837D Health Care Claim: Dental (005010X224A1)
Dental practices send the 837D to submit dental claims and predeterminations to payers and clearinghouses. This is the standard X12 HIPAA 005010 before the errata spec, with 53 loops and 253 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 837D 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 837D files into TS837D objects. See ediFabric .NET.
ediFabric Native
Map version 005010X224A1 to the Native model with set_map, then parse 837D 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 837D classes in Python, Java, Node.js, Go, Rust or C
ediFabric Native returns each 837D 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 TS837D. 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 837D, see the 837D transaction guide.
837D structure
Loops and segments of the standard 837D, with their usage and maximum repeats.
| ID | Name | Usage | Max use |
|---|---|---|---|
| ST | Transaction Set Header | Optional | 1 |
| BHT | Beginning Of Hierarchical Transaction | 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 Provider Hierarchical Level | Mandatory | >1 |
| HL | Billing Provider Hierarchical Level | Mandatory | 1 |
| PRV | Billing Provider Specialty Information | Optional | 1 |
| CUR | Foreign Currency Information | Optional | 1 |
| Loop NM1 | Billing Provider Name | Mandatory | 1 |
| NM1 | Billing Provider Name | Mandatory | 1 |
| N3 | Billing Provider Address | Mandatory | 1 |
| N4 | Billing Provider City State ZIP Code | Mandatory | 1 |
| REF | Billing Provider Tax Identification | Mandatory | 1 |
| REF | Billing Provider UPIN License Information | Optional | 2 |
| PER | Billing Provider Contact Information | Optional | 2 |
| Loop NM1 | Pay Address Name | Optional | 1 |
| NM1 | Pay Address Name | Mandatory | 1 |
| N3 | Pay Address ADDRESS | Mandatory | 1 |
| N4 | Pay Address City State ZIP Code | Mandatory | 1 |
| Loop NM1 | Pay To Plan Name | Optional | 1 |
| NM1 | Pay To Plan Name | Mandatory | 1 |
| N3 | Pay To Plan Address | Mandatory | 1 |
| N4 | Pay To Plan City State Zip Code | Mandatory | 1 |
| REF | Pay To Plan Secondary Identification | Optional | 1 |
| REF | Pay To Plan Tax Identification Number | Mandatory | 1 |
| Loop HL | Subscriber Hierarchical Level | Mandatory | >1 |
| HL | Subscriber Hierarchical Level | Mandatory | 1 |
| SBR | Subscriber Information | Mandatory | 1 |
| Loop NM1 | Subscriber Name | Mandatory | 1 |
| NM1 | Subscriber Name | Mandatory | 1 |
| N3 | Subscriber Address | Optional | 1 |
| N4 | Subscriber City State ZIP Code | Mandatory | 1 |
| DMG | Subscriber Demographic Information | Optional | 1 |
| REF | Subscriber Secondary Identification | Optional | 1 |
| REF | Propertyand Casualty Claim Number | Optional | 1 |
| Loop NM1 | Payer Name | Mandatory | 1 |
| NM1 | Payer Name | Mandatory | 1 |
| N3 | Payer Address | Optional | 1 |
| N4 | Payer City State ZIP Code | Mandatory | 1 |
| REF | Payer Secondary Identification | Optional | 3 |
| REF | Billing Provider Secondary Identification | Optional | 1 |
| Loop CLM | Claim Information | Optional | 100 |
| CLM | Claim Information | Mandatory | 1 |
| DTP | Date Accident | Optional | 1 |
| DTP | Date Appliance Placement | Optional | 1 |
| DTP | Date Service Date | Optional | 1 |
| DTP | Date Repricer Received Date | Optional | 1 |
| DN1 | Orthodontic Total Monthsof Treatment | Optional | 1 |
| DN2 | Tooth Status | Optional | 35 |
| PWK | Claim Supplemental Information | Optional | 10 |
| CN1 | Contract Information | Optional | 1 |
| AMT | Patient Amount Paid | Optional | 1 |
| REF | Predetermination Identification | Optional | 1 |
| REF | Service Authorization Exception Code | Optional | 1 |
| REF | Payer Claim Control Number | Optional | 1 |
| REF | Referral Number | Optional | 1 |
| REF | Prior Authorization | Optional | 1 |
| REF | Repriced Claim Number | Optional | 1 |
| REF | Adjusted Repriced Claim Number | Optional | 1 |
| REF | Claim Identifier For Transmission Intermediaries | Optional | 1 |
| K3 | File Information | Optional | 10 |
| NTE | Claim Note | Optional | 5 |
| HI | Health Care Diagnosis Code | Optional | 1 |
| HCP | Claim Pricing Repricing Information | Optional | 1 |
| Loop NM1 | Referring Provider Name | Optional | 2 |
