837I Health Care Claim: Institutional (005010X223A2)
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 005010 spec, with 59 loops and 273 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 005010X223A2 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 |
| Loop 1000A | Submitter Name | Mandatory | 1 |
| NM1 | Submitter Name | Mandatory | 1 |
| PER | Submitter EDI Contact Information | Mandatory | 2 |
| Loop 1000B | Receiver Name | Mandatory | 1 |
| NM1 | Receiver Name | Mandatory | 1 |
| Loop 2000A | 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 2010AA | 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 |
| PER | Billing Provider Contact Information | Optional | 2 |
| Loop 2010AB | Pay Address Name | Optional | 1 |
| NM1 | Pay Address Name | Mandatory | 1 |
| N3 | Pay To Address ADDRESS | Mandatory | 1 |
| N4 | Pay Address City State ZIP Code | Mandatory | 1 |
| Loop 2010AC | 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 Tax Identification Number | Mandatory | 1 |
| Loop 2000B | Subscriber Hierarchical Level | Mandatory | >1 |
| HL | Subscriber Hierarchical Level | Mandatory | 1 |
| SBR | Subscriber Information | Mandatory | 1 |
| Loop 2010BA | Subscriber Name | Mandatory | 1 |
| NM1 | Subscriber Name | Mandatory | 1 |
| N3 | Subscriber Address | Optional | 1 |
| N4 | Subscriber City State ZIP Code | Optional | 1 |
| DMG | Subscriber Demographic Information | Optional | 1 |
| REF | Subscriber Secondary Identification | Optional | 1 |
| REF | Propertyand Casualty Claim Number | Optional | 1 |
| Loop 2010BB | Payer Name | Mandatory | 1 |
| NM1 | Payer Name | Mandatory | 1 |
| N3 | Payer Address | Optional | 1 |
| N4 | Payer City State ZIP Code | Optional | 1 |
| REF | Payer Secondary Identification | Optional | 3 |
| REF | Billing Provider Secondary Identification | Optional | 1 |
| Loop 2300 | 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 |
| DTP | Date Repricer Received Date | Optional | 1 |
| CL1 | Institutional Claim Code | Mandatory | 1 |
| PWK | Claim Supplemental Information | Optional | 10 |
| CN1 | Contract Information | Optional | 1 |
| AMT | Patient Estimated Amount Due | Optional | 1 |
| REF | Service Authorization Exception Code | Optional | 1 |
| REF | Referral Number | Optional | 1 |
| REF | Prior Authorization | Optional | 1 |
| REF | Payer Claim Control Number | Optional | 1 |
| REF | Repriced Claim Number | Optional | 1 |
| REF | Adjusted Repriced Claim Number | Optional | 1 |
| REF | Investigational Device Exemption Number | Optional | 5 |
| REF | Claim Identifier For Transmission Intermediaries | Optional | 1 |
| REF | Auto Accident State | Optional | 1 |
| REF | Medical Record Number | Optional | 1 |
| REF | Demonstration Project Identifier | Optional | 1 |
| REF | Peer Review Organization PRO Approval Number | Optional | 1 |
| K3 | File Information | Optional | 10 |
| NTE | Claim Note | Optional | 10 |
| NTE | Billing Note | Optional | 1 |
| CRC | EPSDT Referral | Optional | 1 |
| HI | Principal Diagnosis | Mandatory | 1 |
| HI | Admitting Diagnosis | Optional | 1 |
| HI | Patient Reason For Visit | Optional | 1 |
| HI | External Causeof Injury | 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 |
| HCP | Claim Pricing Repricing Information | Optional | 1 |
| Loop 2310A | Attending Provider Name | Optional | 1 |
| NM1 | Attending Provider Name | Mandatory | 1 |
| PRV | Attending Provider Specialty Information | Optional | 1 |
| REF | Attending Provider Secondary Identification | Optional | 4 |
| Loop 2310B | Operating Physician Name | Optional | 1 |
| NM1 | Operating Physician Name | Mandatory | 1 |
| REF | Operating Physician Secondary Identification | Optional | 4 |
| Loop 2310C | Other Operating Physician Name | Optional | 1 |
| NM1 | Other Operating Physician Name | Mandatory | 1 |
| REF | Other Operating Physician Secondary Identification | Optional | 4 |
| Loop 2310D | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 4 |
| Loop 2310E | 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 | Mandatory | 1 |
| REF | Service Facility Secondary Identification | Optional | 3 |
| Loop 2310F | Referring Provider Name | Optional | 1 |
| NM1 | Referring Provider Name | Mandatory | 1 |
| REF | Referring Provider Secondary Identification | Optional | 3 |
| Loop 2320 | 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 |
| MIA | Inpatient Adjudication Information | Optional | 1 |
| MOA | Outpatient Adjudication Information | Optional | 1 |
| Loop 2330A | 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 | 2 |
