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 2010BC Responsible Party Address SN4 2010BC Responsible Party City/State/ZIPCodeNM1 2010BD Credit/Debit Card Holder Name XN2 2010BD Additional Credit/Debit Card HolderName InformationSX – deleted peraddendaREF 2010BD Credit/Debit Card Information XHL 2000C Patient Hierarchical Level XPAT 2000C Patient Information XNM1 2010CA Patient Name XN2 2010CA Additional Patient Name Information X – deleted peraddendaN3 2010CA Patient Address XN4 2010CA Patient City/State/ZIP Code XDMG 2010CA Patient Demographic Information XREF 2010CA Patient Secondary Information XNumberREF 2010CA Property and Casualty Claim XNumberCLM 2300 Claim Information RDTP 2300 Date – Order Date X – deleted peraddendaDTP 2300 Date – Initial Treatment SDTP 2300 Date – Referral Date X – deleted peraddendaDTP 2300 Date – Date Last Seen SDTP 2300 Date – Onset of CurrentSIllness/Symptom24