricer Received Date	Situational	1
`PWK`	Claim Supplemental Information	Situational	10
`CN1`	Contract Information	Situational	1
`AMT`	Patient Amount Paid	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Service Authorization Exception Code	Situational	1
`REF`	Mandatory Medicare Section4081 Crossover Indicator	Situational	1
`REF`	Mammography Certification Number	Situational	1
`REF`	Referral Number	Situational	1
`REF`	Prior Authorization	Situational	1
`REF`	Payer Claim Control Number	Situational	1
`REF`	Clinical Laboratory Improvement Amendment CLIA Number	Situational	1
`REF`	Repriced Claim Number	Situational	1
`REF`	Adjusted Repriced Claim Number	Situational	1
`REF`	Investigational Device Exemption Number	Situational	1
`REF`	Claim Identifier for Transmission Intermediaries	Situational	1
`REF`	Medical Record Number	Situational	1
`REF`	Demonstration Project Identifier	Situational	1
`REF`	Care Plan Oversight	Situational	1
`K3`	File Information	Situational	10
`NTE`	Claim Note	Situational	1
`CR1`	Ambulance Transport Information	Situational	1
`CR2`	Spinal Manipulation Service Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
`CRC`	Ambulance Certification	Situational	3
`CRC`	Patient Condition Information Vision	Situational	3
`CRC`	Homebound Indicator	Situational	1
`CRC`	EPSDT Referral	Situational	1
Any order	The loops below can appear in any order	Required	1
`HI`	Health Care Diagnosis Code	Required	1
`HI`	Anesthesia Related Procedure	Situational	1
`HI`	Condition Information	Situational	2
`HCP`	Claim Pricing Repricing Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2310A	Referring Provider Name	Situational	2
`NM1`	Referring Provider Name	Required	1
`REF`	Referring Provider Secondary Identification	Situational	3
Loop 2310B	Rendering Provider Name	Situational	1
`NM1`	Rendering Provider Name	Required	1
`PRV`	Rendering Provider Specialty Information	Situational	1
`REF`	Rendering Provider Secondary Identification	Situational	4
Loop 2310C	Service Facility Location Name	Situational	1
`NM1`	Service Facility Location Name	Required	1
`N3`	Service Facility Location Address	Required	1
`N4`	Service Facility Location City State ZIP Code	Required	1
`REF`	Service Facility Location Secondary Identification	Situational	3
`PER`	Service Facility Contact Information	Situational	1
Loop 2310D	Supervising Provider Name	Situational	1
`NM1`	Supervising Provider Name	Required	1
`REF`	Supervising Provider Secondary Identification	Situational	4
Loop 2310E	Ambulance Pick Location	Situational	1
`NM1`	Ambulance Pick Location	Required	1
`N3`	Ambulance Pick Location Address	Required	1
`N4`	Ambulance Pick Location City State Zip Code	Required	1
Loop 2310F	Ambulance Drop Location	Situational	1
`NM1`	Ambulance Drop Location	Required	1
`N3`	Ambulance Drop Location Address	Required	1
`N4`	Ambulance Drop Location City State Zip Code	Required	1
Loop 2320	Other Subscriber Information	Situational	10
`SBR`	Other Subscriber Information	Required	1
`CAS`	Claim Level Adjustments	Situational	5
Any order	The loops below can appear in any order	Situational	1
`AMT`	Coordinationof Benefits COB Payer Paid Amount	Situational	1
`AMT`	Coordinationof Benefits COB Total Non Amount	Situational	1
`AMT`	Remaining Patient Liability	Situational	1
`OI`	Other Insurance Coverage Information	Required	1
`MOA`	Outpatient Adjudication Information	Situational	1
Any order	The loops below can appear in any order	Required	1
Loop 2330A	Other Subscriber Name	Required	1
`NM1`	Other Subscriber Name	Required	1
`N3`	Other Subscriber Address	Situational	1
`N4`	Other Subscriber City State ZIP Code	Situational	1
`REF`	Other Subscriber Secondary Identification	Situational	1
Loop 2330B	Other Payer Name	Required	1
`NM1`	Other Payer Name	Required	1
`N3`	Other Payer Address	Situational	1
`N4`	Other Payer City State ZIP Code	Situational	1
`DTP`	Claim Checkor Remittance Date	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Other Payer Secondary Identifier	Situational	2
`REF`	Other Payer Prior Authorization Number	Situational	1
`REF`	Other Payer Referral Number	Situational	1
`REF`	Other Payer Claim Adjustment Indicator	Situational	1
`REF`	Other Payer Claim Control Number	Situational	1
Loop 2330C	Other Payer Referring Provider	Situational	2
`NM1`	Other Payer Referring Provider	Required	1
`REF`	Other Payer Referring Provider Secondary Identification	Required	3
Loop 2330D	Other Payer Rendering Provider	Situational	1
`NM1`	Other Payer Rendering Provider	Required	1
`REF`	Other Payer Rendering Provider Secondary Identification	Required	3
Loop 2330E	Other Payer Service Facility Location	Situational	1
`NM1`	Other Payer Service Facility Location	Required	1
`REF`	Other Payer Service Facility Location Secondary Identification	Required	3
Loop 2330F	Other Payer Supervising Provider	Situational	1
`NM1`	Other Payer Supervising Provider	Required	1
`REF`	Other Payer Supervising Provider Secondary Identification	Required	3
Loop 2330G	Other Payer Billing Provider	Situational	1
`NM1`	Other Payer Billing Provider	Required	1
`REF`	Other Payer Billing Provider Secondary Identification	Required	2
Loop 2400	Service Line Number	Required	50
`LX`	Service Line Number	Required	1
`SV1`	Professional Service	Required	1
`SV5`	Durable Medical Equipment Service	Situational	1
Any order	The loops below can appear in any order	Situational	1
`PWK`	Line Supplemental Information	Situational	10
`PWK`	Durable Medical Equipment Certificateof Medical Necessity Indicator	Situational	1
`CR1`	Ambulance Transport Information	Situational	1
`CR3`	Durable Medical Equipment Certification	Situational	1
Any order	The loops below can appear in any order	Situational	1
`CRC`	Ambulance Certification	Situational	3
`CRC`	Hospice Employee Indicator	Situational	1
`CRC`	Condition Indicator Durable Medical Equipment	Situational	1
Any order	The loops below can appear in any order	Required	1
`DTP`	Date Service Date	Required	1
`DTP`	Date Prescription Date	Situational	1
`DTP`	DATE Certification Revision Recertification Date	Situational	1
`DTP`	Date Begin Therapy Date	Situational	1
`DTP`	Date Last Certification Date	Situational	1
`DTP`	Date Last Seen Date	Situational	1
`DTP`	Date Test Date	Situational	2
`DTP`	Date Shipped Date	Situational	1
`DTP`	Date Last X Date	Situational	1
`DTP`	Date Initial Treatment Date	Situational	1
Any order	The loops below can appear in any order	Situational	1
`QTY`	Ambulance Patient Count	Situational	1
`QTY`	Obstetric Anesthesia Additional Units	Situational	1
`MEA`	Test Result	Situational	5
`CN1`	Contract Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Repriced Line Item Reference Number	Situational	1
`REF`	Adjusted Repriced Line Item Reference Number	Situational	1
`REF`	Prior Authorization	Situational	5
`REF`	Line Item Control Number	Situational	1
`REF`	Mammography Certification Number	Situational	1
`REF`	Clinical Laboratory Improvement Amendment CLIA Number	Situational	1
`REF`	Referring Clinical Laboratory Improvement Amendment CLIA Facility Identification	Situational	1
`REF`	Immunization Batch Number	Situational	1
`REF`	Referral Number	Situational	5
Any order	The loops below can appear in any order	Situational	1
`AMT`	Sales Tax Amount	Situational	1
`AMT`	Postage Claimed Amount	Situational	1
`K3`	File Information	Situational	10
Any order	The loops below can appear in any order	Situational	1
`NTE`	Line Note	Situational	1
`NTE`	Third Party Organization Notes	Situational	1
`PS1`	Purchased Service Information	Situational	1
`HCP`	Line Pricing Repricing Information	Situational	1
Loop 2410	Drug Identification	Situational	1
`LIN`	Drug Identification	Required	1
`CTP`	Drug Quantity	Required	1
`REF`	Prescriptionor Compound Drug Association Number	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2420A	Rendering Provider Name	Situational	1
`NM1`	Rendering Provider Name	Required	1
`PRV`	Rendering Provider Specialty Information	Situational	1
`REF`	Rendering Provider Secondary Identification	Situational	20
Loop 2420B	Purchased Service Provider Name	Situational	1
`NM1`	Purchased Service Provider Name	Required	1
`REF`	Purchased Service Provider Secondary Identification	Situational	20
Loop 2420C	Service Facility Location	Situational	1
`NM1`	Service Facility Location	Required	1
`N3`	Service Facility Location Address	Required	1
`N4`	Service Facility Location City State ZIP Code	Required	1
`REF`	Service Facility Location Secondary Identification	Situational	3
Loop 2420D	Supervising Provider Name	Situational	1
`NM1`	Supervising Provider Name	Required	1
`REF`	Supervising Provider Secondary Identification	Situational	20
Loop 2420E	Ordering Provider Name	Situational	1
`NM1`	Ordering Provider Name	Required	1
`N3`	Ordering Provider Address	Situational	1
`N4`	Ordering Provider City State ZIP Code	Situational	1
`REF`	Ordering Provider Secondary Identification	Situational	20
`PER`	Ordering Provider Contact Information	Situational	1
Loop 2420F	Referring Provider Name	Situational	2
`NM1`	Referring Provider Name	Required	1
`REF`	Referring Provider Secondary Identification	Situational	20
Loop 2420G	Ambulance Pick Location	Situational	1
`NM1`	Ambulance Pick Location	Required	1
`N3`	Ambulance Pick Location Address	Required	1
`N4`	Ambulance Pick Location City State Zip Code	Required	1
Loop 2420H	Ambulance Drop Location	Situational	1
`NM1`	Ambulance Drop Location	Required	1
`N3`	Ambulance Drop Location Address	Required	1
`N4`	Ambulance Drop Location City State Zip Code	Required	1
Loop 2430	Line Adjudication Information	Situational	15
`SVD`	Line Adjudication Information	Required	1
`CAS`	Line Adjustment	Situational	5
`DTP`	Line Checkor Remittance Date	Required	1
`AMT`	Remaining Patient Liability	Situational	1
Loop 2440	Form Identification Code	Situational	>1
`LQ`	Form Identification Code	Required	1
`FRM`	Supporting Documentation	Required	99
`SE`	Transaction Set Trailer	Required	1