| Loop 2330B | 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 Check Or Remittance Date | Optional | 1 |
| REF | Other Payer Secondary Identifier | Optional | 2 |
| 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 Claim Control Number | Optional | 1 |
| Loop 2330C | Other Payer Attending Provider | Optional | 1 |
| NM1 | Other Payer Attending Provider | Mandatory | 1 |
| REF | Other Payer Attending Provider Secondary Identification | Mandatory | 4 |
| Loop 2330D | Other Payer Operating Physician | Optional | 1 |
| NM1 | Other Payer Operating Physician | Mandatory | 1 |
| REF | Other Payer Operating Physician Secondary Identification | Mandatory | 4 |
| Loop 2330E | Other Payer Other Operating Physician | Optional | 1 |
| NM1 | Other Payer Other Operating Physician | Mandatory | 1 |
| REF | Other Payer Other Operating Physician Secondary Identification | Mandatory | 4 |
| Loop 2330F | 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 2330G | Other Payer Rendering Provider Name | Optional | 1 |
| NM1 | Other Payer Rendering Provider Name | Mandatory | 1 |
| REF | Other Payer Rendering Provider Secondary Identifier | Mandatory | 4 |
| Loop 2330H | Other Payer Referring Provider | Optional | 1 |
| NM1 | Other Payer Referring Provider | Mandatory | 1 |
| REF | Other Payer Referring Provider Secondary Identification | Mandatory | 3 |
| Loop 2330I | Other Payer Billing Provider | Optional | 1 |
| NM1 | Other Payer Billing Provider | Mandatory | 1 |
| REF | Other Payer Billing Provider Secondary Identifier | Mandatory | 2 |
| Loop 2400 | Service Line Number | Mandatory | 999 |
| LX | Service Line Number | Mandatory | 1 |
| SV2 | Institutional Service Line | Mandatory | 1 |
| PWK | Line Supplemental Information | Optional | 10 |
| DTP | Date Service Date | Optional | 1 |
| REF | Line Item Control Number | Optional | 1 |
| REF | Repriced Line Item Reference Number | Optional | 1 |
| REF | Adjusted Repriced Line Item Reference Number | Optional | 1 |
| AMT | Service Tax Amount | Optional | 1 |
| AMT | Facility Tax Amount | Optional | 1 |
| NTE | Third Party Organization Notes | Optional | 1 |
| HCP | Line Pricing Repricing Information | Optional | 1 |
| Loop 2410 | Drug Identification | Optional | 1 |
| LIN | Drug Identification | Mandatory | 1 |
| CTP | Drug Quantity | Mandatory | 1 |
| REF | Prescriptionor Compound Drug Association Number | Optional | 1 |
| Loop 2420A | Operating Physician Name | Optional | 1 |
| NM1 | Operating Physician Name | Mandatory | 1 |
| REF | Operating Physician Secondary Identification | Optional | 20 |
| Loop 2420B | Other Operating Physician Name | Optional | 1 |
| NM1 | Other Operating Physician Name | Mandatory | 1 |
| REF | Other Operating Physician Secondary Identification | Optional | 20 |
| Loop 2420C | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 20 |
| Loop 2420D | Referring Provider Name | Optional | 1 |
| NM1 | Referring Provider Name | Mandatory | 1 |
| REF | Referring Provider Secondary Identification | Optional | 20 |
| Loop 2430 | 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 2000C | Patient Hierarchical Level | Optional | >1 |
| HL | Patient Hierarchical Level | Mandatory | 1 |
| PAT | Patient Information | Mandatory | 1 |
| Loop 2010CA | 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 |
| REF | Propertyand Casualty Patient Identifier | Optional | 1 |
| Loop 2300 | 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 |
| DTP | Date Repricer Received Date | Optional | 1 |
| CL1 | Institutional Claim Code | Mandatory | 1 |
| PWK | Claim Supplemental Information | Optional | 10 |
| CN1 | Contract Information | Optional | 1 |
| AMT | Patient Estimated Amount Due | Optional | 1 |
| REF | Service Authorization Exception Code | Optional | 1 |
| REF | Referral Number | Optional | 1 |
| REF | Prior Authorization | Optional | 1 |
| REF | Payer Claim Control Number | Optional | 1 |
| REF | Repriced Claim Number | Optional | 1 |
| REF | Adjusted Repriced Claim Number | Optional | 1 |
| REF | Investigational Device Exemption Number | Optional | 5 |
| REF | Claim Identifier For Transmission Intermediaries | Optional | 1 |
| REF | Auto Accident State | Optional | 1 |
| REF | Medical Record Number | Optional | 1 |
| REF | Demonstration Project Identifier | Optional | 1 |
| REF | Peer Review Organization PRO Approval Number | Optional | 1 |
| K3 | File Information | Optional | 10 |
| NTE | Claim Note | Optional | 10 |
| NTE | Billing Note | Optional | 1 |
| CRC | EPSDT Referral | Optional | 1 |
| HI | Principal Diagnosis | Mandatory | 1 |
| HI | Admitting Diagnosis | Optional | 1 |
