837P Companion Guide - Peach State Health Plan Peach State ...

SECTION 04: PROFESSIONAL CLAIM SUBMISSIONSIntroductionThe ASC X12N 837 (004010X098A1) transaction is the HIPAA-mandated transaction forsubmitting PEACH STATE HEALTH PLAN medical claims to Covered Entities and BusinessAssociates.This is intended only as a companion guide and is not intended to contradict or replace anyinformation in the Implementation Guide or Health Plan Provider Manual’s.It is highly recommended that implementers have the following resources available during thedevelopment process:This document (837 Implementation Companion Document)ASC X12N 837 (004010X098A1) Implementation GuideSegment UsageThe following matrix lists all segments available to the submitted on the 4010 version of the 837Implementation Guide. Additionally, it includes a Usage column that identifies those segments,which are required, situational, or not used by PEACH STATE HEALTH PLAN. A requiredsegment and element will be reported on all transactions. A situational segment may not bereported on every transaction record; however, a situational segment may be reported undercertain circumstances. For example, any data in a segment that is identified in the Usagecolumn with an X will be ignored by PEACH STATE HEALTH PLAN. Any segment identified inthe Usage column as Required is explained in detail in the Data and Element DescriptionSection of the Companion Document.Reminders1. The maximum number of claims within a single ST/SE Transaction Set is 1,000. Therefore,multiple ST/SE Transaction Sets may exist within one transaction file. Multiple 837(ISA/IEA) Transactions may also exist within one file.2. Some element values may be defined as NULL. This means that there will not be a value inthis element (i.e. INS*Y*18*001**A*B**FT)21