none
HIPPA EDI 837P Sample/Test messages

    Question

  • Hey All,

    I am currently building a POC for one of the client for HIPPA 4010 837P processing. Can any one please guide me on how to get a valid test messages. I tried generating the messages from schema in visual studio but this fails in EDIReceive pipeline.

    Thanks,
    Pradeep

    Monday, June 15, 2009 8:08 AM

Answers

  • Hi,
         I generated the following file and it is passing:

    ISA*00*          *00*          *ZZ*7654321        *ZZ*1234567        *991221*1226*U*00200*000000065*0*T*:~
    GS*PO*01*1234567*19991221*1226*122*X*004010X098A1~
    ST*837*ST02~
    BHT*0019*00*BHT03__OriginatorApplicationTr*01230123*01234567*CH~
    REF*87*REF02__TransmissionTypeCode~
    NM1*41*1*NM103__SubmitterLastOrOrganizationN*****46*NM109__SubmitterIdentifier*NM*NM1~
    PER*IC*PER02__SubmitterContactName*ED*PER04__CommunicationNumber*ED*PER06__CommunicationNumber*ED*PER08__CommunicationNumber~
    NM1*40*2*NM103__ReceiverName*****46*NM109__ReceiverPrimaryIdentifier*NM*NM1~
    HL*HL01__Hierar**20*1~
    PRV*BI*ZZ*PRV03__ProviderTaxonomyCode~
    CUR*85*CUR*****CUR*01230123*01234567*CUR*01230123*01234567*CUR*01230123*01234567*CUR*01230123*01234567*CUR*01230123*01234567~
    NM1*85*1*NM103__BillingProviderLastOrOrganiz*****24*NM109__BillingProviderIdentifier*NM*NM1~
    N3*N301__BillingProviderAddressLine~
    N4*N401__BillingProviderCityName*N4*N403__BillingPr**N4*N406~
    REF*0B*REF02__BillingProviderAddition~
    REF*06*REF02__BillingProviderCreditCa~
    PER*IC*PER02__BillingProviderContactName*EM*PER04__CommunicationNumber*EM*PER06__CommunicationNumber*EM*PER08__CommunicationNumber~
    NM1*87*1*NM103__PaytoProviderLastOrOrganizat*****24*NM109__PaytoProviderIdentifier*NM*NM1~
    N3*N301__PaytoProviderAddressLine~
    N4*N401__PaytoProviderCityName*N4*N403__PaytoProv**N4*N406~
    REF*0B*REF02__PaytoProviderIdentifier~
    HL*HL01__Hierar*HL02__Hierar*22*0~
    SBR*P~
    PAT*****D8*PAT06__InsuredIndividualDeathDate*01*891~
    NM1*IL*1*NM103__SubscriberLastName*****MI*NM109__SubscriberPrimaryIdentifier*NM*NM1~
    N3*N301__SubscriberAddressLine~
    N4*N401__SubscriberCityName*N4*N403__Subscribe**N4*N406~
    DMG*D8*DMG02__SubscriberBirthDate*F~
    REF*1W*REF02__SubscriberSupplementalI~
    REF*Y4*REF02__PropertyCasualtyClaimNu~
    NM1*PR*2*NM103__PayerName*****PI*NM109__PayerIdentifier*NM*NM1~
    N3*N301__PayerAddressLine~
    N4*N401__PayerCityName*N4*N403__PayerPost**N4*N406~
    REF*2U*REF02__PayerAdditionalIdentifi~
    NM1*QD*1*NM103__ResponsiblePartyLastOrOrgani*****NM*NM109*NM*NM1~
    N3*N301__ResponsiblePartyAddressLine~
    N4*N401__ResponsiblePartyCityName*N4*N403__Responsib**N4*N406~
    NM1*AO*1*NM103__CreditOrDebitCardHolderLastO*****MI*NM109__CreditOrDebitCardNumber*NM*NM1~
    REF*AB*REF02__CreditOrDebitCardAuthor~
    CLM*CLM01__PatientAccountNumber*892***CL::C*N*A*N*A**AA~
    DTP*454*D8*DTP03__InitialTreatmentDate~
    DTP*304*D8*DTP03__LastSeenDate~
    DTP*431*D8*DTP03__OnsetOfCurrentIllnessOrInjur~
    DTP*453*D8*DTP03__AcuteManifestationDate~
    DTP*438*D8*DTP03__SimilarIllnessOrSymptomDate~
    DTP*439*D8*DTP03__AccidentDate~
    DTP*484*D8*DTP03__LastMenstrualPeriodDate~
    DTP*455*D8*DTP03__LastXRayDate~
    DTP*471*D8*DTP03__PrescriptionDate~
    DTP*360*D8*DTP03__DisabilityFromDate~
    DTP*361*D8*DTP03__DisabilityToDate~
    DTP*297*D8*DTP03__LastWorkedDate~
    DTP*296*D8*DTP03__WorkReturnDate~
    DTP*435*D8*DTP03__RelatedHospitalizationAdmiss~
    DTP*096*D8*DTP03__RelatedHospitalizationDischa~
    DTP*090*D8*DTP03__AssumedOrRelinquishedCareDat~
    PWK*77*AA***AC*PWK06__AttachmentControlNumber~
    CN1*02~
    AMT*MA*893~
    AMT*F5*894~
    AMT*NE*895~
    REF*4N*REF02__ServiceAuthorizationExc~
    REF*F5*REF02__MedicareSection4081Indi~
    REF*EW*REF02__MammographyCertificatio~
    REF*9F*REF02__PriorAuthorizationOrRef~
    REF*F8*REF02__ClaimOriginalReferenceN~
    REF*X4*REF02__ClinicalLaboratoryImpro~
    REF*9A*REF02__RepricedClaimReferenceN~
    REF*9C*REF02__AdjustedRepricedClaimRe~
    REF*LX*REF02__InvestigationalDeviceEx~
    REF*D9*REF02__ClearinghouseTraceNumbe~
    REF*1S*REF02__AmbulatoryPatientGroupN~
    REF*EA*REF02__MedicalRecordNumber~
    REF*P4*REF02__DemonstrationProjectIde~
    K3*K301__FixedFormatInformation~
    NTE*ADD*NTE02__ClaimNoteText~
    CR1*LB*896*I*A*DH*897~
    CR2*898*899*CR2*CR2*CR*900**A~
    CRC*07*N*01~
    CRC*E1*N*L1~
    CRC*75*Y*IH~
    CRC*ZZ*N*AV~
    HI*BK:HI01_C02202U864_DiagnosisCode*BF:HI02_C02202U872_DiagnosisCode*BF:HI03_C02202U880_DiagnosisCode*BF:HI04_C02202U888_DiagnosisCode*BF:HI05_C02202U896_DiagnosisCode*BF:HI06_C02202U904_DiagnosisCode*BF:HI07_C02202U912_DiagnosisCode*BF:HI08_C02202U920_DiagnosisCode~
    HCP*00*901*******HC*HCP10*HC*902~
    CR7*AI*903*904~
