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

SegmentIDTable 3.1 – Segment Usage – 837 ProfessionalLoop ID Segment Name IHCP UsageR – RequiredS – SituationalX – Not UsedN2 2420A Additional Rendering Provider NameInformationREF 2420A Rendering Provider SecondaryInformationNM1 2420B Purchased Service Provider Name XREF 2420B Purchased Service Provider XSecondary InformationNM1 2420C Service Facility Location XN2 2420C Additional Service Facility LocationName InformationN3 2420C Service Facility Location Address XN4 2420C Service Facility LocationXCity/State/ZIP CodeREF 2420C Service Facility Location Secondary XInformationNM1 2420D Supervising Provider Name SN2 2420D Additional Supervising ProviderName InformationREF 2420D Supervising Provider SecondaryInformationNM1 2420E Ordering Provider Name SN2 2420E Additional Ordering Provider NameInformationN3 2420E Ordering Provider Address SN4 2420E Ordering Provider City/State/ZIP SCodeREF 2420E Ordering Provider SecondaryIdentificationX33X – deleted peraddendaSX – deleted peraddendaX – deleted peraddendaSX – deleted peraddenda