Sample 837P file

One claim with four service lines for a patient who is a dependent of the subscriber. Paste it into EdiNation to see every element named and validated.

ISA*00*          *00*          *ZZ*1234567        *ZZ*11111          *170508*1141*^*00501*000000101*1*P*:~
GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X222A1~
ST*837*0021*005010X222A1~
BHT*0019*00*244579*20061015*1023*CH~
NM1*41*2*PREMIER BILLING SERVICE*****46*TGJ23~
PER*IC*JERRY*TE*3055552222*EX*231~
NM1*40*2*KEY INSURANCE COMPANY*****46*66783JJT~
HL*1**20*1~
PRV*BI*PXC*203BF0100Y~
NM1*85*2*BEN KILDARE SERVICE*****XX*9876543210~
N3*234 SEAWAY ST~
N4*MIAMI*FL*33111~
REF*EI*587654321~
NM1*87*2*Kildare Associates~
N3*2345 OCEAN BLVD~
N4*MIAMI*FL*33111~
HL*2*1*22*1~
SBR*P**2222-SJ******CI~
NM1*IL*1*SMITH*JANE****MI*JS00111223333~
DMG*D8*19430501*F~
NM1*PR*2*KEY INSURANCE COMPANY*****PI*999996666~
REF*G2*KA6663~
HL*3*2*23*0~
PAT*19~
NM1*QC*1*SMITH*TED~
N3*236 N MAIN ST~
N4*MIAMI*FL*33413~
DMG*D8*19730501*M~
CLM*26463774*100***11:B:1*Y*A*Y*I~
REF*D9*17312345600006351~
HI*BK:0340*BF:V7389~
LX*1~
SV1*HC:99213*40*UN*1***1~
DTP*472*D8*20061003~
LX*2~
SV1*HC:87070*15*UN*1***1~
DTP*472*D8*20061003~
LX*3~
SV1*HC:99214*35*UN*1***2~
DTP*472*D8*20061010~
LX*4~
SV1*HC:86663*10*UN*1***2~
DTP*472*D8*20061010~
SE*42*0021~
GE*1*101~
IEA*1*000000101~

The same 837P as JSON

ediFabric turns every loop, segment and element into a named field. This is the transaction from the sample, in the JSON that ediFabric Native and Cloud return and accept.