    HSD*VS*905***35*906~
    NM1*DN*1*NM103__ReferringProviderLastName*****24*NM109__ReferringProviderIdentifier*NM*NM1~
    PRV*RF*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__ReferringProviderSecond~
    NM1*82*1*NM103__RenderingProviderLastOrOrgan*****24*NM109__RenderingProviderIdentifier*NM*NM1~
    PRV*PE*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__RenderingProviderSecond~
    NM1*QB*1*NM103__PurchasedServiceProviderLast*****24*NM109__PurchasedServiceProviderIdentifier*NM*NM1~
    REF*0B*REF02__PurchasedServiceProvide~
    NM1*77*2******24*NM109__LaboratoryOrFacilityPrimaryIdentifier*NM*NM1~
    N3*N301__LaboratoryOrFacilityAddressLine~
    N4*N401__LaboratoryOrFacilityCity*N4*N403__Laborator**N4*N406~
    REF*0B*REF02__LaboratoryOrFacilitySec~
    NM1*DQ*1*NM103__SupervisingProviderLastName*NM104__SupervisingProvide****24*NM109__SupervisingProviderIdentifier*NM*NM1~
    REF*0B*REF02__SupervisingProviderSeco~
    SBR*P*01***AP~
    CAS*CO*CAS02*907**CAS05*908*909*CAS08*910*911*CAS11*912*913*CAS14*914*915*CAS17*916*917~
    AMT*D*918~
    AMT*AAE*919~
    AMT*B6*920~
    AMT*F2*921~
    AMT*AU*922~
    AMT*D8*923~
    AMT*DY*924~
    AMT*F5*925~
    AMT*T*926~
    AMT*T2*927~
    DMG*D8*DMG02__OtherInsuredBirthDate*F~
    OI***N***A~
    MOA*928~
    NM1*IL*1*NM103__OtherInsuredLastName*****MI*NM109__OtherInsuredIdentifier*NM*NM1~
    N3*N301__OtherInsuredAddressLine~
    N4*****N4*N406~
    REF*1W*REF02__OtherInsuredAdditionalI~
    NM1*PR*2*NM103__OtherPayerLastOrOrganization*****PI*NM109__OtherPayerPrimaryIdentifier*NM*NM1~
    PER*IC*PER02__OtherPayerContactName*ED*PER04__CommunicationNumber*ED*PER06__CommunicationNumber*ED*PER08__CommunicationNumber~
    DTP*573*D8*DTP03__AdjudicationOrPaymentDate~
    REF*2U*REF02__OtherPayerSecondaryIden~
    REF*9F*REF02__OtherPayerPriorAuthoriz~
    REF*T4*REF02__OtherPayerClaimAdjustme~
    NM1*QC*1******MI*NM109__OtherPayerPatientPrimaryIdentifier*NM*NM1~
    REF*1W*REF02__OtherPayerPatientSecond~
    NM1*DN*1******NM*NM109*NM*NM1~
    REF*1B*REF02__OtherPayerReferringProv~
    NM1*82*1******NM*NM109*NM*NM1~
    REF*1B*REF02__OtherPayerRenderingProv~
    NM1*QB*1******NM*NM109*NM*NM1~
    REF*1A*REF02__OtherPayerPurchasedServ~
    NM1*77*2******NM*NM109*NM*NM1~
    REF*1A*REF02__OtherPayerServiceFacili~
    NM1*DQ*1******NM*NM109*NM*NM1~
    REF*1B*REF02__OtherPayerSupervisingPr~
    LX*929~
    SV1*HC:SV101_C00302U949_ProcedureCode*930*F2*931***932~
    SV5*HC:SV501_C00302U5969_ProcedureCode*DA*933*934**1~
    PWK*CT*AB***PW*PWK06~
    CR1*LB*935*I*A*DH*936~
    CR2*937*938*CR2*CR2*CR*939**A~
    CR3*I*MO*940~
    CR5*I*941**********E~
    CRC*07*N*01~
    CRC*70*N*65~
    CRC*09*N*37~
    DTP*472*D8*DTP03__ServiceDate~
    DTP*607*D8*DTP03__CertificationRevisionDate~
    DTP*463*D8*DTP03__BeginTherapyDate~
    DTP*461*D8*DTP03__LastCertificationDate~
    DTP*304*D8*DTP03__LastSeenDate~
    DTP*738*D8*DTP03__TestPerformedDate~
    DTP*119*D8*DTP03__OxygenSaturationTestDate~
    DTP*011*D8*DTP03__ShippedDate~
    DTP*431*D8*DTP03__OnsetDate~
    DTP*455*D8*DTP03__LastXRayDate~
    DTP*453*D8*DTP03__AcuteManifestationDate~
    DTP*454*D8*DTP03__InitialTreatmentDate~
    DTP*438*D8*DTP03__SimilarIllnessOrSymptomDate~
    MEA*OG*GRA*942*M*943*944*ME~
    CN1*01~
    REF*9B*REF02__RepricedLineItemReferen~
    REF*9D*REF02__AdjustedRepricedLineIte~
    REF*9F*REF02__PriorAuthorizationOrRef~
    REF*6R*REF02__LineItemControlNumber~
    REF*EW*REF02__MammographyCertificatio~
    REF*X4*REF02__ClinicalLaboratoryImpro~
    REF*F4*REF02__ReferringCLIANumber~
    REF*BT*REF02__ImmunizationBatchNumber~
    REF*1S*REF02__AmbulatoryPatientGroupN~
    REF*TP*REF02__OxygenFlowRate~
    REF*OZ*REF02__UniversalProductNumber~
    AMT*T*945~
    AMT*AAE*946~
    AMT*F4*947~
    K3*K301__FixedFormatInformation~
    NTE*ADD*NTE02__LineNoteText~
    PS1*PS101__PurchasedServiceProvide*948~
    HSD*VS*949***34*950~
    HCP*00*951*******HC*HCP10__ProcedureCode*DA*952~
    LIN**N4*LIN03__NationalDrugCode*LI*LIN05*LI*LIN07*LI*LIN09*LI*LIN11*LI*LIN13*LI*LIN15*LI*LIN17*LI*LIN19*LI*LIN21*LI*LIN23*LI*LIN25*LI*LIN27*LI*LIN29*LI*LIN31~
    CTP**CTP*953*954*F2*CTP*955**CT*CTP10*956~
    REF*XZ*REF02__PrescriptionNumber~
    NM1*82*1*NM103__RenderingProviderLastOrOrgan*****24*NM109__RenderingProviderIdentifier*NM*NM1~
    PRV*PE*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__RenderingProviderSecond~
    NM1*QB*1******24*NM109__PurchasedServiceProviderIdentifier*NM*NM1~
    REF*0B*REF02__PurchasedServiceProvide~
    NM1*77*2******24*NM109__LaboratoryOrFacilityPrimaryIdentifier*NM*NM1~
    N3*N301__LaboratoryOrFacilityAddressLine~
    N4*N401__LaboratoryOrFacilityCity*N4*N403__Laborator**N4*N406~
    REF*0B*REF02__ServiceFacilityLocation~
