837I Health Care Claim: Institutional (004010X096A1)
Hospitals and other facilities send the 837I to submit institutional claims, the electronic UB-04, to payers and clearinghouses. This is the standard X12 HIPAA 004010 spec, with 52 loops and 267 segment positions, as OpenEDI JSON, an ediFabric C# template and an ediFabric Native model. To change it for a trading partner, customize it in the EDI Spec Builder.
Use the 837I spec in your code
ediFabric .NET
Add the C# template and its common files to your project, or reference the template NuGet package, and read 837I files into TS837I objects. See ediFabric .NET.
ediFabric Native
Map version 004010X096A1 to the Native model with set_map, then parse 837I files to JSON from Python, Java, C or C#. See Convert between EDI and JSON.
OpenEDI
Select Customize in Spec Builder to copy the spec under your own name, change it for your partner, and parse files against it in EdiNation, ediFabric Native or ediFabric Cloud. Read about OpenEDI.
Generate 837I classes in Python, Java, Node.js, Go, Rust or C
ediFabric Native returns each 837I as JSON, with the property names of the OpenEDI schema. To work with that JSON as typed objects, generate classes from the OpenEDI file in your language and deserialize the JSON into TS837I. Serialize the objects back to JSON to build EDI with ediFabric Native. The classes keep the loops, segments, lengths and code lists, but not the EDI data formats, so validate files with ediFabric Native. Read more in Generate a class from OpenEDI.
Python: datamodel-code-generator. Node.js: openapi-typescript. Java, Go, Rust and C: OpenAPI Generator.
For a sample file, the same data as JSON, and code to parse, validate and generate the 837I, see the 837I transaction guide.
837I structure
Loops and segments of the standard 837I, with their usage and maximum repeats.
| ID | Name | Usage | Max use |
|---|---|---|---|
| ST | Transaction Set Header | Optional | 1 |
| BHT | Beginning Of Hierarchical Transaction | Mandatory | 1 |
| REF | Transmission Type Identification | Mandatory | 1 |
| Loop NM1 | Submitter Name | Mandatory | 1 |
| NM1 | Submitter Name | Mandatory | 1 |
| PER | Submitter EDI Contact Information | Mandatory | 2 |
| Loop NM1 | Receiver Name | Mandatory | 1 |
| NM1 | Receiver Name | Mandatory | 1 |
| Loop HL | Billing Pay To Provider Hierarchical Level | Mandatory | >1 |
| HL | Billing Pay To Provider Hierarchical Level | Mandatory | 1 |
| PRV | Billing Pay To Provider Specialty Information | Optional | 1 |
| CUR | Foreign Currency Information | Optional | 1 |
| Loop NM1 | Billing Provider Name 2010AA | Mandatory | 1 |
| NM1 | Billing Provider Name 2010AA | Mandatory | 1 |
| N3 | Billing Provider Address 2010AA | Mandatory | 1 |
| N4 | Billing Provider City State ZIP Code 2010AA | Mandatory | 1 |
| REF | Billing Provider Secondary Identification 2010AA | Optional | 8 |
| REF | Credit Debit Card Billing Information 2010AA | Optional | 8 |
| PER | Billing Provider Contact Information 2010AA | Optional | 2 |
| Loop NM1 | Pay To Provider Name 2010AB | Optional | 1 |
| NM1 | Pay To Provider Name 2010AB | Mandatory | 1 |
| N3 | Pay To Provider Address 2010AB | Mandatory | 1 |
| N4 | Pay To Provider City State ZIP Code 2010AB | Mandatory | 1 |
| REF | Pay To Provider Secondary Identification 2010AB | Optional | 5 |
| Loop HL | Subscriber Hierarchical Level | Mandatory | >1 |
| HL | Subscriber Hierarchical Level | Mandatory | 1 |
| SBR | Subscriber Information | Mandatory | 1 |
| Loop NM1 | Subscriber Name 2010BA | Mandatory | 1 |
| NM1 | Subscriber Name 2010BA | Mandatory | 1 |
| N3 | Subscriber Address 2010BA | Optional | 1 |
| N4 | Subscriber City State ZIP Code 2010BA | Optional | 1 |
| DMG | Subscriber Demographic Information 2010BA | Optional | 1 |
| REF | Subscriber Secondary Identification 2010BA | Optional | 4 |
| REF | Property And Casualty Claim Number 2010BA | Optional | 1 |
| Loop NM1 | Credit Debit Card Account Holder Name 2010BB | Optional | 1 |
| NM1 | Credit Debit Card Account Holder Name 2010BB | Mandatory | 1 |