{
  "ST": {
    "TransactionSetIdentifierCode_01": "837",
    "TransactionSetControlNumber_02": "0021",
    "ImplementationConventionPreference_03": "005010X222A1"
  },
  "BHT_BeginningOfHierarchicalTransaction": {
    "HierarchicalStructureCode_01": "0019",
    "TransactionSetPurposeCode_02": "00",
    "SubmitterTransactionIdentifier_03": "244579",
    "TransactionSetCreationDate_04": "20061015",
    "TransactionSetCreationTime_05": "1023",
    "TransactionTypeCode_06": "CH"
  },
  "AllNM1": {
    "Loop1000A": {
      "NM1_SubmitterName": {
        "EntityIdentifierCode_01": "41",
        "EntityTypeQualifier_02": "2",
        "ResponseContactLastorOrganizationName_03": "PREMIER BILLING SERVICE",
        "IdentificationCodeQualifier_08": "46",
        "ResponseContactIdentifier_09": "TGJ23"
      },
      "PER_SubmitterEDIContactInformation": [
        {
          "ContactFunctionCode_01": "IC",
          "ResponseContactName_02": "JERRY",
          "CommunicationNumberQualifier_03": "TE",
          "ResponseContactCommunicationNumber_04": "3055552222",
          "CommunicationNumberQualifier_05": "EX",
          "ResponseContactCommunicationNumber_06": "231"
        }
      ]
    },
    "Loop1000B": {
      "NM1_ReceiverName": {
        "EntityIdentifierCode_01": "40",
        "EntityTypeQualifier_02": "2",
        "ResponseContactLastorOrganizationName_03": "KEY INSURANCE COMPANY",
        "IdentificationCodeQualifier_08": "46",
        "ResponseContactIdentifier_09": "66783JJT"
      }
    }
  },
  "Loop2000A": [
    {
      "HL_BillingProviderHierarchicalLevel": {
        "HierarchicalIDNumber_01": "1",
        "HierarchicalLevelCode_03": "20",
        "HierarchicalChildCode_04": "1"
      },
      "PRV_BillingProviderSpecialtyInformation": {
        "ProviderCode_01": "BI",
        "ReferenceIdentificationQualifier_02": "PXC",
        "ProviderTaxonomyCode_03": "203BF0100Y"
      },
      "AllNM1": {
        "Loop2010AA": {
          "NM1_BillingProviderName": {
            "EntityIdentifierCode_01": "85",
            "EntityTypeQualifier_02": "2",
            "ResponseContactLastorOrganizationName_03": "BEN KILDARE SERVICE",
            "IdentificationCodeQualifier_08": "XX",
            "ResponseContactIdentifier_09": "9876543210"
          },
          "N3_BillingProviderAddress": {
            "ResponseContactAddressLine_01": "234 SEAWAY ST"
          },
          "N4_BillingProviderCity_State_ZIPCode": {
            "AdditionalPatientInformationContactCityName_01": "MIAMI",
            "AdditionalPatientInformationContactStateCode_02": "FL",
            "AdditionalPatientInformationContactPostalZoneorZIPCode_03": "33111"
          },
          "AllREF": {
            "REF_BillingProviderTaxIdentification": {
              "ReferenceIdentificationQualifier_01": "EI",
              "MemberGrouporPolicyNumber_02": "587654321"
            }
          }
        },
        "Loop2010AB": {
          "NM1_Pay_AddressName": {
            "EntityIdentifierCode_01": "87",
            "EntityTypeQualifier_02": "2",
            "ResponseContactLastorOrganizationName_03": "Kildare Associates"
          },
          "N3_Pay_ToAddress_ADDRESS": {
            "ResponseContactAddressLine_01": "2345 OCEAN BLVD"
          },
          "N4_Pay_AddressCity_State_ZIPCode": {
            "AdditionalPatientInformationContactCityName_01": "MIAMI",
            "AdditionalPatientInformationContactStateCode_02": "FL",
            "AdditionalPatientInformationContactPostalZoneorZIPCode_03": "33111"
          }
        }
      },
      "Loop2000B": [
        {
          "HL_SubscriberHierarchicalLevel": {
            "HierarchicalIDNumber_01": "2",
            "HierarchicalParentIDNumber_02": "1",
            "HierarchicalLevelCode_03": "22",
            "HierarchicalChildCode_04": "1"
          },
          "SBR_SubscriberInformation": {
            "PayerResponsibilitySequenceNumberCode_01": "P",
            "InsuredGrouporPolicyNumber_03": "2222-SJ",
            "ClaimFilingIndicatorCode_09": "CI"
          },
          "AllNM1": {
            "Loop2010BA": {
              "NM1_SubscriberName": {
                "EntityIdentifierCode_01": "IL",
                "EntityTypeQualifier_02": "1",
                "ResponseContactLastorOrganizationName_03": "SMITH",
                "ResponseContactFirstName_04": "JANE",
                "IdentificationCodeQualifier_08": "MI",
                "ResponseContactIdentifier_09": "JS00111223333"
              },
              "DMG_SubscriberDemographicInformation": {
                "DateTimePeriodFormatQualifier_01": "D8",
                "DependentBirthDate_02": "19430501",
                "DependentGenderCode_03": "F"
              }
            },
            "Loop2010BB": {
              "NM1_PayerName": {
                "EntityIdentifierCode_01": "PR",
                "EntityTypeQualifier_02": "2",
                "ResponseContactLastorOrganizationName_03": "KEY INSURANCE COMPANY",
                "IdentificationCodeQualifier_08": "PI",
                "ResponseContactIdentifier_09": "999996666"
              },
              "AllREF": {
                "REF_BillingProviderSecondaryIdentification": [
                  {
                    "ReferenceIdentificationQualifier_01": "G2",
                    "MemberGrouporPolicyNumber_02": "KA6663"
                  }
                ]
              }
            }
          },
          "Loop2000C": [
            {
              "HL_PatientHierarchicalLevel": {
                "HierarchicalIDNumber_01": "3",
                "HierarchicalParentIDNumber_02": "2",
                "HierarchicalLevelCode_03": "23",
                "HierarchicalChildCode_04": "0"
              },
              "PAT_PatientInformation": {
                "IndividualRelationshipCode_01": "19"
              },
              "Loop2010CA": {
                "NM1_PatientName": {
                  "EntityIdentifierCode_01": "QC",
                  "EntityTypeQualifier_02": "1",
                  "ResponseContactLastorOrganizationName_03": "SMITH",
                  "ResponseContactFirstName_04": "TED"
                },
                "N3_PatientAddress": {
                  "ResponseContactAddressLine_01": "236 N MAIN ST"
                },
                "N4_PatientCity_State_ZIPCode": {
                  "AdditionalPatientInformationContactCityName_01": "MIAMI",
                  "AdditionalPatientInformationContactStateCode_02": "FL",
                  "AdditionalPatientInformationContactPostalZoneorZIPCode_03": "33413"
                },
                "DMG_PatientDemographicInformation": {
                  "DateTimePeriodFormatQualifier_01": "D8",
                  "DependentBirthDate_02": "19730501",
                  "DependentGenderCode_03": "M"
                }
              },
              "Loop2300": [
                {
                  "CLM_ClaimInformation": {
                    "PatientControlNumber_01": "26463774",
                    "TotalClaimChargeAmount_02": "100",
                    "HealthCareServiceLocationInformation_05": {
                      "FacilityTypeCode_01": "11",
                      "FacilityCodeQualifier_02": "B",
                      "ClaimFrequencyTypeCode_03": "1"
                    },
                    "ProviderorSupplierSignatureIndicator_06": "Y",
                    "AssignmentorPlanParticipationCode_07": "A",
                    "BenefitsAssignmentCertificationIndicator_08": "Y",
                    "ReleaseofInformationCode_09": "I"
                  },
                  "AllREF": {
                    "REF_ClaimIdentifierForTransmissionIntermediaries": {
                      "ReferenceIdentificationQualifier_01": "D9",
                      "MemberGrouporPolicyNumber_02": "17312345600006351"
                    }
                  },
                  "AllHI": {
                    "HI_HealthCareDiagnosisCode": {
                      "HealthCareCodeInformation_01": {
                        "CodeListQualifierCode_01": "BK",
                        "IndustryCode_02": "0340"
                      },
                      "HealthCareCodeInformation_02": {
                        "CodeListQualifierCode_01": "BF",
                        "IndustryCode_02": "V7389"
                      }
                    }
                  },
                  "Loop2400": [
                    {
                      "LX_ServiceLineNumber": {
                        "AssignedNumber_01": "1"
                      },
                      "SV1_ProfessionalService": {
                        "CompositeMedicalProcedureIdentifier_01": {
                          "ProductorServiceIDQualifier_01": "HC",
                          "ProcedureCode_02": "99213"
                        },
                        "LineItemChargeAmount_02": "40",
                        "UnitorBasisforMeasurementCode_03": "UN",
                        "ServiceUnitCount_04": "1",
                        "CompositeDiagnosisCodePointer_07": {
                          "DiagnosisCodePointer_01": "1"
                        }
                      },
                      "AllDTP": {
                        "DTP_Date_ServiceDate": {
                          "DateTimeQualifier_01": "472",
                          "DateTimePeriodFormatQualifier_02": "D8",
                          "DateTimePeriod_03": "20061003"
                        }
                      }
                    },
                    {
                      "LX_ServiceLineNumber": {
                        "AssignedNumber_01": "2"
                      },
                      "SV1_ProfessionalService": {
                        "CompositeMedicalProcedureIdentifier_01": {
                          "ProductorServiceIDQualifier_01": "HC",
                          "ProcedureCode_02": "87070"
                        },
                        "LineItemChargeAmount_02": "15",
                        "UnitorBasisforMeasurementCode_03": "UN",
                        "ServiceUnitCount_04": "1",
                        "CompositeDiagnosisCodePointer_07": {
                          "DiagnosisCodePointer_01": "1"
                        }
                      },
                      "AllDTP": {
                        "DTP_Date_ServiceDate": {
                          "DateTimeQualifier_01": "472",
                          "DateTimePeriodFormatQualifier_02": "D8",
                          "DateTimePeriod_03": "20061003"
                        }
                      }
                    },
                    {
                      "LX_ServiceLineNumber": {
                        "AssignedNumber_01": "3"
                      },
                      "SV1_ProfessionalService": {
                        "CompositeMedicalProcedureIdentifier_01": {
                          "ProductorServiceIDQualifier_01": "HC",
                          "ProcedureCode_02": "99214"
                        },
                        "LineItemChargeAmount_02": "35",
                        "UnitorBasisforMeasurementCode_03": "UN",
                        "ServiceUnitCount_04": "1",
                        "CompositeDiagnosisCodePointer_07": {
                          "DiagnosisCodePointer_01": "2"
                        }
                      },
                      "AllDTP": {
                        "DTP_Date_ServiceDate": {
                          "DateTimeQualifier_01": "472",
                          "DateTimePeriodFormatQualifier_02": "D8",
                          "DateTimePeriod_03": "20061010"
                        }
                      }
                    },
                    {
                      "LX_ServiceLineNumber": {
                        "AssignedNumber_01": "4"
                      },
                      "SV1_ProfessionalService": {
                        "CompositeMedicalProcedureIdentifier_01": {
                          "ProductorServiceIDQualifier_01": "HC",
                          "ProcedureCode_02": "86663"
                        },
                        "LineItemChargeAmount_02": "10",
                        "UnitorBasisforMeasurementCode_03": "UN",
                        "ServiceUnitCount_04": "1",
                        "CompositeDiagnosisCodePointer_07": {
                          "DiagnosisCodePointer_01": "2"
                        }
                      },
                      "AllDTP": {
                        "DTP_Date_ServiceDate": {
                          "DateTimeQualifier_01": "472",
                          "DateTimePeriodFormatQualifier_02": "D8",
                          "DateTimePeriod_03": "20061010"
                        }
                      }
                    }
                  ]
                }
              ]
            }
          ]
        }
      ]
    }
  ],
  "SE": {
    "NumberofIncludedSegments_01": "42",
    "TransactionSetControlNumber_02": "0021"
  }
}

Parse and validate an 837P file

Read the file into typed objects with ediFabric .NET, convert it to JSON in process with the ediFabric Native bindings for Python, Java and C, or post it to the ediFabric Cloud REST API from any language.

