837 Health Care Claim: Institutional - Louisiana Medicaid
837 Health Care Claim: Institutional - Louisiana Medicaid
837 Health Care Claim: Institutional - Louisiana Medicaid
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06/30/2014 <strong>Health</strong> <strong>Care</strong> <strong>Claim</strong>: <strong>Institutional</strong> - <strong>837</strong>HLUser Option (Usage): RequiredElement Summary:Subscriber HierarchicalLevelPos: 0010 Max: 1Detail - MandatoryLoop: 2000B Elements: 4RefHL04Id736Element NameHierarchical Child CodeReqOTypeIDMin/Max1/1LA <strong>Medicaid</strong>: Use the value 0 for this element.For <strong>Medicaid</strong> purposes, the subscriber will always equal thepatient. Therefore, an additional subordinate HL segment willnot be required.SBRSubscriber InformationPos: 0050 Max: 1Detail - OptionalLoop: 2000B Elements: 6User Option (Usage): RequiredElement Summary:Ref Id Element Name Req Type Min/MaxSBR09 1032 <strong>Claim</strong> Filing Indicator Code O ID 1/2LA <strong>Medicaid</strong>: Use the value MC for this elementNM1Subscriber NamePos: 0150 Max: 1Detail - OptionalLoop: 2010BA Elements: 8User Option (Usage): RequiredElement Summary:RefNM102Id1065Element NameEntity Type QualifierReqMTypeIDMin/Max1/1NM108 66NM109 67LA <strong>Medicaid</strong>: Use the value 1 for this elementIdentification Code Qualifier X ID 1/2LA <strong>Medicaid</strong>: Use the value MI for this elementIdentification Code X AN 2/80LA <strong>Medicaid</strong>: Use the thirteen digit <strong>Medicaid</strong> Recipient IDnumber for this element6
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