| REF | Credit Debit Card Information 2010BB | Optional | 2 |
| Loop NM1 | Payer Name 2010BC | Mandatory | 1 |
| NM1 | Payer Name 2010BC | Mandatory | 1 |
| N3 | Payer Address 2010BC | Optional | 1 |
| N4 | Payer City State ZIP Code 2010BC | Optional | 1 |
| REF | Payer Secondary Identification 2010BC | Optional | 3 |
| Loop NM1 | Responsible Party Name 2010BD | Optional | 1 |
| NM1 | Responsible Party Name 2010BD | Mandatory | 1 |
| N3 | Responsible Party Address 2010BD | Mandatory | 1 |
| N4 | Responsible Party City State ZIP Code 2010BD | Mandatory | 1 |
| Loop CLM | Claim Information | Optional | 100 |
| CLM | Claim Information | Mandatory | 1 |
| DTP | Discharge Hour | Optional | 1 |
| DTP | Statement Dates | Mandatory | 1 |
| DTP | Admission Date Hour | Optional | 1 |
| CL1 | Institutional Claim Code | Optional | 1 |
| PWK | Claim Supplemental Information | Optional | 10 |
| CN1 | Contract Information | Optional | 1 |
| AMT | Payer Estimated Amount Due | Optional | 1 |
| AMT | Patient Estimated Amount Due | Optional | 1 |
| AMT | Patient Paid Amount | Optional | 1 |
| AMT | Credit Debit Card Maximum Amount | Optional | 1 |
| REF | Adjusted Repriced Claim Number | Optional | 1 |
| REF | Repriced Claim Number | Optional | 1 |
| REF | Claim Identification Number For Clearinghouses And Other Transmission Intermediaries | Optional | 1 |
| REF | Document Identification Code | Optional | 2 |
| REF | Original Reference Number ICNDCN | Optional | 1 |
| REF | Investigational Device Exemption Number | Optional | 1 |
| REF | Service Authorization Exception Code | Optional | 1 |
| REF | Peer Review Organization PRO Approval Number | Optional | 1 |
| REF | Prior Authorization Or Referral Number | Optional | 2 |
| REF | Medical Record Number | Optional | 1 |
| REF | Demonstration Project Identifier | Optional | 1 |
| K3 | File Information | Optional | 10 |
| NTE | Claim Note | Optional | 10 |
| NTE | Billing Note | Optional | 1 |
| CR6 | Home Health Care Information | Optional | 1 |
| CRC | Home Health Functional Limitations | Optional | 3 |
| CRC | Home Health Activities Permitted | Optional | 3 |
| CRC | Home Health Mental Status | Optional | 2 |
| HI | Principal Admitting E Code And Patient Reason For Visit Diagnosis Information | Optional | 1 |
| HI | Diagnosis Related Group DRG Information | Optional | 1 |
| HI | Other Diagnosis Information | Optional | 2 |
| HI | Principal Procedure Information | Optional | 1 |
| HI | Other Procedure Information | Optional | 2 |
| HI | Occurrence Span Information | Optional | 2 |
| HI | Occurrence Information | Optional | 2 |
| HI | Value Information | Optional | 2 |
| HI | Condition Information | Optional | 2 |
| HI | Treatment Code Information | Optional | 2 |
| QTY | Claim Quantity | Optional | 4 |
| HCP | Claim Pricing Repricing Information | Optional | 1 |
| Loop CR7 | Home Health Care Plan Information | Optional | 6 |
| CR7 | Home Health Care Plan Information | Mandatory | 1 |
| HSD | Health Care Services Delivery | Optional | 12 |
| Loop NM1 | Attending Physician Name | Optional | 1 |
| NM1 | Attending Physician Name | Mandatory | 1 |
| PRV | Attending Physician Specialty Information | Optional | 1 |
| REF | Attending Physician Secondary Identification | Optional | 5 |
| Loop NM1 | Operating Physician Name | Optional | 1 |
| NM1 | Operating Physician Name | Mandatory | 1 |
| REF | Operating Physician Secondary Identification | Optional | 5 |
| Loop NM1 | Other Provider Name | Optional | 1 |
| NM1 | Other Provider Name | Mandatory | 1 |
| REF | Other Provider Secondary Identification | Optional | 5 |
| Loop NM1 | Service Facility Name | Optional | 1 |
| NM1 | Service Facility Name | Mandatory | 1 |
| N3 | Service Facility Address | Mandatory | 1 |
| N4 | Service Facility City State Zip Code | Mandatory | 1 |
| REF | Service Facility Secondary Identification | Optional | 5 |
| Loop SBR | Other Subscriber Information | Optional | 10 |
| SBR | Other Subscriber Information | Mandatory | 1 |
