NEW 837P 5010 Crosswalk (Loops and Segments)
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ISA
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LOOP 1000A-Submitter Name
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LOOP 1000B-Receiver Name
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LOOP 2000A-Billing/Pay-To Provider
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LOOP 2010AA-Billing Provider Name
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LOOP 2010AB-Pay-To Provider Name
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LOOP 2010AC-TBD
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LOOP 2000B-Subscriber Hierarchical Level
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LOOP 2010BA-Subscriber Name
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LOOP 2010BB-Payer Name
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LOOP 2000C-Patient Hierarchical Level
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LOOP 2010CA-Patient Name
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LOOP 2300-Claim Information
- Segment: CLM
- Segment: DTP
- Segment: PWK
- Segment: CN1
- Segment: AMT
- Segment: REF
- Segment: K3
- Segment: NTE
- Segment: CR1
- Segment: CR2
- Segment: CRC (Ambulance)
- Segment: CRC (Vision)
- Segment: CRC (Homebound Indicator Code Category)
- Segment: CRC (EPSDT)
- Segment: HI
- Segment: HI (Anesthesia Related Procedure Code)
- Segment: HI (Condition Information)
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Loop 2310A-Referring Provider Name
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Loop 2310B-Rendering Provider Name
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Loop 2310C-Service Facility Location
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Loop 2310D-Supervising Provider Name
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Loop 2310E-Ambulance Pick-Up Location
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Loop 2310F-ambulance Drop-Off Location
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Loop 2330A-Other Subscrier Name
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Loop 2330B-Other Payer Name
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Loop 2330C-Other Payer Referring Provider
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Loop 2330D-Other Payer Rendering Provider
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Loop 2330E-Other Payer Service Facility Location
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Loop 2330F-Other Payer Supervising Provider
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Loop 2330G-Other Payer Billing Provider
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Loop 2400
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Loop 2410-Drug Identification
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Loop 2420B-Purchased Service Provider
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Loop 2420C-Service Facility Location Name
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Loop 2420D-Supervising Provider Name
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Loop 2420E-Ordering Provider Name
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Loop 2420F-Referring Provider Name
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Loop 2420G-Ambulance Pick-Up Location
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Loop 2420H-Ambulance Drop-Off Location
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Loop 2430 (Not Implemented)
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Loop 2440-Form Identification Code
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SE - Transaction Set Trailer