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

Segment NotesElement UsageIDGuideDescription/ValidValues68CommentsHI01 R Health Care CodeInformationHI01-01 R Diagnosis Type Code BK: principle diagnosisHI01-02 R Diagnosis CodeHI01-03 N/A Date Time PeriodFormat QualifierNot UsedHI01-04 N/A Date Time Period Not UsedHI01-05 N/A Monetary Amount Not UsedHI01-06 N/A Quantity Not UsedHI01-07 N/A Version Identifier Not UsedHI02 S Health Care CodeInformationHI02-01 R Diagnosis Type Code BF: DiagnosisICD-9 CodesHI02-02 R Diagnosis CodeHI02-03 N/A Date Time PeriodFormat QualifierNot UsedHI02-04 N/A Date Time Period Not UsedHI02-05 N/A Monetary Amount Not UsedHI02-06 N/A Quantity Not UsedHI02-07 N/A Version Identifier Not UsedHI03 S Health Care CodeInformationHI03-01 R Diagnosis Type Code BF: DiagnosisICD-9 CodesHI03-02 R Diagnosis CodeHI03-03 R Date Time PeriodFormat QualifierHI03-04 N/A Date Time Period Not UsedHI03-05 N/A Monetary Amount Not UsedHI03-06 N/A Quantity Not UsedHI03-07 N/A Version Identifier Not UsedHI04 S Health Care CodeInformationHI04-01 R Diagnosis Type Code BF: DiagnosisICD-9 Codes