| CAS | Claim Level Adjustment | Optional | 5 |
| AMT | Payer Prior Payment | Optional | 1 |
| AMT | Coordination Of Benefits COB Total Allowed Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Total Submitted Charges | Optional | 1 |
| AMT | Diagnostic Related Group DRG Outlier Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Total Medicare Paid Amount | Optional | 1 |
| AMT | Medicare Paid Amount100 | Optional | 1 |
| AMT | Medicare Paid Amount80 | Optional | 1 |
| AMT | Coordination Of Benefits COB Medicare A Trust Fund Paid Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Medicare B Trust Fund Paid Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Total Noncovered Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Total Denied Amount | Optional | 1 |
| DMG | Other Subscriber Demographic Information | Optional | 1 |
| OI | Other Insurance Coverage Information | Mandatory | 1 |
| MIA | Medicare Inpatient Adjudication Information | Optional | 1 |
| MOA | Medicare Outpatient Adjudication Information | Optional | 1 |
| Loop NM1 | Other Subscriber Name | Mandatory | 1 |
| NM1 | Other Subscriber Name | Mandatory | 1 |
| N3 | Other Subscriber Address | Optional | 1 |
| N4 | Other Subscriber City State ZIP Code | Optional | 1 |
| REF | Other Subscriber Secondary Information | Optional | 3 |
| Loop NM1 | Other Payer Name | Mandatory | 1 |
| NM1 | Other Payer Name | Mandatory | 1 |
| N3 | Other Payer Address | Optional | 1 |
| N4 | Other Payer City State ZIP Code | Optional | 1 |
| DTP | Claim Adjudication Date | Optional | 1 |
| REF | Other Payer Secondary Identification And Reference Number | Optional | 2 |
| REF | Other Payer Prior Authorization Or Referral Number | Optional | 1 |
| Loop NM1 | Other Payer Patient Information | Optional | 1 |
| NM1 | Other Payer Patient Information | Mandatory | 1 |
| REF | Other Payer Patient Identification Number | Optional | 3 |
| Loop NM1 | Other Payer Attending Provider | Optional | 1 |
| NM1 | Other Payer Attending Provider | Mandatory | 1 |
| REF | Other Payer Attending Provider Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Operating Provider | Optional | 1 |
| NM1 | Other Payer Operating Provider | Mandatory | 1 |
| REF | Other Payer Operating Provider Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Other Provider | Optional | 1 |
| NM1 | Other Payer Other Provider | Mandatory | 1 |
| REF | Other Payer Other Provider Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Service Facility Provider | Optional | 1 |
| NM1 | Other Payer Service Facility Provider | Mandatory | 1 |
| REF | Other Payer Service Facility Provider Identification | Mandatory | 3 |
| Loop LX | Service Line Number | Mandatory | 999 |
| LX | Service Line Number | Mandatory | 1 |
| SV2 | Institutional Service Line | Mandatory | 1 |
| PWK | Line Supplemental Information | Optional | 5 |
| DTP | Service Line Date | Optional | 1 |
| DTP | Assessment Date | Optional | 1 |
| AMT | Service Tax Amount | Optional | 1 |
| AMT | Facility Tax Amount | Optional | 1 |
| HCP | Line Pricing Repricing Information | Optional | 1 |
| Loop LIN | Drug Identification | Optional | 25 |
| LIN | Drug Identification | Mandatory | 1 |
| CTP | Drug Pricing | Optional | 1 |
| REF | Prescription Number | Optional | 1 |
| Loop NM1 | Attending Physician Name | Optional | 1 |
| NM1 | Attending Physician Name | Mandatory | 1 |
| REF | Attending Physician Secondary Identification | Optional | 1 |
| Loop NM1 | Operating Physician Name | Optional | 1 |
| NM1 | Operating Physician Name | Mandatory | 1 |
| REF | Operating Physician Secondary Identification | Optional | 1 |
| Loop NM1 | Other Provider Name | Optional | 1 |
| NM1 | Other Provider Name | Mandatory | 1 |
| REF | Other Provider Secondary Identification | Optional | 1 |
| Loop SVD | Service Line Adjudication Information | Optional | 25 |
| SVD | Service Line Adjudication Information | Mandatory | 1 |
| CAS | Service Line Adjustment | Optional | 99 |
| DTP | Service Adjudication Date | Optional | 1 |