| NM1 | Referring Provider Name | Mandatory | 1 |
| PRV | Referring Provider Specialty Information | Optional | 1 |
| REF | Referring Provider Secondary Identification | Optional | 3 |
| Loop NM1 | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| PRV | Rendering Provider Specialty Information | Mandatory | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 4 |
| Loop NM1 | Service Facility Location Name | Optional | 1 |
| NM1 | Service Facility Location Name | Mandatory | 1 |
| N3 | Service Facility Location Address | Mandatory | 1 |
| N4 | Service Facility Location City State Zip Code | Mandatory | 1 |
| REF | Service Facility Location Secondary Identification | Optional | 3 |
| Loop NM1 | Assistant Surgeon Name | Optional | 1 |
| NM1 | Assistant Surgeon Name | Mandatory | 1 |
| PRV | Assistant Surgeon Specialty Information | Mandatory | 1 |
| REF | Assistant Surgeon Secondary Identification | Optional | 4 |
| Loop NM1 | Supervising Provider Name | Optional | 1 |
| NM1 | Supervising Provider Name | Mandatory | 1 |
| REF | Supervising Provider Secondary Identification | Optional | 4 |
| Loop SBR | Other Subscriber Information | Optional | 10 |
| SBR | Other Subscriber Information | Mandatory | 1 |
| CAS | Claim Level Adjustments | Optional | 5 |
| AMT | Coordinationof Benefits COB Payer Paid Amount | Optional | 1 |
| AMT | Remaining Patient Liability | Optional | 1 |
| AMT | Coordinationof Benefits COB Total Non Amount | Optional | 1 |
| OI | Other Insurance Coverage Information | Mandatory | 1 |
| MOA | 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 | Mandatory | 1 |
| REF | Other Subscriber Secondary Identification | Optional | 2 |
| 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 | Mandatory | 1 |
| DTP | Claim Check Or Remittance Date | Optional | 1 |
| REF | Other Payer Secondary Identifier | Optional | 3 |
| REF | Other Payer Prior Authorization Number | Optional | 1 |
| REF | Other Payer Referral Number | Optional | 1 |
| REF | Other Payer Claim Adjustment Indicator | Optional | 1 |
| REF | Other Payer Predetermination Identification | Optional | 1 |
| REF | Other Payer Claim Control Number | Optional | 1 |
| Loop NM1 | Other Payer Referring Provider | Optional | 2 |
| NM1 | Other Payer Referring Provider | Mandatory | 1 |
| REF | Other Payer Referring Provider Secondary Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Rendering Provider | Optional | 1 |
| NM1 | Other Payer Rendering Provider | Mandatory | 1 |
| REF | Other Payer Rendering Provider Secondary Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Supervising Provider | Optional | 1 |
| NM1 | Other Payer Supervising Provider | Mandatory | 1 |
| REF | Other Payer Supervising Provider Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Billing Provider | Optional | 1 |
| NM1 | Other Payer Billing Provider | Mandatory | 1 |
| REF | Other Payer Billing Provider Secondary Identification | Mandatory | 2 |
| Loop NM1 | Other Payer Service Facility Location | Optional | 1 |
| NM1 | Other Payer Service Facility Location | Mandatory | 1 |
| REF | Other Payer Service Facility Location Secondary Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Assistant Surgeon | Optional | 1 |
| NM1 | Other Payer Assistant Surgeon | Mandatory | 1 |
| REF | Other Payer Assistant Surgeon Secondary Identifier | Mandatory | 3 |
| Loop LX | Service Line Counter | Mandatory | 50 |
| LX | Service Line Counter | Mandatory | 1 |
| SV3 | Dental Service | Mandatory | 1 |
| TOO | Tooth Information | Optional | 32 |
| DTP | Date Service Date | Optional | 1 |
| DTP | Date Prior Placement | Optional | 1 |
| DTP | Date Appliance Placement | Optional | 1 |
| DTP | Date Replacement | Optional | 1 |
| DTP | Date Treatment Start | Optional | 1 |
| DTP | Date Treatment Completion | Optional | 1 |
| CN1 | Contract Information | Optional | 1 |
| REF | Service Predetermination Identification | Optional | 5 |
| REF | Prior Authorization | Optional | 5 |
| REF | Line Item Control Number | Optional | 1 |
| REF | Repriced Claim Number | Optional | 1 |
| REF | Adjusted Repriced Claim Number | Optional | 1 |
| REF | Referral Number | Optional | 5 |
| AMT | Sales Tax Amount | Optional | 1 |
| K3 | File Information | Optional | 10 |