    NM1*DQ*1*NM103__SupervisingProviderLastName*NM104__SupervisingProvide****24*NM109__SupervisingProviderIdentifier*NM*NM1~
    REF*0B*REF02__SupervisingProviderSeco~
    NM1*DK*1*NM103__OrderingProviderLastName*NM104__OrderingProviderFi****24*NM109__OrderingProviderIdentifier*NM*NM1~
    N3*N301__OrderingProviderAddressLine~
    N4*N401__OrderingProviderCityName*N4*N403__OrderingP**N4*N406~
    REF*0B*REF02__OrderingProviderSeconda~
    PER*IC*PER02__OrderingProviderContactName*EM*PER04__CommunicationNumber*EM*PER06__CommunicationNumber*EM*PER08__CommunicationNumber~
    NM1*DN*1*NM103__ReferringProviderLastName*NM104__ReferringProviderF****24*NM109__ReferringProviderIdentifier*NM*NM1~
    PRV*RF*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__ReferringProviderSecond~
    NM1*PR*2*NM103__PayerName*****PI*NM109__OtherPayerIdentificationNumber*NM*NM1~
    REF*9F*REF02__OtherPayerPriorAuthoriz~
    SVD*SVD01__OtherPayerPrimaryIdentifier*957*HC:SVD03_C00302U987_ProcedureCode**958~
    CAS*CO*CAS02*959**CAS05*960*961*CAS08*962*963*CAS11*964*965*CAS14*966*967*CAS17*968*969~
    DTP*573*D8*DTP03__AdjudicationOrPaymentDate~
    LQ*AS*LQ02__FormIdentifier~
    FRM*FRM01__QuestionNumbe*N~
    HL*HL01__Hierar*HL02__Hierar*23*0~
    PAT*01****D8*PAT06__PatientDeathDate*01*970~
    NM1*QC*1*NM103__PatientLastName*NM104__PatientFirstName****MI*NM109__PatientPrimaryIdentifier*NM*NM1~
    N3*N301__PatientAddressLine~
    N4*N401__PatientCityName*N4*N403__PatientPo**N4*N406~
    DMG*D8*DMG02__PatientBirthDate*F~
    REF*1W*REF02__PatientSecondaryIdentif~
    REF*Y4*REF02__PropertyCasualtyClaimNu~
    CLM*CLM01__PatientAccountNumber*971***CL::C*N*A*N*A**AA~
    DTP*454*D8*DTP03__InitialTreatmentDate~
    DTP*304*D8*DTP03__LastSeenDate~
    DTP*431*D8*DTP03__OnsetOfCurrentIllnessOrInjur~
    DTP*453*D8*DTP03__AcuteManifestationDate~
    DTP*438*D8*DTP03__SimilarIllnessOrSymptomDate~
    DTP*439*D8*DTP03__AccidentDate~
    DTP*484*D8*DTP03__LastMenstrualPeriodDate~
    DTP*455*D8*DTP03__LastXRayDate~
    DTP*471*D8*DTP03__PrescriptionDate~
    DTP*360*D8*DTP03__DisabilityFromDate~
    DTP*361*D8*DTP03__DisabilityToDate~
    DTP*297*D8*DTP03__LastWorkedDate~
    DTP*296*D8*DTP03__WorkReturnDate~
    DTP*435*D8*DTP03__RelatedHospitalizationAdmiss~
    DTP*096*D8*DTP03__RelatedHospitalizationDischa~
    DTP*090*D8*DTP03__AssumedOrRelinquishedCareDat~
    PWK*77*AA***AC*PWK06__AttachmentControlNumber~
    CN1*02~
    AMT*MA*972~
    AMT*F5*973~
    AMT*NE*974~
    REF*4N*REF02__ServiceAuthorizationExc~
    REF*F5*REF02__MedicareSection4081Indi~
    REF*EW*REF02__MammographyCertificatio~
    REF*9F*REF02__PriorAuthorizationOrRef~
    REF*F8*REF02__ClaimOriginalReferenceN~
    REF*X4*REF02__ClinicalLaboratoryImpro~
    REF*9A*REF02__RepricedClaimReferenceN~
    REF*9C*REF02__AdjustedRepricedClaimRe~
    REF*LX*REF02__InvestigationalDeviceEx~
    REF*D9*REF02__ClearinghouseTraceNumbe~
    REF*1S*REF02__AmbulatoryPatientGroupN~
    REF*EA*REF02__MedicalRecordNumber~
    REF*P4*REF02__DemonstrationProjectIde~
    K3*K301__FixedFormatInformation~
    NTE*ADD*NTE02__ClaimNoteText~
    CR1*LB*975*I*A*DH*976~
    CR2*977*978*CR2*CR2*CR*979**A~
    CRC*07*N*01~
    CRC*E1*N*L1~
    CRC*75*Y*IH~
    CRC*ZZ*N*AV~
    HI*BK:HI01_C02202U864_DiagnosisCode*BF:HI02_C02202U872_DiagnosisCode*BF:HI03_C02202U880_DiagnosisCode*BF:HI04_C02202U888_DiagnosisCode*BF:HI05_C02202U896_DiagnosisCode*BF:HI06_C02202U904_DiagnosisCode*BF:HI07_C02202U912_DiagnosisCode*BF:HI08_C02202U920_DiagnosisCode~
    HCP*00*980*******HC*HCP10*HC*981~
    CR7*AI*982*983~
    HSD*VS*984***35*985~
    NM1*DN*1*NM103__ReferringProviderLastName*****24*NM109__ReferringProviderIdentifier*NM*NM1~
    PRV*RF*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__ReferringProviderSecond~
    NM1*82*1*NM103__RenderingProviderLastOrOrgan*****24*NM109__RenderingProviderIdentifier*NM*NM1~
    PRV*PE*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__RenderingProviderSecond~
    NM1*QB*1*NM103__PurchasedServiceProviderLast*****24*NM109__PurchasedServiceProviderIdentifier*NM*NM1~
    REF*0B*REF02__PurchasedServiceProvide~
    NM1*77*2******24*NM109__LaboratoryOrFacilityPrimaryIdentifier*NM*NM1~
    N3*N301__LaboratoryOrFacilityAddressLine~
    N4*N401__LaboratoryOrFacilityCity*N4*N403__Laborator**N4*N406~
    REF*0B*REF02__LaboratoryOrFacilitySec~
    NM1*DQ*1*NM103__SupervisingProviderLastName*NM104__SupervisingProvide****24*NM109__SupervisingProviderIdentifier*NM*NM1~
    REF*0B*REF02__SupervisingProviderSeco~
    SBR*P*01***AP~
    CAS*CO*CAS02*986**CAS05*987*988*CAS08*989*990*CAS11*991*992*CAS14*993*994*CAS17*995*996~
    AMT*D*997~
    AMT*AAE*998~
    AMT*B6*999~
    AMT*F2*1000~
    AMT*AU*1001~
    AMT*D8*1002~
    AMT*DY*1003~
    AMT*F5*1004~
    AMT*T*1005~
    AMT*T2*1006~
    DMG*D8*DMG02__OtherInsuredBirthDate*F~