.NET
Python
Java
C
Cloud

using EdiFabric.Templates.Hipaa5010;

License.SetSerial("YOUR_SERIAL_KEY");

using (var stream = File.OpenRead(@"C:\edi\ClaimPayment.txt"))
using (var reader = new X12Reader(stream, "EdiFabric.Templates.Hipaa"))
{
    var items = await reader.ReadToEndAsync();
    foreach (var transaction in items.OfType<TS837P>())
    {
        if (transaction.IsValid(out MessageErrorContext errors))
            Console.WriteLine($"{transaction.ST.TransactionSetControlNumber_02} is valid");
        else
            Console.WriteLine(string.Join(Environment.NewLine, errors.Flatten()));
    }
} Install and get started 837P example project Walkthrough
import json
import edifabric_x12 as ef

serial = "YOUR_SERIAL_KEY"
ef.load_library()
ef.set_serial(serial)
ef.set_map(json.dumps({"default": serial, "maps": {}}))

edi = open("ClaimPayment.txt", "rb").read()
output, offset = ef.parse(edi, ef.ParseMode.JSON_VALIDATE)
transactions = output[:offset]
report = json.loads(output[offset:])
print(report["errors_count"]) Python bindingsediFabric Native
import com.edifabric.nativex12.EdiFabricX12;
import com.edifabric.nativex12.ParseMode;
import com.edifabric.nativex12.ParseResult;

String serial = "YOUR_SERIAL_KEY";
EdiFabricX12.loadLibrary();
EdiFabricX12.setSerial(serial);
EdiFabricX12.setMap("{\"default\":\"" + serial + "\",\"maps\":{}}");

String edi = Files.readString(Path.of("ClaimPayment.txt"));
ParseResult result = EdiFabricX12.parse(edi, ParseMode.JSON_VALIDATE);
System.out.println(result.getTransactions());
System.out.println(result.getReport()); Java bindingsediFabric Native
#include "edifabric_x12.h"

const char *serial = "YOUR_SERIAL_KEY";
ef_parse_result result;

if (ef_load_library(NULL) != 0)
    return 1;
ef_set_serial(serial);
ef_set_map("{\"default\":\"YOUR_SERIAL_KEY\",\"maps\":{}}");

char *edi = read_file("ClaimPayment.txt", NULL);   /* helper in example_all_functions.c */
if (ef_parse(edi, EF_PARSE_JSON_VALIDATE, NULL, &result) == 0) {
    /* transactions = output[0 .. offset), report = output[offset .. length) */
    fwrite(result.output.data, 1, (size_t)result.output.length, stdout);
    ef_free(result.output.data);
} C bindingsediFabric Native
curl -X POST 'https://api.edination.com/v2/x12/read' \
-H 'Ocp-Apim-Subscription-Key: YOUR_SERIAL_KEY' \
-H 'Content-Type: application/octet-stream' \
--data-binary '@ClaimPayment.txt' TranslateValidateediFabric Cloud

Generate an 837P file

Populate a TS837P object in .NET, or pass JSON in the shape shown above to ediFabric Native or ediFabric Cloud, and get a valid 837P file back.

.NET
Python
Java
C
Cloud

using EdiFabric.Templates.Hipaa5010;

License.SetSerial("YOUR_SERIAL_KEY");

var transaction = new TS837P();

//  Indicates the start of a claim transaction set and assigns a control number.
transaction.ST = new ST();
transaction.ST.TransactionSetIdentifierCode_01 = "837";
transaction.ST.TransactionSetControlNumber_02 = "0001";
transaction.ST.ImplementationConventionPreference_03 = "005010X222A1";

//  Indicates the claim was created on October 15, 2006 and submitter is identified with 244579. 
transaction.BHT_BeginningOfHierarchicalTransaction = new BHT_BeginningOfHierarchicalTransaction_8();
transaction.BHT_BeginningOfHierarchicalTransaction.HierarchicalStructureCode_01 = "0019";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetPurposeCode_02 = "00";
transaction.BHT_BeginningOfHierarchicalTransaction.SubmitterTransactionIdentifier_03 = "244579";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationDate_04 = "20061015";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationTime_05 = "1023";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionTypeCode_06 = "CH";

//  Occurrence of NM1 Loops in any order
transaction.AllNM1 = new All_NM1_837P_6();

//  Begin 1000A Loop SUBMITTER
transaction.AllNM1.Loop1000A = new Loop_1000A_837P();

// ... set the remaining loops and segments the same way

// SegmentBuilders is in the Common project of the example repository
using (var stream = new MemoryStream())
{
    using (var writer = new X12Writer(stream))
    {
        writer.Write(SegmentBuilders.BuildIsa("1"));
        writer.Write(SegmentBuilders.BuildGs("1", "SENDER1", "RECEIVER1", "005010X222A1"));
        writer.Write(transaction);
    }
    Console.WriteLine(Encoding.UTF8.GetString(stream.ToArray()));
} Install and get started Full 837P build methodExample repository
import json
import edifabric_x12 as ef

serial = "YOUR_SERIAL_KEY"
ef.load_library()
ef.set_serial(serial)
ef.set_map(json.dumps({"default": serial, "maps": {}}))

# the transactions JSON returned by ef.parse, edited or produced by your application
transactions = open("ClaimPayment.json", "rb").read()
edi = ef.build(transactions, postfix="\r\n")
print(edi) Python bindings
import com.edifabric.nativex12.EdiFabricX12;

String serial = "YOUR_SERIAL_KEY";
EdiFabricX12.loadLibrary();
EdiFabricX12.setSerial(serial);
EdiFabricX12.setMap("{\"default\":\"" + serial + "\",\"maps\":{}}");

// the transactions JSON returned by parse, edited or produced by your application
String transactions = Files.readString(Path.of("ClaimPayment.json"));
String edi = EdiFabricX12.build(transactions, "\r\n");
System.out.println(edi); Java bindings
#include "edifabric_x12.h"

ef_buffer edi;

if (ef_load_library(NULL) != 0)
    return 1;
ef_set_serial("YOUR_SERIAL_KEY");
ef_set_map("{\"default\":\"YOUR_SERIAL_KEY\",\"maps\":{}}");

/* the transactions JSON returned by ef_parse, edited or produced by your application */
char *transactions = read_file("ClaimPayment.json", NULL);
if (ef_build(transactions, "\r\n", &edi) == 0) {
    fwrite(edi.data, 1, (size_t)edi.length, stdout);
    ef_free(edi.data);
} C bindings
# the JSON returned by /read, edited or produced by your application
curl -X POST 'https://api.edination.com/v2/x12/write' \
-H 'Ocp-Apim-Subscription-Key: YOUR_SERIAL_KEY' \
-H 'Content-Type: application/json' \
--data-binary '@ClaimPayment.json' \
-o 'ClaimPayment.txt' How-tosediFabric Cloud

Complete ediFabric .NET example

A complete C# program for the X12 837P, built on TS837P in EdiFabric.Templates.Hipaa. The same code is in the ediFabric .NET examples on GitHub.

using EdiFabric.Framework.Readers;
using EdiFabric.Framework.Writers;
using EdiFabric.Templates.Hipaa5010;
using System.Collections.Generic;
using System.IO;
using System.Linq;
using EdiFabric.Core.Model.Edi;
using EdiFabric.Core.Model.Edi.X12;
using EdiFabric.Examples.X12.Common;

namespace EdiFabric.Examples.X12.T837P
{
    class Program
    {
        static void Main(string[] args)
        {
            SerialKey.Set(Common.SerialKey.Get());
            Read();
            Write();
        }

