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

SegmentIDTable 3.1 – Segment Usage – 837 ProfessionalLoop ID Segment Name IHCP UsageR – RequiredS – SituationalX – Not UsedDTP 2300 Date – Acute Manifestation SDTP 2300 Date – Similar Illness/SymptomOnsetDTP 2300 Date – Accident SDTP 2300 Date – Last Menstrual Period SDTP 2300 Date – Last X-Ray SDTP 2300 Date – Estimated Date of Birth X – deleted peraddendaDTP 2300 Date – Hearing and VisionPrescription DateDTP 2300 Date – Disability Begin SDTP 2300 Date – Disability End SDTP 2300 Date – Date Last Worked XDTP 2300 Date – Authorized Return to Work SDTP 2300 Date – Admission SDTP 2300 Date – Date Discharge SDTP 2300 Date – Assumed and RelinquishedCare DatesPWK 2300 Claim Supplemental Information XCN1 2300 Contract Information XAMT 2300 Credit/Debit Card Maximum Amount XAMT 2300 Patient Paid Amount SAMT 2300 Total Purchased Service Amount SREF 2300 Service Authorization ExceptionCodeREF 2300 Mandatory Medicare (Section 4081)Crossover Indicator25SXSXX