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

SegmentIDTable 3.1 – Segment Usage – 837 ProfessionalLoop ID Segment Name IHCP UsageR – RequiredS – SituationalX – Not UsedN3 2010AB Pay-To Provider Address SN4 2010AB Pay-To Provider City/State/ZIPCodeREF 2010AB Pay-To Provider SecondaryInformationHL 2000B Subscriber Hierarchical Level RSBR 2000B Subscriber Information RPAT 2000B Patient Information SNM1 2010BA Subscriber Name RN2 2010BA Additional Subscriber NameInformation23SSX – deleted peraddendaN3 2010BA Subscriber Address RN4 2010BA Subscriber City/State/ZIP Code RDMG 2010BA Subscriber DemographicRInformationREF 2010BA Subscriber Secondary Information XREF 2010BA Property and Casualty Claim XNumberNM1 2010BB Payer Name RN2 2010BB Additional Payer Name Information X – deleted peraddendaN3 2010BB Payer Address RN4 2010BB Payer City/State/ZIP Code RREF 2010BB Payer Secondary Information RNM1 2010BC Responsible Party Name SN2 2010BC Additional Responsible Party NameInformationX – deleted peraddenda