    OI***N***A~
    MOA*1007~
    NM1*IL*1*NM103__OtherInsuredLastName*****MI*NM109__OtherInsuredIdentifier*NM*NM1~
    N3*N301__OtherInsuredAddressLine~
    N4*****N4*N406~
    REF*1W*REF02__OtherInsuredAdditionalI~
    NM1*PR*2*NM103__OtherPayerLastOrOrganization*****PI*NM109__OtherPayerPrimaryIdentifier*NM*NM1~
    PER*IC*PER02__OtherPayerContactName*ED*PER04__CommunicationNumber*ED*PER06__CommunicationNumber*ED*PER08__CommunicationNumber~
    DTP*573*D8*DTP03__AdjudicationOrPaymentDate~
    REF*2U*REF02__OtherPayerSecondaryIden~
    REF*9F*REF02__OtherPayerPriorAuthoriz~
    REF*T4*REF02__OtherPayerClaimAdjustme~
    NM1*QC*1******MI*NM109__OtherPayerPatientPrimaryIdentifier*NM*NM1~
    REF*1W*REF02__OtherPayerPatientSecond~
    NM1*DN*1******NM*NM109*NM*NM1~
    REF*1B*REF02__OtherPayerReferringProv~
    NM1*82*1******NM*NM109*NM*NM1~
    REF*1B*REF02__OtherPayerRenderingProv~
    NM1*QB*1******NM*NM109*NM*NM1~
    REF*1A*REF02__OtherPayerPurchasedServ~
    NM1*77*2******NM*NM109*NM*NM1~
    REF*1A*REF02__OtherPayerServiceFacili~
    NM1*DQ*1******NM*NM109*NM*NM1~
    REF*1B*REF02__OtherPayerSupervisingPr~
    LX*1008~
    SV1*HC:SV101_C00302U949_ProcedureCode*1009*F2*1010***1011~
    SV5*HC:SV501_C00302U5969_ProcedureCode*DA*1012*1013**1~
    PWK*CT*AB***PW*PWK06~
    CR1*LB*1014*I*A*DH*1015~
    CR2*1016*1017*CR2*CR2*CR*1018**A~
    CR3*I*MO*1019~
    CR5*I*1020**********E~
    CRC*07*N*01~
    CRC*70*N*65~
    CRC*09*N*37~
    DTP*472*D8*DTP03__ServiceDate~
    DTP*607*D8*DTP03__CertificationRevisionDate~
    DTP*463*D8*DTP03__BeginTherapyDate~
    DTP*461*D8*DTP03__LastCertificationDate~
    DTP*304*D8*DTP03__LastSeenDate~
    DTP*738*D8*DTP03__TestPerformedDate~
    DTP*119*D8*DTP03__OxygenSaturationTestDate~
    DTP*011*D8*DTP03__ShippedDate~
    DTP*431*D8*DTP03__OnsetDate~
    DTP*455*D8*DTP03__LastXRayDate~
    DTP*453*D8*DTP03__AcuteManifestationDate~
    DTP*454*D8*DTP03__InitialTreatmentDate~
    DTP*438*D8*DTP03__SimilarIllnessOrSymptomDate~
    MEA*OG*GRA*1021*M*1022*1023*ME~
    CN1*01~
    REF*9B*REF02__RepricedLineItemReferen~
    REF*9D*REF02__AdjustedRepricedLineIte~
    REF*9F*REF02__PriorAuthorizationOrRef~
    REF*6R*REF02__LineItemControlNumber~
    REF*EW*REF02__MammographyCertificatio~
    REF*X4*REF02__ClinicalLaboratoryImpro~
    REF*F4*REF02__ReferringCLIANumber~
    REF*BT*REF02__ImmunizationBatchNumber~
    REF*1S*REF02__AmbulatoryPatientGroupN~
    REF*TP*REF02__OxygenFlowRate~
    REF*OZ*REF02__UniversalProductNumber~
    AMT*T*1024~
    AMT*AAE*1025~
    AMT*F4*1026~
    K3*K301__FixedFormatInformation~
    NTE*ADD*NTE02__LineNoteText~
    PS1*PS101__PurchasedServiceProvide*1027~
    HSD*VS*1028***34*1029~
    HCP*00*1030*******HC*HCP10__ProcedureCode*DA*1031~
    LIN**N4*LIN03__NationalDrugCode*LI*LIN05*LI*LIN07*LI*LIN09*LI*LIN11*LI*LIN13*LI*LIN15*LI*LIN17*LI*LIN19*LI*LIN21*LI*LIN23*LI*LIN25*LI*LIN27*LI*LIN29*LI*LIN31~
    CTP**CTP*1032*1033*F2*CTP*1034**CT*CTP10*1035~
    REF*XZ*REF02__PrescriptionNumber~
    NM1*82*1*NM103__RenderingProviderLastOrOrgan*****24*NM109__RenderingProviderIdentifier*NM*NM1~
    PRV*PE*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__RenderingProviderSecond~
    NM1*QB*1******24*NM109__PurchasedServiceProviderIdentifier*NM*NM1~
    REF*0B*REF02__PurchasedServiceProvide~
    NM1*77*2******24*NM109__LaboratoryOrFacilityPrimaryIdentifier*NM*NM1~
    N3*N301__LaboratoryOrFacilityAddressLine~
    N4*N401__LaboratoryOrFacilityCity*N4*N403__Laborator**N4*N406~
    REF*0B*REF02__ServiceFacilityLocation~
    NM1*DQ*1*NM103__SupervisingProviderLastName*NM104__SupervisingProvide****24*NM109__SupervisingProviderIdentifier*NM*NM1~
    REF*0B*REF02__SupervisingProviderSeco~
    NM1*DK*1*NM103__OrderingProviderLastName*NM104__OrderingProviderFi****24*NM109__OrderingProviderIdentifier*NM*NM1~
    N3*N301__OrderingProviderAddressLine~
    N4*N401__OrderingProviderCityName*N4*N403__OrderingP**N4*N406~
    REF*0B*REF02__OrderingProviderSeconda~
    PER*IC*PER02__OrderingProviderContactName*EM*PER04__CommunicationNumber*EM*PER06__CommunicationNumber*EM*PER08__CommunicationNumber~
    NM1*DN*1*NM103__ReferringProviderLastName*NM104__ReferringProviderF****24*NM109__ReferringProviderIdentifier*NM*NM1~
    PRV*RF*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__ReferringProviderSecond~
    NM1*PR*2*NM103__PayerName*****PI*NM109__OtherPayerIdentificationNumber*NM*NM1~
    REF*9F*REF02__OtherPayerPriorAuthoriz~
    SVD*SVD01__OtherPayerPrimaryIdentifier*1036*HC:SVD03_C00302U987_ProcedureCode**1037~
    CAS*CO*CAS02*1038**CAS05*1039*1040*CAS08*1041*1042*CAS11*1043*1044*CAS14*1045*1046*CAS17*1047*1048~
    DTP*573*D8*DTP03__AdjudicationOrPaymentDate~
    LQ*AS*LQ02__FormIdentifier~
    FRM*FRM01__QuestionNumbe*N~
    SE*390*ST02~
    GE*1*122~
    IEA*1*000000065~