| Loop HL | Patient Hierarchical Level | Optional | >1 |
| HL | Patient Hierarchical Level | Mandatory | 1 |
| PAT | Patient Information | Mandatory | 1 |
| Loop NM1 | Patient Name 2010CA | Mandatory | 1 |
| NM1 | Patient Name 2010CA | Mandatory | 1 |
| N3 | Patient Address 2010CA | Mandatory | 1 |
| N4 | Patient City State ZIP Code 2010CA | Mandatory | 1 |
| DMG | Patient Demographic Information 2010CA | Mandatory | 1 |
| REF | Subscriber Secondary Identification 2010BA | Optional | 4 |
| REF | Property And Casualty Claim Number 2010BA | Optional | 1 |
| Loop CLM | Claim Information | Mandatory | 100 |
| CLM | Claim Information | Mandatory | 1 |
| DTP | Discharge Hour | Optional | 1 |
| DTP | Statement Dates | Mandatory | 1 |
| DTP | Admission Date Hour | Optional | 1 |
| CL1 | Institutional Claim Code | Optional | 1 |
| PWK | Claim Supplemental Information | Optional | 10 |
| CN1 | Contract Information | Optional | 1 |
| AMT | Payer Estimated Amount Due | Optional | 1 |
| AMT | Patient Estimated Amount Due | Optional | 1 |
| AMT | Patient Paid Amount | Optional | 1 |
| AMT | Credit Debit Card Maximum Amount | Optional | 1 |
| REF | Adjusted Repriced Claim Number | Optional | 1 |
| REF | Repriced Claim Number | Optional | 1 |
| REF | Claim Identification Number For Clearinghouses And Other Transmission Intermediaries | Optional | 1 |
| REF | Document Identification Code | Optional | 2 |
| REF | Original Reference Number ICNDCN | Optional | 1 |
| REF | Investigational Device Exemption Number | Optional | 1 |
| REF | Service Authorization Exception Code | Optional | 1 |
| REF | Peer Review Organization PRO Approval Number | Optional | 1 |
| REF | Prior Authorization Or Referral Number | Optional | 2 |
| REF | Medical Record Number | Optional | 1 |
| REF | Demonstration Project Identifier | Optional | 1 |
| K3 | File Information | Optional | 10 |
| NTE | Claim Note | Optional | 10 |
| NTE | Billing Note | Optional | 1 |
| CR6 | Home Health Care Information | Optional | 1 |
| CRC | Home Health Functional Limitations | Optional | 3 |
| CRC | Home Health Activities Permitted | Optional | 3 |
| CRC | Home Health Mental Status | Optional | 2 |
| HI | Principal Admitting E Code And Patient Reason For Visit Diagnosis Information | Optional | 1 |
| HI | Diagnosis Related Group DRG Information | Optional | 1 |
| HI | Other Diagnosis Information | Optional | 2 |
| HI | Principal Procedure Information | Optional | 1 |
| HI | Other Procedure Information | Optional | 2 |
| HI | Occurrence Span Information | Optional | 2 |
| HI | Occurrence Information | Optional | 2 |
| HI | Value Information | Optional | 2 |
| HI | Condition Information | Optional | 2 |
| HI | Treatment Code Information | Optional | 2 |
| QTY | Claim Quantity | Optional | 4 |
| HCP | Claim Pricing Repricing Information | Optional | 1 |
| Loop CR7 | Home Health Care Plan Information | Optional | 6 |
| CR7 | Home Health Care Plan Information | Mandatory | 1 |
| HSD | Health Care Services Delivery | Optional | 12 |
| Loop NM1 | Attending Physician Name | Optional | 1 |
| NM1 | Attending Physician Name | Mandatory | 1 |
| PRV | Attending Physician Specialty Information | Optional | 1 |
| REF | Attending Physician Secondary Identification | Optional | 5 |
| Loop NM1 | Operating Physician Name | Optional | 1 |
| NM1 | Operating Physician Name | Mandatory | 1 |
| REF | Operating Physician Secondary Identification | Optional | 5 |
| Loop NM1 | Other Provider Name | Optional | 1 |
| NM1 | Other Provider Name | Mandatory | 1 |
| REF | Other Provider Secondary Identification | Optional | 5 |
| Loop NM1 | Service Facility Name | Optional | 1 |
| NM1 | Service Facility Name | Mandatory | 1 |
| N3 | Service Facility Address | Mandatory | 1 |
| N4 | Service Facility City State Zip Code | Mandatory | 1 |
| REF | Service Facility Secondary Identification | Optional | 5 |
| Loop SBR | Other Subscriber Information | Optional | 10 |
| SBR | Other Subscriber Information | Mandatory | 1 |
| CAS | Claim Level Adjustment | Optional | 5 |