| HI | Patient Reason For Visit | Optional | 1 |
| HI | External Causeof Injury | 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 |
| HCP | Claim Pricing Repricing Information | Optional | 1 |
| Loop 2310A | Attending Provider Name | Optional | 1 |
| NM1 | Attending Provider Name | Mandatory | 1 |
| PRV | Attending Provider Specialty Information | Optional | 1 |
| REF | Attending Provider Secondary Identification | Optional | 4 |
| Loop 2310B | Operating Physician Name | Optional | 1 |
| NM1 | Operating Physician Name | Mandatory | 1 |
| REF | Operating Physician Secondary Identification | Optional | 4 |
| Loop 2310C | Other Operating Physician Name | Optional | 1 |
| NM1 | Other Operating Physician Name | Mandatory | 1 |
| REF | Other Operating Physician Secondary Identification | Optional | 4 |
| Loop 2310D | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 4 |
| Loop 2310E | 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 | Mandatory | 1 |
| REF | Service Facility Secondary Identification | Optional | 3 |
| Loop 2310F | Referring Provider Name | Optional | 1 |
| NM1 | Referring Provider Name | Mandatory | 1 |
| REF | Referring Provider Secondary Identification | Optional | 3 |
| Loop 2320 | 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 |
| MIA | Inpatient Adjudication Information | Optional | 1 |
| MOA | Outpatient Adjudication Information | Optional | 1 |
| Loop 2330A | 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 | 2 |
| Loop 2330B | 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 Check Or Remittance Date | Optional | 1 |
| REF | Other Payer Secondary Identifier | Optional | 2 |
| 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 Claim Control Number | Optional | 1 |
| Loop 2330C | Other Payer Attending Provider | Optional | 1 |
| NM1 | Other Payer Attending Provider | Mandatory | 1 |
| REF | Other Payer Attending Provider Secondary Identification | Mandatory | 4 |
| Loop 2330D | Other Payer Operating Physician | Optional | 1 |
| NM1 | Other Payer Operating Physician | Mandatory | 1 |
| REF | Other Payer Operating Physician Secondary Identification | Mandatory | 4 |
| Loop 2330E | Other Payer Other Operating Physician | Optional | 1 |
| NM1 | Other Payer Other Operating Physician | Mandatory | 1 |
| REF | Other Payer Other Operating Physician Secondary Identification | Mandatory | 4 |
| Loop 2330F | 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 2330G | Other Payer Rendering Provider Name | Optional | 1 |
| NM1 | Other Payer Rendering Provider Name | Mandatory | 1 |
| REF | Other Payer Rendering Provider Secondary Identifier | Mandatory | 4 |
| Loop 2330H | Other Payer Referring Provider | Optional | 1 |
| NM1 | Other Payer Referring Provider | Mandatory | 1 |
| REF | Other Payer Referring Provider Secondary Identification | Mandatory | 3 |
| Loop 2330I | Other Payer Billing Provider | Optional | 1 |
| NM1 | Other Payer Billing Provider | Mandatory | 1 |
| REF | Other Payer Billing Provider Secondary Identifier | Mandatory | 2 |
| Loop 2400 | Service Line Number | Mandatory | 999 |
| LX | Service Line Number | Mandatory | 1 |
| SV2 | Institutional Service Line | Mandatory | 1 |
| PWK | Line Supplemental Information | Optional | 10 |
| DTP | Date Service Date | Optional | 1 |
| REF | Line Item Control Number | Optional | 1 |
| REF | Repriced Line Item Reference Number | Optional | 1 |
| REF | Adjusted Repriced Line Item Reference Number | Optional | 1 |
| AMT | Service Tax Amount | Optional | 1 |
| AMT | Facility Tax Amount | Optional | 1 |
| NTE | Third Party Organization Notes | Optional | 1 |
| HCP | Line Pricing Repricing Information | Optional | 1 |
| Loop 2410 | Drug Identification | Optional | 1 |
| LIN | Drug Identification | Mandatory | 1 |
| CTP | Drug Quantity | Mandatory | 1 |
| REF | Prescriptionor Compound Drug Association Number | Optional | 1 |
| Loop 2420A | Operating Physician Name | Optional | 1 |
| NM1 | Operating Physician Name | Mandatory | 1 |
| REF | Operating Physician Secondary Identification | Optional | 20 |
| Loop 2420B | Other Operating Physician Name | Optional | 1 |
| NM1 | Other Operating Physician Name | Mandatory | 1 |
| REF | Other Operating Physician Secondary Identification | Optional | 20 |
| Loop 2420C | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 20 |
| Loop 2420D | Referring Provider Name | Optional | 1 |
| NM1 | Referring Provider Name | Mandatory | 1 |
| REF | Referring Provider Secondary Identification | Optional | 20 |
| Loop 2430 | 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 |