        ///
        /// Read Claim
        ///
        static void Read()
        {
            var ediStream = File.OpenRead(Directory.GetCurrentDirectory() + @"\..\..\..\Files\Hipaa\ClaimPayment.txt");

            List ediItems;
            using (var ediReader = new X12Reader(ediStream, "EdiFabric.Templates.Hipaa"))
                ediItems = ediReader.ReadToEnd().ToList();

            var transactions = ediItems.OfType();

            foreach (var transaction in transactions)
            {
                if (transaction.HasErrors)
                {
                    //  partially parsed
                    var errors = transaction.ErrorContext.Flatten();
                }
            }
        }

        ///
        /// Write Claim
        ///
        static void Write()
        {
            var transaction = BuildClaim("1");

            using (var stream = new MemoryStream())
            {
                using (var writer = new X12Writer(stream))
                {
                    writer.Write(SegmentBuilders.BuildIsa("1"));
                    writer.Write(SegmentBuilders.BuildGs("1", "SENDER1", "RECEIVER1", "005010X222A1"));
                    writer.Write(transaction);
                }

                var ediString = stream.LoadToString();
            }
        }

        ///
        /// Build claim.
        /// Original from http://www.x12.org/examples/005010X222/commercial-health-insurance/
        ///
        public static TS837P BuildClaim(string controlNumber)
        {
            var result = new TS837P();

            //  Indicates the start of a claim transaction set and assigns a control number.
            result.ST = new ST();
            result.ST.TransactionSetIdentifierCode_01 = "837";
            result.ST.TransactionSetControlNumber_02 = controlNumber.PadLeft(9, '0');
            result.ST.ImplementationConventionPreference_03 = "005010X222A1";

            //  Indicates the claim was created on October 15, 2006 and submitter is identified with 244579.
            result.BHT_BeginningOfHierarchicalTransaction = new BHT_BeginningOfHierarchicalTransaction_8();
            result.BHT_BeginningOfHierarchicalTransaction.HierarchicalStructureCode_01 = "0019";
            result.BHT_BeginningOfHierarchicalTransaction.TransactionSetPurposeCode_02 = "00";
            result.BHT_BeginningOfHierarchicalTransaction.SubmitterTransactionIdentifier_03 = "244579";
            result.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationDate_04 = "20061015";
            result.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationTime_05 = "1023";
            result.BHT_BeginningOfHierarchicalTransaction.TransactionTypeCode_06 = "CH";

            //  Occurrence of NM1 Loops in any order
            result.AllNM1 = new All_NM1_837P_6();

            //  Begin 1000A Loop SUBMITTER
            result.AllNM1.Loop1000A = new Loop_1000A_837P();

            //  Premier Billing Service with EDI# TGJ23
            result.AllNM1.Loop1000A.NM1_SubmitterName = new NM1_InformationReceiverName_4();
            result.AllNM1.Loop1000A.NM1_SubmitterName.EntityIdentifierCode_01 = "41";
            result.AllNM1.Loop1000A.NM1_SubmitterName.EntityTypeQualifier_02 = "2";
            result.AllNM1.Loop1000A.NM1_SubmitterName.ResponseContactLastorOrganizationName_03 = "PREMIER BILLING SERVICE";
            result.AllNM1.Loop1000A.NM1_SubmitterName.IdentificationCodeQualifier_08 = "46";
            result.AllNM1.Loop1000A.NM1_SubmitterName.ResponseContactIdentifier_09 = "TGJ23";

            //  Repeating PER
            result.AllNM1.Loop1000A.PER_SubmitterEDIContactInformation = new List();

            //  CONTACT PERSON AND PHONE NUMBER: JERRY, 305-555-2222 ext. 231
            var perLoop1000A = new PER_BillingProviderContactInformation();
            perLoop1000A.ContactFunctionCode_01 = "IC";
            perLoop1000A.ResponseContactName_02 = "JERRY";
            perLoop1000A.CommunicationNumberQualifier_03 = "TE";
            perLoop1000A.ResponseContactCommunicationNumber_04 = "3055552222";
            perLoop1000A.CommunicationNumberQualifier_05 = "EX";
            perLoop1000A.ResponseContactCommunicationNumber_06 = "231";
            result.AllNM1.Loop1000A.PER_SubmitterEDIContactInformation.Add(perLoop1000A);

            //  End 1000A Loop SUBMITTER

            //  Begin 1000B Loop RECEIVER
            result.AllNM1.Loop1000B = new Loop_1000B_837P();

            //  Key Insurance Company with EDI #:66783JJT
            result.AllNM1.Loop1000B.NM1_ReceiverName = new NM1_ReceiverName();
            result.AllNM1.Loop1000B.NM1_ReceiverName.EntityIdentifierCode_01 = "40";
            result.AllNM1.Loop1000B.NM1_ReceiverName.EntityTypeQualifier_02 = "2";
            result.AllNM1.Loop1000B.NM1_ReceiverName.ResponseContactLastorOrganizationName_03 = "KEY INSURANCE COMPANY";
            result.AllNM1.Loop1000B.NM1_ReceiverName.IdentificationCodeQualifier_08 = "46";
            result.AllNM1.Loop1000B.NM1_ReceiverName.ResponseContactIdentifier_09 = "66783JJT";

            //  End 1000B Loop RECEIVER

            //  Repeating 2000A Loops
            result.Loop2000A = new List();

            //  Begin 2000A Loop BILLING PROVIDER Hierarchy
            var loop2000A = new Loop_2000A_837P();

            //  Hierarchical Number 1
            loop2000A.HL_BillingProviderHierarchicalLevel = new HL_BillingProviderHierarchicalLevel();
            loop2000A.HL_BillingProviderHierarchicalLevel.HierarchicalIDNumber_01 = "1";
            loop2000A.HL_BillingProviderHierarchicalLevel.HierarchicalLevelCode_03 = "20";
            loop2000A.HL_BillingProviderHierarchicalLevel.HierarchicalChildCode_04 = "1";

            //  Taxonomy Code: 203BF0100Y
            loop2000A.PRV_BillingProviderSpecialtyInformation = new PRV_BillingProviderSpecialtyInformation();
            loop2000A.PRV_BillingProviderSpecialtyInformation.ProviderCode_01 = "BI";
            loop2000A.PRV_BillingProviderSpecialtyInformation.ReferenceIdentificationQualifier_02 = "PXC";
            loop2000A.PRV_BillingProviderSpecialtyInformation.ProviderTaxonomyCode_03 = "203BF0100Y";

            //  Occurrence of NM1 Loops in any order
            loop2000A.AllNM1 = new All_NM1_837P();

            //  Begin 2010AA Loop BILLING PROVIDER
            loop2000A.AllNM1.Loop2010AA = new Loop_2010AA_837P();

            //  Name is BEN KILDARE SERVICE with NPI: 9876543210
            loop2000A.AllNM1.Loop2010AA.NM1_BillingProviderName = new NM1_BillingProviderName_2();
            loop2000A.AllNM1.Loop2010AA.NM1_BillingProviderName.EntityIdentifierCode_01 = "85";
            loop2000A.AllNM1.Loop2010AA.NM1_BillingProviderName.EntityTypeQualifier_02 = "2";
            loop2000A.AllNM1.Loop2010AA.NM1_BillingProviderName.ResponseContactLastorOrganizationName_03 = "BEN KILDARE SERVICE";
            loop2000A.AllNM1.Loop2010AA.NM1_BillingProviderName.IdentificationCodeQualifier_08 = "XX";
            loop2000A.AllNM1.Loop2010AA.NM1_BillingProviderName.ResponseContactIdentifier_09 = "9876543210";

            //  ADDRESS: 234 Seaway St
            loop2000A.AllNM1.Loop2010AA.N3_BillingProviderAddress = new N3_AdditionalPatientInformationContactAddress();
            loop2000A.AllNM1.Loop2010AA.N3_BillingProviderAddress.ResponseContactAddressLine_01 = "234 SEAWAY ST";

