837P — Professional Claims

The 837P (Professional) transaction is used by physicians, laboratories, and other non-institutional providers to submit claims for healthcare services. It's one of the most common EDI files in healthcare billing.

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Purpose

The 837P transmits:

• Claims for professional services (office visits, procedures, tests)
• Supporting clinical information (diagnosis codes, referring providers)
• Billing and payment details (charges, prior authorization)

It flows from provider → clearinghouse → payer during the claims submission process.

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Loop Structure

Loop 1000A — Submitter Name
Loop 1000B — Receiver Name
Loop 2000A — Billing Provider (HL*20)
  Loop 2010AA — Billing Provider Name
  Loop 2010AB — Pay-To Address (if different)
  Loop 2010AC — Pay-To Plan Name (if different)
  Loop 2000B — Subscriber (HL*22)
    Loop 2010BA — Subscriber Name
    Loop 2010BB — Payer Name
    Loop 2000C — Patient (HL*23, if different from subscriber)
      Loop 2010CA — Patient Name
      Loop 2300 — Claim Information
        Loop 2310A — Referring Provider
        Loop 2310B — Rendering Provider
        Loop 2310C — Service Facility
        Loop 2310D — Supervising Provider
        Loop 2320 — Other Subscriber Info (COB)
        Loop 2400 — Service Lines
          Loop 2420A-F — Line-level providers

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Key Segments

CLM — Claim Information

The heart of every claim:

CLM*CLAIM001*1500***11:B:1*Y*A*Y*Y~

Element	Position	Description	Example
Claim ID	01	Submitter's claim identifier	CLAIM001
Total Charge	02	Total billed amount	1500
Facility Code	05	Place of service (05-1 = 11 = Office)	11:B:1
Provider Signature	06	Signature on file indicator	Y
Assignment	07	Accept assignment code	A
Benefits Assignment	08	Benefits assigned indicator	Y
Release of Info	09	Information release signed	Y

SV1 — Professional Service Line

Each procedure on the claim:

SV1*HC:99213:25*125*UN*1***1~

Element	Position	Description	Example
Procedure Code	01	Composite: qualifier:CPT:modifiers	HC:99213:25
Charge Amount	02	Line item charge	125
Unit Type	03	UN=Units, MJ=Minutes	UN
Quantity	04	Number of units	1
Diagnosis Pointer	07	Links to HI segment (1,2,3,4)	1

HI — Diagnosis Codes

ICD-10 diagnosis codes:

HI*ABK:J0690*ABF:E119~

Element	Position	Description
Principal Diagnosis	01	ABK = ICD-10 Principal, value after colon
Additional Diagnoses	02+	ABF = ICD-10 Other

HL — Hierarchical Level

Organizes the claim structure:

HL*1**20*1~     (Billing Provider, has children)
HL*2*1*22*1~   (Subscriber, parent=1, has children)
HL*3*2*23*0~   (Patient, parent=2, no children)

Element	Position	Description
ID	01	Unique ID within transaction
Parent ID	02	ID of parent HL (empty for top level)
Level Code	03	20=Provider, 22=Subscriber, 23=Patient
Has Children	04	1=yes, 0=no

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EDI Paisan Features

Viewing

• Claim tree navigation — Expand/collapse by provider, subscriber, patient, claim
• Claim summary panel — Total claims, charges, service lines at a glance
• Segment inspector — Click any segment to see element descriptions
• Search — Find claims by ID, patient name, diagnosis code, or procedure

Splitting (Pro)

Split Mode	What It Does
By Claim	One file per CLM segment with proper envelopes
By Subscriber	All claims for one subscriber in a file
By Rendering Provider	Group by who performed the service (NM1*82)
By Transaction	One file per ST...SE envelope
In Half	Divide claims evenly into two files
Into N Parts	Divide claims evenly into N files

Each split file includes:

• Correct ISA/IEA envelope with new control numbers
• Correct GS/GE envelope with new control numbers
• Proper ST/SE with accurate segment counts
• All required header segments (BHT, submitter, receiver, billing provider)
• Subscriber/patient hierarchy for each claim

Anonymization

Strip patient identifiers in the viewer for Free; download the cleaned file with Pro.

Masks PHI while preserving file structure:

Data Type	Masking Method
Names	First character preserved: "SMITH" → "S****"
Addresses	First character preserved
DOB	Year only: "19850315" → "1985XXXX"
Member IDs	Consistent replacement (same ID = same mask)
SSN	Full mask: "*********"
Phone Numbers	Preserve area code: "555-123-4567" → "555-XXX-XXXX"
ZIP Codes	HIPAA Safe Harbor: preserve first 3 digits

Anonymization only affects patient/subscriber data, not provider information.

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Common Issues

Missing Required Segments

EDI Paisan validates and warns about:

• Missing CLM segment in claim loop
• Missing subscriber/patient NM1 segments
• Missing payer NM1 segment
• Missing HI (diagnosis) segment

Control Number Mismatches

When splitting, EDI Paisan automatically:

• Generates new ISA13/IEA02 control numbers
• Generates new GS06/GE02 control numbers
• Updates ST02/SE02 transaction control numbers
• Recalculates SE01 segment counts

Hierarchy Issues

If HL segments have incorrect parent references, EDI Paisan will:

• Display warnings in the validation panel
• Still render the file with best-effort hierarchy

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Example 837P Structure

ISA*00*          *00*          *ZZ*SENDER         *ZZ*RECEIVER       *240115*1200*^*00501*000000001*0*P*:~
GS*HC*SENDER*RECEIVER*20240115*1200*1*X*005010X222A1~
ST*837*0001*005010X222A1~
BHT*0019*00*BATCH001*20240115*1200*CH~
NM1*41*2*ACME BILLING SERVICE*****46*123456789~
PER*IC*JOHN SMITH*TE*5551234567~
NM1*40*2*BLUE CROSS*****46*987654321~
HL*1**20*1~
NM1*85*2*ABC MEDICAL GROUP*****XX*1234567890~
N3*100 MAIN STREET~
N4*ANYTOWN*NY*12345~
REF*EI*111111111~
HL*2*1*22*0~
SBR*P*18*GROUP001******CI~
NM1*IL*1*SMITH*JOHN****MI*MEM123456~
N3*200 OAK AVENUE~
N4*SOMEWHERE*NY*12346~
DMG*D8*19850315*M~
NM1*PR*2*BLUE CROSS*****PI*BCBS~
CLM*CLAIM001*250***11:B:1*Y*A*Y*Y~
DTP*472*D8*20240110~
HI*ABK:J0690~
NM1*82*1*JONES*MARY****XX*9876543210~
LX*1~
SV1*HC:99213*125*UN*1***1~
DTP*472*D8*20240110~
LX*2~
SV1*HC:85025*125*UN*1***1~
DTP*472*D8*20240110~
SE*28*0001~
GE*1*1~
IEA*1*000000001~

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Related Documentation

• 999 Troubleshooting — Diagnose and fix rejected claims
• Claim Splitting Guide — Step-by-step splitting instructions
• PHI Anonymization — Detailed anonymization options
• Segment Reference — All segment types