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 2400 Prior Authorization or ReferralNumberREF 2400 Line Item Control Number SREF 2400 Mammography Certification Number XREF 2400 Clinical Laboratory ImprovementAmendment (CLIA) InformationREF 2400 Referring Clinical Laboratory XImprovement Amendment (CLIA)Facility IdentificationREF 2400 Immunization Batch Number XREF 2400 Ambulatory Patient Group (APG) XREF 2400 Oxygen Flow Rate XREF 2400 Universal Product Number (UPN) XAMT 2400 Sales Tax Amount XAMT 2400 Approved Amount XAMT 2400 Postage Claimed Amount XK3 2400 File Information XNTE 2400 Line Note SPS1 2400 Purchased Service Information XHSD 2400 Health Care Services Delivery XHCP 2400 Line Pricing/Repricing Information XLIN 2410 Drug Identification XCTP 2410 Drug Pricing XREF 2410 Prescription Number XNM1 2420A Rendering Provider Name SPRV 2420A Rendering Provider SpecialtyInformationS32XX