            //  LOCATION: Miami, FL, 33111
            loop2000A.AllNM1.Loop2010AA.N4_BillingProviderCity_State_ZIPCode = new N4_AdditionalPatientInformationContactCity();
            loop2000A.AllNM1.Loop2010AA.N4_BillingProviderCity_State_ZIPCode.AdditionalPatientInformationContactCityName_01 = "MIAMI";
            loop2000A.AllNM1.Loop2010AA.N4_BillingProviderCity_State_ZIPCode.AdditionalPatientInformationContactStateCode_02 = "FL";
            loop2000A.AllNM1.Loop2010AA.N4_BillingProviderCity_State_ZIPCode.AdditionalPatientInformationContactPostalZoneorZIPCode_03 = "33111";

            //  Occurrence of REF Loops in any order
            loop2000A.AllNM1.Loop2010AA.AllREF = new All_REF_837P_8();

            //  TIN: 587654321
            loop2000A.AllNM1.Loop2010AA.AllREF.REF_BillingProviderTaxIdentification = new REF_BillingProviderTaxIdentification();
            loop2000A.AllNM1.Loop2010AA.AllREF.REF_BillingProviderTaxIdentification.ReferenceIdentificationQualifier_01 = "EI";
            loop2000A.AllNM1.Loop2010AA.AllREF.REF_BillingProviderTaxIdentification.MemberGrouporPolicyNumber_02 = "587654321";

            //  End 2010AA Loop BILLING PROVIDER

            //  Begin 2010AB Loop PAY-TO PROVIDER
            loop2000A.AllNM1.Loop2010AB = new Loop_2010AB_837P();

            //  PAY-TO PROVIDER Name is Kildare Associates
            loop2000A.AllNM1.Loop2010AB.NM1_Pay_AddressName = new NM1_Pay();
            loop2000A.AllNM1.Loop2010AB.NM1_Pay_AddressName.EntityIdentifierCode_01 = "87";
            loop2000A.AllNM1.Loop2010AB.NM1_Pay_AddressName.EntityTypeQualifier_02 = "2";
            loop2000A.AllNM1.Loop2010AB.NM1_Pay_AddressName.ResponseContactLastorOrganizationName_03 = "Kildare Associates";

            //  PROVIDER ADDRESS: 2345 Ocean Blvd
            loop2000A.AllNM1.Loop2010AB.N3_Pay_ToAddress_ADDRESS = new N3_AdditionalPatientInformationContactAddress();
            loop2000A.AllNM1.Loop2010AB.N3_Pay_ToAddress_ADDRESS.ResponseContactAddressLine_01 = "2345 OCEAN BLVD";

            //  PROVIDER LOCATION: Miami, Fl 33111
            loop2000A.AllNM1.Loop2010AB.N4_Pay_AddressCity_State_ZIPCode = new N4_AdditionalPatientInformationContactCity();
            loop2000A.AllNM1.Loop2010AB.N4_Pay_AddressCity_State_ZIPCode.AdditionalPatientInformationContactCityName_01 = "MIAMI";
            loop2000A.AllNM1.Loop2010AB.N4_Pay_AddressCity_State_ZIPCode.AdditionalPatientInformationContactStateCode_02 = "FL";
            loop2000A.AllNM1.Loop2010AB.N4_Pay_AddressCity_State_ZIPCode.AdditionalPatientInformationContactPostalZoneorZIPCode_03 = "33111";

            //  End 2010AB Loop PAY-TO PROVIDER

            //  Repeating 2000B Loops
            loop2000A.Loop2000B = new List();

            //  Begin 2000B Loop SUBSCRIBER Hierarchy
            var loop2000B = new Loop_2000B_837P();

            //  Hierarchical Number 2
            loop2000B.HL_SubscriberHierarchicalLevel = new HL_SubscriberHierarchicalLevel();
            loop2000B.HL_SubscriberHierarchicalLevel.HierarchicalIDNumber_01 = "2";
            loop2000B.HL_SubscriberHierarchicalLevel.HierarchicalParentIDNumber_02 = "1";
            loop2000B.HL_SubscriberHierarchicalLevel.HierarchicalLevelCode_03 = "22";
            loop2000B.HL_SubscriberHierarchicalLevel.HierarchicalChildCode_04 = "1";

            //  SUBSCRIBER GROUP #: 2222-SJ
            loop2000B.SBR_SubscriberInformation = new SBR_SubscriberInformation();
            loop2000B.SBR_SubscriberInformation.PayerResponsibilitySequenceNumberCode_01 = "P";
            loop2000B.SBR_SubscriberInformation.InsuredGrouporPolicyNumber_03 = "2222-SJ";
            loop2000B.SBR_SubscriberInformation.ClaimFilingIndicatorCode_09 = "CI";

            //  Occurrence of NM1 Loops in any order
            loop2000B.AllNM1 = new All_NM1_837P_2();

            //  Begin 2010BA Loop SUBSCRIBER
            loop2000B.AllNM1.Loop2010BA = new Loop_2010BA_837P();

            //  SUBSCRIBER name is Jane Smith
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName = new NM1_SubscriberName_5();
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName.EntityIdentifierCode_01 = "IL";
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName.EntityTypeQualifier_02 = "1";
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName.ResponseContactLastorOrganizationName_03 = "SMITH";
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName.ResponseContactFirstName_04 = "JANE";
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName.IdentificationCodeQualifier_08 = "MI";
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName.ResponseContactIdentifier_09 = "JS00111223333";

            //  SUBSCRIBER SEX: F and DOB: 05 / 01 / 43
            loop2000B.AllNM1.Loop2010BA.DMG_SubscriberDemographicInformation = new DMG_PatientDemographicInformation();
            loop2000B.AllNM1.Loop2010BA.DMG_SubscriberDemographicInformation.DateTimePeriodFormatQualifier_01 = "D8";
            loop2000B.AllNM1.Loop2010BA.DMG_SubscriberDemographicInformation.DependentBirthDate_02 = "19430501";
            loop2000B.AllNM1.Loop2010BA.DMG_SubscriberDemographicInformation.DependentGenderCode_03 = "F";

            //  End 2010BA Loop SUBSCRIBER

            //  Begin 2010BB Loop PAYER
            loop2000B.AllNM1.Loop2010BB = new Loop_2010BB_837P();

            //  Payer name is Key Insurance Company with PAYER ID: 999996666
            loop2000B.AllNM1.Loop2010BB.NM1_PayerName = new NM1_OtherPayerName();
            loop2000B.AllNM1.Loop2010BB.NM1_PayerName.EntityIdentifierCode_01 = "PR";
            loop2000B.AllNM1.Loop2010BB.NM1_PayerName.EntityTypeQualifier_02 = "2";
            loop2000B.AllNM1.Loop2010BB.NM1_PayerName.ResponseContactLastorOrganizationName_03 = "KEY INSURANCE COMPANY";
            loop2000B.AllNM1.Loop2010BB.NM1_PayerName.IdentificationCodeQualifier_08 = "PI";
            loop2000B.AllNM1.Loop2010BB.NM1_PayerName.ResponseContactIdentifier_09 = "999996666";

            //  Occurrence of REF in any order
            loop2000B.AllNM1.Loop2010BB.AllREF = new All_REF_837P_5();

            //  Repeating REF
            loop2000B.AllNM1.Loop2010BB.AllREF.REF_BillingProviderSecondaryIdentification = new List();

            //  KEY INSURANCE COMPANY PROVIDER ID #: KA6663
            var refLoop2000B = new REF_BillingProviderSecondaryIdentification();
            refLoop2000B.ReferenceIdentificationQualifier_01 = "G2";
            refLoop2000B.MemberGrouporPolicyNumber_02 = "KA6663";
            loop2000B.AllNM1.Loop2010BB.AllREF.REF_BillingProviderSecondaryIdentification.Add(refLoop2000B);

            //  End 2010BB Loop PAYER

            //  Repeating 2000C Loops
            loop2000B.Loop2000C = new List();

            //  Begin 2000C Loop PATIENT Hierarchy
            var loop2000C = new Loop_2000C_837P();

            //  Hierarchical Number 3
            loop2000C.HL_PatientHierarchicalLevel = new HL_DependentLevel();
            loop2000C.HL_PatientHierarchicalLevel.HierarchicalIDNumber_01 = "3";
            loop2000C.HL_PatientHierarchicalLevel.HierarchicalParentIDNumber_02 = "2";
            loop2000C.HL_PatientHierarchicalLevel.HierarchicalLevelCode_03 = "23";
            loop2000C.HL_PatientHierarchicalLevel.HierarchicalChildCode_04 = "0";

            loop2000C.PAT_PatientInformation = new PAT_PatientInformation();
            loop2000C.PAT_PatientInformation.IndividualRelationshipCode_01 = "19";