    Look into your error message if it is resolving to the wrong schema. Please do see that GS08 should be 004010X098A1 for 837_P.


    Thanks
    Gyan

    If this answers your question, please mark it as "Answered".
    Monday, June 15, 2009 2:09 PM

All replies

  • Hi,
       I think you did not add the headers and traillers in the message. that is ISA, GS , GE and IEA. Put these segments before and after message then try to pass it. If this is not the cases then put your error message here.

    You can provide it like this:
    Header:
    ISA*00*          *00*          *ZZ*7654321        *ZZ*1234567        *991221*1226*U*00200*000000065*0*T*:~
    GS*PO*01*1234567*19991221*1226*122*X*004010X098A1~

    Trailer:
    GE*1*122~
    IEA*1*000000065~


    And be careful in giving GS08 value , for 837P it should be 004010X098A1.


    Thanks
    Gyan
    If this answers your question, please mark it as "Answered".
    Monday, June 15, 2009 9:04 AM
  • Hey Prakash,

    Thanks for the reply.

    It seems to be message generated out of visual studio for schemas does not have logically correct values henceforth it is failing. I edited the message with proper data to generate a valid sample message and it works fine now. 

    I am looking out for the test messages for 837 professional schema.

    Please find the error as below.

    Error: 21 (Field level error)
    SegmentID: SV1
    Position in TS: 317
    Data Element ID: SV101_C00301U948_ProductOrServiceIDQualifier
    Position in Segment: 1
    Position in Field: 1
    Data Value: HC:SV101_C00302U949_ProcedureCode
    7: Invalid code value

    Error: 22 (Field level error)
    SegmentID: SV1
    Position in TS: 317
    Data Element ID: SV101_C00302U949_ProcedureCode
    Position in Segment: 1
    Position in Field: 2
    Data Value: 
    1: Mandatory data element missing

    Error: 23 (Field level error)
    SegmentID: SV5
    Position in TS: 318
    Data Element ID: SV501_C00301U5968_ProcedureIdentifier
    Position in Segment: 1
    Position in Field: 1
    Data Value: HC:SV501_C00302U5969_ProcedureCode
    7: Invalid code value

    Error: 24 (Field level error)
    SegmentID: SV5
    Position in TS: 318
    Data Element ID: SV501_C00302U5969_ProcedureCode
    Position in Segment: 1
    Position in Field: 2
    Data Value: 
    1: Mandatory data element missing

    Error: 25 (Field level error)
    SegmentID: SVD
    Position in TS: 385
    Data Element ID: SVD03_C00301U986_ProductOrServiceIDQualifier
    Position in Segment: 3
    Position in Field: 1
    Data Value: HC:SVD03_C00302U987_ProcedureCode
    7: Invalid code value

    Error: 26 (Field level error)
    SegmentID: SVD
    Position in TS: 385
    Data Element ID: SVD03_C00302U987_ProcedureCode
    Position in Segment: 3
    Position in Field: 2
    Data Value: 
    1: Mandatory data element missing

    Thanks,
    Pradeep


    preps2
    Monday, June 15, 2009 12:47 PM
  • Hi,
         I generated the following file and it is passing:

    ISA*00*          *00*          *ZZ*7654321        *ZZ*1234567        *991221*1226*U*00200*000000065*0*T*:~
    GS*PO*01*1234567*19991221*1226*122*X*004010X098A1~
    ST*837*ST02~
    BHT*0019*00*BHT03__OriginatorApplicationTr*01230123*01234567*CH~
    REF*87*REF02__TransmissionTypeCode~
    NM1*41*1*NM103__SubmitterLastOrOrganizationN*****46*NM109__SubmitterIdentifier*NM*NM1~
    PER*IC*PER02__SubmitterContactName*ED*PER04__CommunicationNumber*ED*PER06__CommunicationNumber*ED*PER08__CommunicationNumber~
    NM1*40*2*NM103__ReceiverName*****46*NM109__ReceiverPrimaryIdentifier*NM*NM1~
    HL*HL01__Hierar**20*1~
    PRV*BI*ZZ*PRV03__ProviderTaxonomyCode~
    CUR*85*CUR*****CUR*01230123*01234567*CUR*01230123*01234567*CUR*01230123*01234567*CUR*01230123*01234567*CUR*01230123*01234567~
    NM1*85*1*NM103__BillingProviderLastOrOrganiz*****24*NM109__BillingProviderIdentifier*NM*NM1~
    N3*N301__BillingProviderAddressLine~
    N4*N401__BillingProviderCityName*N4*N403__BillingPr**N4*N406~
    REF*0B*REF02__BillingProviderAddition~
    REF*06*REF02__BillingProviderCreditCa~
    PER*IC*PER02__BillingProviderContactName*EM*PER04__CommunicationNumber*EM*PER06__CommunicationNumber*EM*PER08__CommunicationNumber~
    NM1*87*1*NM103__PaytoProviderLastOrOrganizat*****24*NM109__PaytoProviderIdentifier*NM*NM1~
    N3*N301__PaytoProviderAddressLine~
    N4*N401__PaytoProviderCityName*N4*N403__PaytoProv**N4*N406~
    REF*0B*REF02__PaytoProviderIdentifier~
    HL*HL01__Hierar*HL02__Hierar*22*0~
    SBR*P~
    PAT*****D8*PAT06__InsuredIndividualDeathDate*01*891~
    NM1*IL*1*NM103__SubscriberLastName*****MI*NM109__SubscriberPrimaryIdentifier*NM*NM1~
    N3*N301__SubscriberAddressLine~
    N4*N401__SubscriberCityName*N4*N403__Subscribe**N4*N406~
    DMG*D8*DMG02__SubscriberBirthDate*F~
    REF*1W*REF02__SubscriberSupplementalI~
    REF*Y4*REF02__PropertyCasualtyClaimNu~
    NM1*PR*2*NM103__PayerName*****PI*NM109__PayerIdentifier*NM*NM1~
    N3*N301__PayerAddressLine~
    N4*N401__PayerCityName*N4*N403__PayerPost**N4*N406~
    REF*2U*REF02__PayerAdditionalIdentifi~
    NM1*QD*1*NM103__ResponsiblePartyLastOrOrgani*****NM*NM109*NM*NM1~
    N3*N301__ResponsiblePartyAddressLine~
    N4*N401__ResponsiblePartyCityName*N4*N403__Responsib**N4*N406~
    NM1*AO*1*NM103__CreditOrDebitCardHolderLastO*****MI*NM109__CreditOrDebitCardNumber*NM*NM1~
    REF*AB*REF02__CreditOrDebitCardAuthor~
    CLM*CLM01__PatientAccountNumber*892***CL::C*N*A*N*A**AA~
    DTP*454*D8*DTP03__InitialTreatmentDate~
    DTP*304*D8*DTP03__LastSeenDate~
    DTP*431*D8*DTP03__OnsetOfCurrentIllnessOrInjur~
    DTP*453*D8*DTP03__AcuteManifestationDate~
    DTP*438*D8*DTP03__SimilarIllnessOrSymptomDate~
    DTP*439*D8*DTP03__AccidentDate~
    DTP*484*D8*DTP03__LastMenstrualPeriodDate~
    DTP*455*D8*DTP03__LastXRayDate~
    DTP*471*D8*DTP03__PrescriptionDate~
    DTP*360*D8*DTP03__DisabilityFromDate~
    DTP*361*D8*DTP03__DisabilityToDate~
    DTP*297*D8*DTP03__LastWorkedDate~
    DTP*296*D8*DTP03__WorkReturnDate~
    DTP*435*D8*DTP03__RelatedHospitalizationAdmiss~
    DTP*096*D8*DTP03__RelatedHospitalizationDischa~
    DTP*090*D8*DTP03__AssumedOrRelinquishedCareDat~
    PWK*77*AA***AC*PWK06__AttachmentControlNumber~
    CN1*02~
    AMT*MA*893~
    AMT*F5*894~
    AMT*NE*895~
    REF*4N*REF02__ServiceAuthorizationExc~
    REF*F5*REF02__MedicareSection4081Indi~
    REF*EW*REF02__MammographyCertificatio~
    REF*9F*REF02__PriorAuthorizationOrRef~
    REF*F8*REF02__ClaimOriginalReferenceN~
    REF*X4*REF02__ClinicalLaboratoryImpro~
    REF*9A*REF02__RepricedClaimReferenceN~
    REF*9C*REF02__AdjustedRepricedClaimRe~
    REF*LX*REF02__InvestigationalDeviceEx~
    REF*D9*REF02__ClearinghouseTraceNumbe~
    REF*1S*REF02__AmbulatoryPatientGroupN~
    REF*EA*REF02__MedicalRecordNumber~
    REF*P4*REF02__DemonstrationProjectIde~
    K3*K301__FixedFormatInformation~
    NTE*ADD*NTE02__ClaimNoteText~
    CR1*LB*896*I*A*DH*897~
    CR2*898*899*CR2*CR2*CR*900**A~
    CRC*07*N*01~
    CRC*E1*N*L1~
    CRC*75*Y*IH~
    CRC*ZZ*N*AV~
    HI*BK:HI01_C02202U864_DiagnosisCode*BF:HI02_C02202U872_DiagnosisCode*BF:HI03_C02202U880_DiagnosisCode*BF:HI04_C02202U888_DiagnosisCode*BF:HI05_C02202U896_DiagnosisCode*BF:HI06_C02202U904_DiagnosisCode*BF:HI07_C02202U912_DiagnosisCode*BF:HI08_C02202U920_DiagnosisCode~
    HCP*00*901*******HC*HCP10*HC*902~
    CR7*AI*903*904~
    HSD*VS*905***35*906~
    NM1*DN*1*NM103__ReferringProviderLastName*****24*NM109__ReferringProviderIdentifier*NM*NM1~
    PRV*RF*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__ReferringProviderSecond~
    NM1*82*1*NM103__RenderingProviderLastOrOrgan*****24*NM109__RenderingProviderIdentifier*NM*NM1~
    PRV*PE*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__RenderingProviderSecond~
    NM1*QB*1*NM103__PurchasedServiceProviderLast*****24*NM109__PurchasedServiceProviderIdentifier*NM*NM1~
    REF*0B*REF02__PurchasedServiceProvide~