| AMT | Payer Prior Payment | Optional | 1 |
| AMT | Coordination Of Benefits COB Total Allowed Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Total Submitted Charges | Optional | 1 |
| AMT | Diagnostic Related Group DRG Outlier Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Total Medicare Paid Amount | Optional | 1 |
| AMT | Medicare Paid Amount100 | Optional | 1 |
| AMT | Medicare Paid Amount80 | Optional | 1 |
| AMT | Coordination Of Benefits COB Medicare A Trust Fund Paid Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Medicare B Trust Fund Paid Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Total Noncovered Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Total Denied Amount | Optional | 1 |
| DMG | Other Subscriber Demographic Information | Optional | 1 |
| OI | Other Insurance Coverage Information | Mandatory | 1 |
| MIA | Medicare Inpatient Adjudication Information | Optional | 1 |
| MOA | Medicare Outpatient Adjudication Information | Optional | 1 |
| Loop NM1 | Other Subscriber Name | Mandatory | 1 |
| NM1 | Other Subscriber Name | Mandatory | 1 |
| N3 | Other Subscriber Address | Optional | 1 |
| N4 | Other Subscriber City State ZIP Code | Optional | 1 |
| REF | Other Subscriber Secondary Information | Optional | 3 |
| Loop NM1 | Other Payer Name | Mandatory | 1 |
| NM1 | Other Payer Name | Mandatory | 1 |
| N3 | Other Payer Address | Optional | 1 |
| N4 | Other Payer City State ZIP Code | Optional | 1 |
| DTP | Claim Adjudication Date | Optional | 1 |
| REF | Other Payer Secondary Identification And Reference Number | Optional | 2 |
| REF | Other Payer Prior Authorization Or Referral Number | Optional | 1 |
| Loop NM1 | Other Payer Patient Information | Optional | 1 |
| NM1 | Other Payer Patient Information | Mandatory | 1 |
| REF | Other Payer Patient Identification Number | Optional | 3 |
| Loop NM1 | Other Payer Attending Provider | Optional | 1 |
| NM1 | Other Payer Attending Provider | Mandatory | 1 |
| REF | Other Payer Attending Provider Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Operating Provider | Optional | 1 |
| NM1 | Other Payer Operating Provider | Mandatory | 1 |
| REF | Other Payer Operating Provider Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Other Provider | Optional | 1 |
| NM1 | Other Payer Other Provider | Mandatory | 1 |
| REF | Other Payer Other Provider Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Service Facility Provider | Optional | 1 |
| NM1 | Other Payer Service Facility Provider | Mandatory | 1 |
| REF | Other Payer Service Facility Provider Identification | Mandatory | 3 |
| Loop LX | Service Line Number | Mandatory | 999 |
| LX | Service Line Number | Mandatory | 1 |
| SV2 | Institutional Service Line | Mandatory | 1 |
| PWK | Line Supplemental Information | Optional | 5 |
| DTP | Service Line Date | Optional | 1 |
| DTP | Assessment Date | Optional | 1 |
| AMT | Service Tax Amount | Optional | 1 |
| AMT | Facility Tax Amount | Optional | 1 |
| HCP | Line Pricing Repricing Information | Optional | 1 |
| Loop LIN | Drug Identification | Optional | 25 |
| LIN | Drug Identification | Mandatory | 1 |
| CTP | Drug Pricing | Optional | 1 |
| REF | Prescription Number | Optional | 1 |
| Loop NM1 | Attending Physician Name | Optional | 1 |
| NM1 | Attending Physician Name | Mandatory | 1 |
| REF | Attending Physician Secondary Identification | Optional | 1 |
| Loop NM1 | Operating Physician Name | Optional | 1 |
| NM1 | Operating Physician Name | Mandatory | 1 |
| REF | Operating Physician Secondary Identification | Optional | 1 |
| Loop NM1 | Other Provider Name | Optional | 1 |
| NM1 | Other Provider Name | Mandatory | 1 |
| REF | Other Provider Secondary Identification | Optional | 1 |
| Loop SVD | Service Line Adjudication Information | Optional | 25 |
| SVD | Service Line Adjudication Information | Mandatory | 1 |
| CAS | Service Line Adjustment | Optional | 99 |
| DTP | Service Adjudication Date | Optional | 1 |
| SE | Transaction Set Trailer | Optional | 1 |