            //  Begin 2010CA Loop PATIENT
            loop2000C.Loop2010CA = new Loop_2010CA_837P();

            //  PATIENT name is Ted Smith
            loop2000C.Loop2010CA.NM1_PatientName = new NM1_PatientName_3();
            loop2000C.Loop2010CA.NM1_PatientName.EntityIdentifierCode_01 = "QC";
            loop2000C.Loop2010CA.NM1_PatientName.EntityTypeQualifier_02 = "1";
            loop2000C.Loop2010CA.NM1_PatientName.ResponseContactLastorOrganizationName_03 = "SMITH";
            loop2000C.Loop2010CA.NM1_PatientName.ResponseContactFirstName_04 = "TED";

            //  PATIENT ADDRESS: 236 N. Main St.
            loop2000C.Loop2010CA.N3_PatientAddress = new N3_AdditionalPatientInformationContactAddress();
            loop2000C.Loop2010CA.N3_PatientAddress.ResponseContactAddressLine_01 = "236 N MAIN ST";

            //  PATIENT LOCATION: Miami, Fl, 33413
            loop2000C.Loop2010CA.N4_PatientCity_State_ZIPCode = new N4_AdditionalPatientInformationContactCity();
            loop2000C.Loop2010CA.N4_PatientCity_State_ZIPCode.AdditionalPatientInformationContactCityName_01 = "MIAMI";
            loop2000C.Loop2010CA.N4_PatientCity_State_ZIPCode.AdditionalPatientInformationContactStateCode_02 = "FL";
            loop2000C.Loop2010CA.N4_PatientCity_State_ZIPCode.AdditionalPatientInformationContactPostalZoneorZIPCode_03 = "33413";

            //  PATIENT SEX: M and DOB: 05 / 01 / 73
            loop2000C.Loop2010CA.DMG_PatientDemographicInformation = new DMG_PatientDemographicInformation();
            loop2000C.Loop2010CA.DMG_PatientDemographicInformation.DateTimePeriodFormatQualifier_01 = "D8";
            loop2000C.Loop2010CA.DMG_PatientDemographicInformation.DependentBirthDate_02 = "19730501";
            loop2000C.Loop2010CA.DMG_PatientDemographicInformation.DependentGenderCode_03 = "M";

            //  End 2010CA Loop PATIENT

            //  Repeating 2300 Loops
            loop2000C.Loop2300 = new List();

            //  Begin 2300 Loop CLAIM
            var loop2300 = new Loop_2300_837P();

            //  PATIENT ACCOUNT NUMBER: 2-646-3774
            loop2300.CLM_ClaimInformation = new CLM_ClaimInformation_3();
            loop2300.CLM_ClaimInformation.PatientControlNumber_01 = "26463774";
            loop2300.CLM_ClaimInformation.TotalClaimChargeAmount_02 = "100";
            loop2300.CLM_ClaimInformation.HealthCareServiceLocationInformation_05 = new C023_HealthCareServiceLocationInformation_2();
            loop2300.CLM_ClaimInformation.HealthCareServiceLocationInformation_05.FacilityTypeCode_01 = "11";
            loop2300.CLM_ClaimInformation.HealthCareServiceLocationInformation_05.FacilityCodeQualifier_02 = "B";
            loop2300.CLM_ClaimInformation.HealthCareServiceLocationInformation_05.ClaimFrequencyTypeCode_03 = "1";
            loop2300.CLM_ClaimInformation.ProviderorSupplierSignatureIndicator_06 = "Y";
            loop2300.CLM_ClaimInformation.AssignmentorPlanParticipationCode_07 = "A";
            loop2300.CLM_ClaimInformation.BenefitsAssignmentCertificationIndicator_08 = "Y";
            loop2300.CLM_ClaimInformation.ReleaseofInformationCode_09 = "I";

            //  Occurrence of REF in any order
            loop2300.AllREF = new All_REF_837P_6();

            //  ELECTRONIC ROUTE: Billing provider (sender), to VAN to Key Insurance Company (receiver). VAN claim identification number = 17312345600006351.
            loop2300.AllREF.REF_ClaimIdentifierForTransmissionIntermediaries = new REF_ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries();
            loop2300.AllREF.REF_ClaimIdentifierForTransmissionIntermediaries.ReferenceIdentificationQualifier_01 = "D9";
            loop2300.AllREF.REF_ClaimIdentifierForTransmissionIntermediaries.MemberGrouporPolicyNumber_02 = "17312345600006351";

            //  Occurrence of HI in any order
            loop2300.AllHI = new All_HI_837P();

            //  CASE: Patient has sore throat.
            loop2300.AllHI.HI_HealthCareDiagnosisCode = new HI_DependentHealthCareDiagnosisCode_2();
            loop2300.AllHI.HI_HealthCareDiagnosisCode.HealthCareCodeInformation_01 = new C022_HealthCareCodeInformation_8();
            loop2300.AllHI.HI_HealthCareDiagnosisCode.HealthCareCodeInformation_01.CodeListQualifierCode_01 = "BK";
            loop2300.AllHI.HI_HealthCareDiagnosisCode.HealthCareCodeInformation_01.IndustryCode_02 = "0340";
            loop2300.AllHI.HI_HealthCareDiagnosisCode.HealthCareCodeInformation_02 = new C022_HealthCareCodeInformation_4();
            loop2300.AllHI.HI_HealthCareDiagnosisCode.HealthCareCodeInformation_02.CodeListQualifierCode_01 = "BF";
            loop2300.AllHI.HI_HealthCareDiagnosisCode.HealthCareCodeInformation_02.IndustryCode_02 = "V7389";

            //  Repeating 2400 Loops
            loop2300.Loop2400 = new List();

            //  Begin 2400 Loop SERVICE LINE 1
            var loop24001 = new Loop_2400_837P();

            loop24001.LX_ServiceLineNumber = new LX_HeaderNumber();
            loop24001.LX_ServiceLineNumber.AssignedNumber_01 = "1";

            //  SERVICES: Office visit, intermediate service, established patient, throat culture.
            //  CHARGES: Office first visit = $40.00
            loop24001.SV1_ProfessionalService = new SV1_ProfessionalService();
            loop24001.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01 = new C003_CompositeMedicalProcedureIdentifier_12();
            loop24001.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01.ProductorServiceIDQualifier_01 = "HC";
            loop24001.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01.ProcedureCode_02 = "99213";
            loop24001.SV1_ProfessionalService.LineItemChargeAmount_02 = "40";
            loop24001.SV1_ProfessionalService.UnitorBasisforMeasurementCode_03 = "UN";
            loop24001.SV1_ProfessionalService.ServiceUnitCount_04 = "1";
            loop24001.SV1_ProfessionalService.CompositeDiagnosisCodePointer_07 = new C004_CompositeDiagnosisCodePointer();
            loop24001.SV1_ProfessionalService.CompositeDiagnosisCodePointer_07.DiagnosisCodePointer_01 = "1";

            //  Occurrence of DTP in any order
            loop24001.AllDTP = new All_DTP_837P();

            //  INITIAL VISIT: DOS=10/03/06. POS=Office
            loop24001.AllDTP.DTP_Date_ServiceDate = new DTP_ClaimLevelServiceDate();
            loop24001.AllDTP.DTP_Date_ServiceDate.DateTimeQualifier_01 = "472";
            loop24001.AllDTP.DTP_Date_ServiceDate.DateTimePeriodFormatQualifier_02 = "D8";
            loop24001.AllDTP.DTP_Date_ServiceDate.DateTimePeriod_03 = "20061003";

            //  End 2400 Loop SERVICE LINE 1
            loop2300.Loop2400.Add(loop24001);

            //  Begin 2400 Loop SERVICE LINE 2
            var loop24002 = new Loop_2400_837P();

            loop24002.LX_ServiceLineNumber = new LX_HeaderNumber();
            loop24002.LX_ServiceLineNumber.AssignedNumber_01 = "2";