    NM1*77*2******24*NM109__LaboratoryOrFacilityPrimaryIdentifier*NM*NM1~
    N3*N301__LaboratoryOrFacilityAddressLine~
    N4*N401__LaboratoryOrFacilityCity*N4*N403__Laborator**N4*N406~
    REF*0B*REF02__LaboratoryOrFacilitySec~
    NM1*DQ*1*NM103__SupervisingProviderLastName*NM104__SupervisingProvide****24*NM109__SupervisingProviderIdentifier*NM*NM1~
    REF*0B*REF02__SupervisingProviderSeco~
    SBR*P*01***AP~
    CAS*CO*CAS02*907**CAS05*908*909*CAS08*910*911*CAS11*912*913*CAS14*914*915*CAS17*916*917~
    AMT*D*918~
    AMT*AAE*919~
    AMT*B6*920~
    AMT*F2*921~
    AMT*AU*922~
    AMT*D8*923~
    AMT*DY*924~
    AMT*F5*925~
    AMT*T*926~
    AMT*T2*927~
    DMG*D8*DMG02__OtherInsuredBirthDate*F~
    OI***N***A~
    MOA*928~
    NM1*IL*1*NM103__OtherInsuredLastName*****MI*NM109__OtherInsuredIdentifier*NM*NM1~
    N3*N301__OtherInsuredAddressLine~
    N4*****N4*N406~
    REF*1W*REF02__OtherInsuredAdditionalI~
    NM1*PR*2*NM103__OtherPayerLastOrOrganization*****PI*NM109__OtherPayerPrimaryIdentifier*NM*NM1~
    PER*IC*PER02__OtherPayerContactName*ED*PER04__CommunicationNumber*ED*PER06__CommunicationNumber*ED*PER08__CommunicationNumber~
    DTP*573*D8*DTP03__AdjudicationOrPaymentDate~
    REF*2U*REF02__OtherPayerSecondaryIden~
    REF*9F*REF02__OtherPayerPriorAuthoriz~
    REF*T4*REF02__OtherPayerClaimAdjustme~
    NM1*QC*1******MI*NM109__OtherPayerPatientPrimaryIdentifier*NM*NM1~
    REF*1W*REF02__OtherPayerPatientSecond~
    NM1*DN*1******NM*NM109*NM*NM1~
    REF*1B*REF02__OtherPayerReferringProv~
    NM1*82*1******NM*NM109*NM*NM1~
    REF*1B*REF02__OtherPayerRenderingProv~
    NM1*QB*1******NM*NM109*NM*NM1~
    REF*1A*REF02__OtherPayerPurchasedServ~
    NM1*77*2******NM*NM109*NM*NM1~
    REF*1A*REF02__OtherPayerServiceFacili~
    NM1*DQ*1******NM*NM109*NM*NM1~
    REF*1B*REF02__OtherPayerSupervisingPr~
    LX*929~
    SV1*HC:SV101_C00302U949_ProcedureCode*930*F2*931***932~
    SV5*HC:SV501_C00302U5969_ProcedureCode*DA*933*934**1~
    PWK*CT*AB***PW*PWK06~
    CR1*LB*935*I*A*DH*936~
    CR2*937*938*CR2*CR2*CR*939**A~
    CR3*I*MO*940~
    CR5*I*941**********E~
    CRC*07*N*01~
    CRC*70*N*65~
    CRC*09*N*37~
    DTP*472*D8*DTP03__ServiceDate~
    DTP*607*D8*DTP03__CertificationRevisionDate~
    DTP*463*D8*DTP03__BeginTherapyDate~
    DTP*461*D8*DTP03__LastCertificationDate~
    DTP*304*D8*DTP03__LastSeenDate~
    DTP*738*D8*DTP03__TestPerformedDate~
    DTP*119*D8*DTP03__OxygenSaturationTestDate~
    DTP*011*D8*DTP03__ShippedDate~
    DTP*431*D8*DTP03__OnsetDate~
    DTP*455*D8*DTP03__LastXRayDate~
    DTP*453*D8*DTP03__AcuteManifestationDate~
    DTP*454*D8*DTP03__InitialTreatmentDate~
    DTP*438*D8*DTP03__SimilarIllnessOrSymptomDate~
    MEA*OG*GRA*942*M*943*944*ME~
    CN1*01~
    REF*9B*REF02__RepricedLineItemReferen~
    REF*9D*REF02__AdjustedRepricedLineIte~
    REF*9F*REF02__PriorAuthorizationOrRef~
    REF*6R*REF02__LineItemControlNumber~
    REF*EW*REF02__MammographyCertificatio~
    REF*X4*REF02__ClinicalLaboratoryImpro~
    REF*F4*REF02__ReferringCLIANumber~
    REF*BT*REF02__ImmunizationBatchNumber~
    REF*1S*REF02__AmbulatoryPatientGroupN~
    REF*TP*REF02__OxygenFlowRate~
    REF*OZ*REF02__UniversalProductNumber~
    AMT*T*945~
    AMT*AAE*946~
    AMT*F4*947~
    K3*K301__FixedFormatInformation~
    NTE*ADD*NTE02__LineNoteText~
    PS1*PS101__PurchasedServiceProvide*948~
    HSD*VS*949***34*950~
    HCP*00*951*******HC*HCP10__ProcedureCode*DA*952~
    LIN**N4*LIN03__NationalDrugCode*LI*LIN05*LI*LIN07*LI*LIN09*LI*LIN11*LI*LIN13*LI*LIN15*LI*LIN17*LI*LIN19*LI*LIN21*LI*LIN23*LI*LIN25*LI*LIN27*LI*LIN29*LI*LIN31~
    CTP**CTP*953*954*F2*CTP*955**CT*CTP10*956~
    REF*XZ*REF02__PrescriptionNumber~
    NM1*82*1*NM103__RenderingProviderLastOrOrgan*****24*NM109__RenderingProviderIdentifier*NM*NM1~
    PRV*PE*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__RenderingProviderSecond~
    NM1*QB*1******24*NM109__PurchasedServiceProviderIdentifier*NM*NM1~
    REF*0B*REF02__PurchasedServiceProvide~
    NM1*77*2******24*NM109__LaboratoryOrFacilityPrimaryIdentifier*NM*NM1~
    N3*N301__LaboratoryOrFacilityAddressLine~
    N4*N401__LaboratoryOrFacilityCity*N4*N403__Laborator**N4*N406~
    REF*0B*REF02__ServiceFacilityLocation~
    NM1*DQ*1*NM103__SupervisingProviderLastName*NM104__SupervisingProvide****24*NM109__SupervisingProviderIdentifier*NM*NM1~
    REF*0B*REF02__SupervisingProviderSeco~
    NM1*DK*1*NM103__OrderingProviderLastName*NM104__OrderingProviderFi****24*NM109__OrderingProviderIdentifier*NM*NM1~
    N3*N301__OrderingProviderAddressLine~
    N4*N401__OrderingProviderCityName*N4*N403__OrderingP**N4*N406~
    REF*0B*REF02__OrderingProviderSeconda~
    PER*IC*PER02__OrderingProviderContactName*EM*PER04__CommunicationNumber*EM*PER06__CommunicationNumber*EM*PER08__CommunicationNumber~
    NM1*DN*1*NM103__ReferringProviderLastName*NM104__ReferringProviderF****24*NM109__ReferringProviderIdentifier*NM*NM1~