| HCP | Line Pricing Repricing Information | Optional | 1 |
| Loop NM1 | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| PRV | Rendering Provider Specialty Information | Mandatory | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 20 |
| Loop NM1 | Assistant Surgeon Name | Optional | 1 |
| NM1 | Assistant Surgeon Name | Mandatory | 1 |
| PRV | Assistant Surgeon Specialty Information | Optional | 1 |
| REF | Assistant Surgeon Secondary Identification | Optional | 20 |
| Loop NM1 | Supervising Provider Name | Optional | 1 |
| NM1 | Supervising Provider Name | Mandatory | 1 |
| REF | Supervising Provider Secondary Identification | Optional | 20 |
| Loop NM1 | Service Facility Location Name | Optional | 1 |
| NM1 | Service Facility Location Name | Mandatory | 1 |
| N3 | Service Facility Location Address | Mandatory | 1 |
| N4 | Service Facility Location City State ZIP Code | Mandatory | 1 |
| REF | Service Facility Location Secondary Identification | Optional | 20 |
| Loop SVD | Line Adjudication Information | Optional | 15 |
| SVD | Line Adjudication Information | Mandatory | 1 |
| CAS | Line Adjustment | Optional | 5 |
| DTP | Line Checkor Remittance Date | Mandatory | 1 |
| AMT | Remaining Patient Liability | Optional | 1 |
| Loop HL | Patient Hierarchical Level | Optional | >1 |
| HL | Patient Hierarchical Level | Mandatory | 1 |
| PAT | Patient Information | Mandatory | 1 |
| Loop NM1 | Patient Name | Mandatory | 1 |
| NM1 | Patient Name | Mandatory | 1 |
| N3 | Patient Address | Mandatory | 1 |
| N4 | Patient City State ZIP Code | Mandatory | 1 |
| DMG | Patient Demographic Information | Mandatory | 1 |
| REF | Propertyand Casualty Claim Number | Optional | 1 |
| Loop CLM | Claim Information | Mandatory | 100 |
| CLM | Claim Information | Mandatory | 1 |
| DTP | Date Accident | Optional | 1 |
| DTP | Date Appliance Placement | Optional | 1 |
| DTP | Date Service Date | Optional | 1 |
| DTP | Date Repricer Received Date | Optional | 1 |
| DN1 | Orthodontic Total Monthsof Treatment | Optional | 1 |
| DN2 | Tooth Status | Optional | 35 |
| PWK | Claim Supplemental Information | Optional | 10 |
| CN1 | Contract Information | Optional | 1 |
| AMT | Patient Amount Paid | Optional | 1 |
| REF | Predetermination Identification | Optional | 1 |
| REF | Service Authorization Exception Code | Optional | 1 |
| REF | Payer Claim Control Number | Optional | 1 |
| REF | Referral Number | Optional | 1 |
| REF | Prior Authorization | Optional | 1 |
| REF | Repriced Claim Number | Optional | 1 |
| REF | Adjusted Repriced Claim Number | Optional | 1 |
| REF | Claim Identifier For Transmission Intermediaries | Optional | 1 |
| K3 | File Information | Optional | 10 |
| NTE | Claim Note | Optional | 5 |
| HI | Health Care Diagnosis Code | Optional | 1 |
| HCP | Claim Pricing Repricing Information | Optional | 1 |
| Loop NM1 | Referring Provider Name | Optional | 2 |
| NM1 | Referring Provider Name | Mandatory | 1 |
| PRV | Referring Provider Specialty Information | Optional | 1 |
| REF | Referring Provider Secondary Identification | Optional | 3 |
| Loop NM1 | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| PRV | Rendering Provider Specialty Information | Mandatory | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 4 |
| Loop NM1 | Service Facility Location Name | Optional | 1 |
| NM1 | Service Facility Location Name | Mandatory | 1 |
| N3 | Service Facility Location Address | Mandatory | 1 |
| N4 | Service Facility Location City State Zip Code | Mandatory | 1 |
| REF | Service Facility Location Secondary Identification | Optional | 3 |
| Loop NM1 | Assistant Surgeon Name | Optional | 1 |
| NM1 | Assistant Surgeon Name | Mandatory | 1 |
| PRV | Assistant Surgeon Specialty Information | Mandatory | 1 |
| REF | Assistant Surgeon Secondary Identification | Optional | 4 |
| Loop NM1 | Supervising Provider Name | Optional | 1 |
| NM1 | Supervising Provider Name | Mandatory | 1 |
| REF | Supervising Provider Secondary Identification | Optional | 4 |
| Loop SBR | Other Subscriber Information | Optional | 10 |
| SBR | Other Subscriber Information | Mandatory | 1 |
| CAS | Claim Level Adjustments | Optional | 5 |
| AMT | Coordinationof Benefits COB Payer Paid Amount | Optional | 1 |
