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 2400 Date – Service Date RDTP 2400 Date – Certification Revision Date XDTP 2400 Date – Referral Date X – deleted peraddendaDTP 2400 Date – Begin Therapy Date XDTP 2400 Date – Last Certification Date XDTP 2400 Date – Order Date X – deleted peraddendaDTP 2400 Date – Date Last Seen XDTP 2400 Date – Test XDTP 2400 Date – Oxygen Saturation/ArterialBlood Gas TestDTP 2400 Date – Shipped XDTP 2400 Date – Onset of CurrentSymptom/IllnessDTP 2400 Date – Last X-ray XDTP 2400 Date – Acute Manifestation XDTP 2400 Date – Initial Treatment XDTP 2400 Date – Similar Illness/SymptomOnsetQTY 2400 Anesthesia Modifying Units X – deleted peraddendaMEA 2400 Test Result SCN1 2400 Contract Information XREF 2400 Repriced Line Item ReferenceNumberREF 2400 Adjusted Repriced Line ItemReference Number31XSXXX