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

SegmentIDTable 3.1 – Segment Usage – 837 ProfessionalLoop ID Segment Name IHCP UsageR – RequiredS – SituationalX – Not UsedREF 2330E Other Payer Rendering ProviderSecondary IdentificationNM1 2330F Other Payer Purchased ServiceProviderREF 2330F Other Payer Purchased ServiceProvider IdentificationNM1 2330G Other Payer Service FacilityLocationREF 2330G Other Payer Service FacilityLocation IdentificationNM1 2330H Other Payer Supervising Provider XREF 2330H Other Payer Supervising ProviderIdentificationLX 2400 Service Line Number RSV1 2400 Professional Service RSV4 2400 Prescription Number X – deleted peraddendaSV5 2400 Durable Medical Equipment Service XPWK 2400 DMERC CMN Indicator XCR1 2400 Ambulance Transport Information SCR2 2400 Spinal Manipulation ServiceInformationCR3 2400 Durable Medical EquipmentCertificationCR5 2400 Home Oxygen Therapy Information XCRC 2400 Ambulance Certification SCRC 2400 Hospice Employee Indicator SCRC 2400 DMERC Condition Indicator X30XXXXXXSX