| AMT | Remaining Patient Liability | Optional | 1 |
| AMT | Coordinationof Benefits COB Total Non Amount | Optional | 1 |
| OI | Other Insurance Coverage Information | Mandatory | 1 |
| MOA | 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 | Mandatory | 1 |
| REF | Other Subscriber Secondary Identification | Optional | 2 |
| 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 | Mandatory | 1 |
| DTP | Claim Check Or Remittance Date | Optional | 1 |
| REF | Other Payer Secondary Identifier | Optional | 3 |
| REF | Other Payer Prior Authorization Number | Optional | 1 |
| REF | Other Payer Referral Number | Optional | 1 |
| REF | Other Payer Claim Adjustment Indicator | Optional | 1 |
| REF | Other Payer Predetermination Identification | Optional | 1 |
| REF | Other Payer Claim Control Number | Optional | 1 |
| Loop NM1 | Other Payer Referring Provider | Optional | 2 |
| NM1 | Other Payer Referring Provider | Mandatory | 1 |
| REF | Other Payer Referring Provider Secondary Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Rendering Provider | Optional | 1 |
| NM1 | Other Payer Rendering Provider | Mandatory | 1 |
| REF | Other Payer Rendering Provider Secondary Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Supervising Provider | Optional | 1 |
| NM1 | Other Payer Supervising Provider | Mandatory | 1 |
| REF | Other Payer Supervising Provider Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Billing Provider | Optional | 1 |
| NM1 | Other Payer Billing Provider | Mandatory | 1 |
| REF | Other Payer Billing Provider Secondary Identification | Mandatory | 2 |
| Loop NM1 | Other Payer Service Facility Location | Optional | 1 |
| NM1 | Other Payer Service Facility Location | Mandatory | 1 |
| REF | Other Payer Service Facility Location Secondary Identification | Mandatory | 3 |
| Loop NM1 | Other Payer Assistant Surgeon | Optional | 1 |
| NM1 | Other Payer Assistant Surgeon | Mandatory | 1 |
| REF | Other Payer Assistant Surgeon Secondary Identifier | Mandatory | 3 |
| Loop LX | Service Line Counter | Mandatory | 50 |
| LX | Service Line Counter | Mandatory | 1 |
| SV3 | Dental Service | Mandatory | 1 |
| TOO | Tooth Information | Optional | 32 |
| DTP | Date Service Date | Optional | 1 |
| DTP | Date Prior Placement | Optional | 1 |
| DTP | Date Appliance Placement | Optional | 1 |
| DTP | Date Replacement | Optional | 1 |
| DTP | Date Treatment Start | Optional | 1 |
| DTP | Date Treatment Completion | Optional | 1 |
| CN1 | Contract Information | Optional | 1 |
| REF | Service Predetermination Identification | Optional | 5 |
| REF | Prior Authorization | Optional | 5 |
| REF | Line Item Control Number | Optional | 1 |
| REF | Repriced Claim Number | Optional | 1 |
| REF | Adjusted Repriced Claim Number | Optional | 1 |
| REF | Referral Number | Optional | 5 |
| AMT | Sales Tax Amount | Optional | 1 |
| K3 | File Information | Optional | 10 |
| HCP | Line Pricing Repricing Information | Optional | 1 |
| Loop NM1 | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| PRV | Rendering Provider Specialty Information | Mandatory | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 20 |
| Loop NM1 | Assistant Surgeon Name | Optional | 1 |
| NM1 | Assistant Surgeon Name | Mandatory | 1 |
| PRV | Assistant Surgeon Specialty Information | Optional | 1 |
| REF | Assistant Surgeon Secondary Identification | Optional | 20 |
| Loop NM1 | Supervising Provider Name | Optional | 1 |
| NM1 | Supervising Provider Name | Mandatory | 1 |
| REF | Supervising Provider Secondary Identification | Optional | 20 |
| Loop NM1 | Service Facility Location Name | Optional | 1 |
| NM1 | Service Facility Location Name | Mandatory | 1 |
| N3 | Service Facility Location Address | Mandatory | 1 |
| N4 | Service Facility Location City State ZIP Code | Mandatory | 1 |
| REF | Service Facility Location Secondary Identification | Optional | 20 |
| Loop SVD | Line Adjudication Information | Optional | 15 |
| SVD | Line Adjudication Information | Mandatory | 1 |
| CAS | Line Adjustment | Optional | 5 |
| DTP | Line Checkor Remittance Date | Mandatory | 1 |
| AMT | Remaining Patient Liability | Optional | 1 |
| SE | Transaction Set Trailer | Optional | 1 |