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TABLE 4 - 837 PROFESSIONAL HEALTH CARE CLAIM (CONTINUED) LOOP ID REFERENCE NAME CODES NOTES/COMMENTS 2300 NTE Claim Note NTE01 Note Reference Code ADD NTE02 Claim Note Text See Section 11.0 for the use and message requirements of proxy data information 2310E N3 Ambulance Pick-Up Location Address N301 Ambulance Pick-Up Location Address Line Provide the address line for the Rendering Provider if the true ambulance pick-up address line is not available 2310E N4 Ambulance Pick-Up Location City, State, and ZIP Code N401 Ambulance Pick-Up City Name Provide the address line for the Billing Provider if the Rendering Provider is the same as the Billing Provider and the true ambulance pick-up address line is not unavailable Provide the city name for the Rendering Provider if the true ambulance pick-up city name is not available Provide the city name for the Billing Provider if the Rendering Provider is the same as the Billing Provider and the true ambulance pick-up city name is not unavailable 837 Professional Companion Guide Version 12.0/November 2012 16
TABLE 4 - 837 PROFESSIONAL HEALTH CARE CLAIM (CONTINUED) LOOP ID REFERENCE NAME CODES NOTES/COMMENTS 2310E N402 Ambulance Pick-Up State Name Provide the state name for the Rendering Provider if the true ambulance pick-up state name is not available N403 Ambulance Pick-Up Zip Code Provide the state name for the Billing Provider if the Rendering Provider is the same as the Billing Provider and the true ambulance pick-up state name is not unavailable Provide the ZIP code for the Rendering Provider if the true ambulance pick-up ZIP code is not available 2310F N3 Ambulance Drop-Off Location Address N301 Ambulance Drop-Off Location Address Line Provide the ZIP code for the Billing Provider if the Rendering Provider is the same as the Billing Provider and the true ambulance pick-up ZIP code is not unavailable Provide the address line for the Rendering Provider if the true ambulance drop-off address line is not available Provide the address line for the Billing Provider if the Rendering Provider is the same as the Billing Provider and the true ambulance drop-off address line is not unavailable 837 Professional Companion Guide Version 12.0/November 2012 17
Page 1 and 2: ___________________________________
Page 3 and 4: Table of Contents 1.0 Introduction
Page 5 and 6: 1.0 Introduction 1.1 Scope The CMS
Page 7 and 8: The effective date of the spreadshe
Page 9 and 10: specifically for encounter data pur
Page 11 and 12: TABLE 2 - GS/GE FUNCTIONAL GROUP EL
Page 13 and 14: TABLE 4 - 837 PROFESSIONAL HEALTH C
Page 15: TABLE 4 - 837 PROFESSIONAL HEALTH C
Page 19 and 20: TABLE 4 - 837 PROFESSIONAL HEALTH C
Page 21 and 22: specific error. If a fatal error oc
Page 23 and 24: The MAO-002 report is a fixed lengt
Page 25 and 26: Table 9 below provides the producti
Page 27 and 28: TABLE 10 - EDFES NOTIFICATIONS (CON
Page 29 and 30: TABLE 11 - 837P PROFESSIONAL PERMAN
Page 31 and 32: 9.1 Standard Professional Encounter
Page 33 and 34: 9.2 Capitated Professional Encounte
Page 35 and 36: 9.3 Chart Review Professional Encou
Page 37 and 38: 9.4 Chart Review Professional Encou
Page 39 and 40: 9.5 Complete Replacement Profession
Page 41 and 42: 9. 6 Deletion Professional Encounte
Page 43 and 44: 9. 7 Atypical Provider Professional
Page 45 and 46: 9.8 Paper Generated Professional En
Page 47 and 48: 9.9 True Coordination of Benefits P
Page 49 and 50: 9.10 Bundled Professional Encounter
Page 51 and 52: 10.0 Encounter Data Professional Pr
Page 53 and 54: 10.1 EDPPPS Edits Enhancements Impl
Page 55 and 56: TABLE 14 - EDPPPS EDITS PREVENTION
Page 57 and 58: TABLE 15 - EDPS EDITS PREVENTION AN
Page 59 and 60: TABLE 15 - EDPS EDITS PREVENTION AN
Page 61 and 62: TABLE 17 - EDS ACRONYMS (CONTINUED)
Page 63: REVISION HISTORY VERSION DATE DESCR

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