            //  SERVICES: Office visit, intermediate service, established patient, throat culture.
            //  CHARGES: Lab test for strep = $15.00
            loop24002.SV1_ProfessionalService = new SV1_ProfessionalService();
            loop24002.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01 = new C003_CompositeMedicalProcedureIdentifier_12();
            loop24002.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01.ProductorServiceIDQualifier_01 = "HC";
            loop24002.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01.ProcedureCode_02 = "87070";
            loop24002.SV1_ProfessionalService.LineItemChargeAmount_02 = "15";
            loop24002.SV1_ProfessionalService.UnitorBasisforMeasurementCode_03 = "UN";
            loop24002.SV1_ProfessionalService.ServiceUnitCount_04 = "1";
            loop24002.SV1_ProfessionalService.CompositeDiagnosisCodePointer_07 = new C004_CompositeDiagnosisCodePointer();
            loop24002.SV1_ProfessionalService.CompositeDiagnosisCodePointer_07.DiagnosisCodePointer_01 = "1";

            //  Occurrence of DTP in any order
            loop24002.AllDTP = new All_DTP_837P();

            //  INITIAL VISIT: DOS=10/03/06. POS=Office
            loop24002.AllDTP.DTP_Date_ServiceDate = new DTP_ClaimLevelServiceDate();
            loop24002.AllDTP.DTP_Date_ServiceDate.DateTimeQualifier_01 = "472";
            loop24002.AllDTP.DTP_Date_ServiceDate.DateTimePeriodFormatQualifier_02 = "D8";
            loop24002.AllDTP.DTP_Date_ServiceDate.DateTimePeriod_03 = "20061003";

            //  End 2400 Loop SERVICE LINE 2
            loop2300.Loop2400.Add(loop24002);

            //  Begin 2400 Loop SERVICE LINE 3
            var loop24003 = new Loop_2400_837P();

            loop24003.LX_ServiceLineNumber = new LX_HeaderNumber();
            loop24003.LX_ServiceLineNumber.AssignedNumber_01 = "3";

            //  SERVICES: Office visit, intermediate service, established patient, mono screening.
            //  CHARGES: Follow-up visit = $35.00
            loop24003.SV1_ProfessionalService = new SV1_ProfessionalService();
            loop24003.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01 = new C003_CompositeMedicalProcedureIdentifier_12();
            loop24003.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01.ProductorServiceIDQualifier_01 = "HC";
            loop24003.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01.ProcedureCode_02 = "99214";
            loop24003.SV1_ProfessionalService.LineItemChargeAmount_02 = "35";
            loop24003.SV1_ProfessionalService.UnitorBasisforMeasurementCode_03 = "UN";
            loop24003.SV1_ProfessionalService.ServiceUnitCount_04 = "1";
            loop24003.SV1_ProfessionalService.CompositeDiagnosisCodePointer_07 = new C004_CompositeDiagnosisCodePointer();
            loop24003.SV1_ProfessionalService.CompositeDiagnosisCodePointer_07.DiagnosisCodePointer_01 = "2";

            //  Occurrence of DTP in any order
            loop24003.AllDTP = new All_DTP_837P();

            //  FOLLOW-UP VISIT: DOS=10/10/06 POS=Office
            loop24003.AllDTP.DTP_Date_ServiceDate = new DTP_ClaimLevelServiceDate();
            loop24003.AllDTP.DTP_Date_ServiceDate.DateTimeQualifier_01 = "472";
            loop24003.AllDTP.DTP_Date_ServiceDate.DateTimePeriodFormatQualifier_02 = "D8";
            loop24003.AllDTP.DTP_Date_ServiceDate.DateTimePeriod_03 = "20061010";

            //  End 2400 Loop SERVICE LINE 3
            loop2300.Loop2400.Add(loop24003);

            //  Begin 2400 Loop SERVICE LINE 4
            var loop24004 = new Loop_2400_837P();

            loop24004.LX_ServiceLineNumber = new LX_HeaderNumber();
            loop24004.LX_ServiceLineNumber.AssignedNumber_01 = "4";

            //  SERVICES: Office visit, intermediate service, established patient, mono screening.
            //  CHARGES: Lab test for mono = $10.00
            loop24004.SV1_ProfessionalService = new SV1_ProfessionalService();
            loop24004.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01 = new C003_CompositeMedicalProcedureIdentifier_12();
            loop24004.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01.ProductorServiceIDQualifier_01 = "HC";
            loop24004.SV1_ProfessionalService.CompositeMedicalProcedureIdentifier_01.ProcedureCode_02 = "86663";
            loop24004.SV1_ProfessionalService.LineItemChargeAmount_02 = "10";
            loop24004.SV1_ProfessionalService.UnitorBasisforMeasurementCode_03 = "UN";
            loop24004.SV1_ProfessionalService.ServiceUnitCount_04 = "1";
            loop24004.SV1_ProfessionalService.CompositeDiagnosisCodePointer_07 = new C004_CompositeDiagnosisCodePointer();
            loop24004.SV1_ProfessionalService.CompositeDiagnosisCodePointer_07.DiagnosisCodePointer_01 = "2";

            //  Occurrence of DTP in any order
            loop24004.AllDTP = new All_DTP_837P();

            //  FOLLOW-UP VISIT: DOS=10/10/06 POS=Office
            loop24004.AllDTP.DTP_Date_ServiceDate = new DTP_ClaimLevelServiceDate();
            loop24004.AllDTP.DTP_Date_ServiceDate.DateTimeQualifier_01 = "472";
            loop24004.AllDTP.DTP_Date_ServiceDate.DateTimePeriodFormatQualifier_02 = "D8";
            loop24004.AllDTP.DTP_Date_ServiceDate.DateTimePeriod_03 = "20061010";

            //  End 2400 Loop SERVICE LINE 4
            loop2300.Loop2400.Add(loop24004);

            //  End 2300 Loop CLAIM
            loop2000C.Loop2300.Add(loop2300);

            //  End 2000C Loop PATIENT Hierarchy
            loop2000B.Loop2000C.Add(loop2000C);

            //  End 2000B Loop SUBSCRIBER Hierarchy
            loop2000A.Loop2000B.Add(loop2000B);

            //  End 2000A Loop BILLING PROVIDER Hierarchy
            result.Loop2000A.Add(loop2000A);

            return result;
        }
    }
}

More operations in ediFabric .NET

Template and sample downloads

ediFabric .NET parses, validates and generates the X12 837P with TS837P in EdiFabric.Templates.Hipaa. The template ships in the NuGet package; download the source to adapt it to a trading partner's implementation guide.

EF_HIPAA_005010_837P.cs 67.5 KB
EF_HIPAA_005010_Codes.cs 221.6 KB
EF_HIPAA_005010_Segments.cs 253.8 KB
EF_HIPAA_005010_SegmentInterfaces.cs 21.7 KB
EF_HIPAA_005010_ComplexElementInterfaces.cs 5.4 KB
EF_HIPAA_005010_ComplexElements.cs 38.6 KB

837P questions

What is the difference between the 837P, 837I and 837D?

All three are X12 837 health care claims. The 837P (005010X222A1) bills professional services and replaces the CMS-1500 form. The 837I (005010X223A2) bills institutional services such as hospital stays and replaces the UB-04. The 837D (005010X224A2) bills dental services.

What response does a payer send for an 837P?

A 999 implementation acknowledgment that reports whether the file is syntactically valid, then a 277CA claim acknowledgment that accepts or rejects each claim. Paid and denied claims are reported later in an 835 remittance advice.

How many service lines can one 837P claim have?

Up to 50 service lines (loop 2400) per claim, and up to 12 diagnosis codes in the HI segment. Larger encounters are split into multiple claims.

How do I parse and generate X12 837P files in .NET, Python, Java and C?

In .NET, install EdiFabric and EdiFabric.Templates.Hipaa, read the file with X12Reader into TS837P objects and write them back with X12Writer. From Python, Java or C, use ediFabric Native, which converts 837P files to JSON and JSON back to X12 inside your process. From any other language, post the file to the ediFabric Cloud REST API.

Related transactions

X12 835 - Health Care Claim Payment/Advice
X12 837I - Health Care Claim: Institutional
X12 837D - Health Care Claim: Dental
X12 277CA - Health Care Claim Acknowledgment
X12 276 - Health Care Claim Status Request
All EDI transactions →

X12 837P Health Care Claim: Professional Last updated: 2026-09-29