    PRV*RF*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__ReferringProviderSecond~
    NM1*PR*2*NM103__PayerName*****PI*NM109__OtherPayerIdentificationNumber*NM*NM1~
    REF*9F*REF02__OtherPayerPriorAuthoriz~
    SVD*SVD01__OtherPayerPrimaryIdentifier*957*HC:SVD03_C00302U987_ProcedureCode**958~
    CAS*CO*CAS02*959**CAS05*960*961*CAS08*962*963*CAS11*964*965*CAS14*966*967*CAS17*968*969~
    DTP*573*D8*DTP03__AdjudicationOrPaymentDate~
    LQ*AS*LQ02__FormIdentifier~
    FRM*FRM01__QuestionNumbe*N~
    HL*HL01__Hierar*HL02__Hierar*23*0~
    PAT*01****D8*PAT06__PatientDeathDate*01*970~
    NM1*QC*1*NM103__PatientLastName*NM104__PatientFirstName****MI*NM109__PatientPrimaryIdentifier*NM*NM1~
    N3*N301__PatientAddressLine~
    N4*N401__PatientCityName*N4*N403__PatientPo**N4*N406~
    DMG*D8*DMG02__PatientBirthDate*F~
    REF*1W*REF02__PatientSecondaryIdentif~
    REF*Y4*REF02__PropertyCasualtyClaimNu~
    CLM*CLM01__PatientAccountNumber*971***CL::C*N*A*N*A**AA~
    DTP*454*D8*DTP03__InitialTreatmentDate~
    DTP*304*D8*DTP03__LastSeenDate~
    DTP*431*D8*DTP03__OnsetOfCurrentIllnessOrInjur~
    DTP*453*D8*DTP03__AcuteManifestationDate~
    DTP*438*D8*DTP03__SimilarIllnessOrSymptomDate~
    DTP*439*D8*DTP03__AccidentDate~
    DTP*484*D8*DTP03__LastMenstrualPeriodDate~
    DTP*455*D8*DTP03__LastXRayDate~
    DTP*471*D8*DTP03__PrescriptionDate~
    DTP*360*D8*DTP03__DisabilityFromDate~
    DTP*361*D8*DTP03__DisabilityToDate~
    DTP*297*D8*DTP03__LastWorkedDate~
    DTP*296*D8*DTP03__WorkReturnDate~
    DTP*435*D8*DTP03__RelatedHospitalizationAdmiss~
    DTP*096*D8*DTP03__RelatedHospitalizationDischa~
    DTP*090*D8*DTP03__AssumedOrRelinquishedCareDat~
    PWK*77*AA***AC*PWK06__AttachmentControlNumber~
    CN1*02~
    AMT*MA*972~
    AMT*F5*973~
    AMT*NE*974~
    REF*4N*REF02__ServiceAuthorizationExc~
    REF*F5*REF02__MedicareSection4081Indi~
    REF*EW*REF02__MammographyCertificatio~
    REF*9F*REF02__PriorAuthorizationOrRef~
    REF*F8*REF02__ClaimOriginalReferenceN~
    REF*X4*REF02__ClinicalLaboratoryImpro~
    REF*9A*REF02__RepricedClaimReferenceN~
    REF*9C*REF02__AdjustedRepricedClaimRe~
    REF*LX*REF02__InvestigationalDeviceEx~
    REF*D9*REF02__ClearinghouseTraceNumbe~
    REF*1S*REF02__AmbulatoryPatientGroupN~
    REF*EA*REF02__MedicalRecordNumber~
    REF*P4*REF02__DemonstrationProjectIde~
    K3*K301__FixedFormatInformation~
    NTE*ADD*NTE02__ClaimNoteText~
    CR1*LB*975*I*A*DH*976~
    CR2*977*978*CR2*CR2*CR*979**A~
    CRC*07*N*01~
    CRC*E1*N*L1~
    CRC*75*Y*IH~
    CRC*ZZ*N*AV~
    HI*BK:HI01_C02202U864_DiagnosisCode*BF:HI02_C02202U872_DiagnosisCode*BF:HI03_C02202U880_DiagnosisCode*BF:HI04_C02202U888_DiagnosisCode*BF:HI05_C02202U896_DiagnosisCode*BF:HI06_C02202U904_DiagnosisCode*BF:HI07_C02202U912_DiagnosisCode*BF:HI08_C02202U920_DiagnosisCode~
    HCP*00*980*******HC*HCP10*HC*981~
    CR7*AI*982*983~
    HSD*VS*984***35*985~
    NM1*DN*1*NM103__ReferringProviderLastName*****24*NM109__ReferringProviderIdentifier*NM*NM1~
    PRV*RF*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__ReferringProviderSecond~
    NM1*82*1*NM103__RenderingProviderLastOrOrgan*****24*NM109__RenderingProviderIdentifier*NM*NM1~
    PRV*PE*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__RenderingProviderSecond~
    NM1*QB*1*NM103__PurchasedServiceProviderLast*****24*NM109__PurchasedServiceProviderIdentifier*NM*NM1~
    REF*0B*REF02__PurchasedServiceProvide~
    NM1*77*2******24*NM109__LaboratoryOrFacilityPrimaryIdentifier*NM*NM1~
    N3*N301__LaboratoryOrFacilityAddressLine~
    N4*N401__LaboratoryOrFacilityCity*N4*N403__Laborator**N4*N406~
    REF*0B*REF02__LaboratoryOrFacilitySec~
    NM1*DQ*1*NM103__SupervisingProviderLastName*NM104__SupervisingProvide****24*NM109__SupervisingProviderIdentifier*NM*NM1~
    REF*0B*REF02__SupervisingProviderSeco~
    SBR*P*01***AP~
    CAS*CO*CAS02*986**CAS05*987*988*CAS08*989*990*CAS11*991*992*CAS14*993*994*CAS17*995*996~
    AMT*D*997~
    AMT*AAE*998~
    AMT*B6*999~
    AMT*F2*1000~
    AMT*AU*1001~
    AMT*D8*1002~
    AMT*DY*1003~
    AMT*F5*1004~
    AMT*T*1005~
    AMT*T2*1006~
    DMG*D8*DMG02__OtherInsuredBirthDate*F~
    OI***N***A~
    MOA*1007~
    NM1*IL*1*NM103__OtherInsuredLastName*****MI*NM109__OtherInsuredIdentifier*NM*NM1~
    N3*N301__OtherInsuredAddressLine~
    N4*****N4*N406~
    REF*1W*REF02__OtherInsuredAdditionalI~
    NM1*PR*2*NM103__OtherPayerLastOrOrganization*****PI*NM109__OtherPayerPrimaryIdentifier*NM*NM1~
    PER*IC*PER02__OtherPayerContactName*ED*PER04__CommunicationNumber*ED*PER06__CommunicationNumber*ED*PER08__CommunicationNumber~
    DTP*573*D8*DTP03__AdjudicationOrPaymentDate~
    REF*2U*REF02__OtherPayerSecondaryIden~
    REF*9F*REF02__OtherPayerPriorAuthoriz~
    REF*T4*REF02__OtherPayerClaimAdjustme~
    NM1*QC*1******MI*NM109__OtherPayerPatientPrimaryIdentifier*NM*NM1~
    REF*1W*REF02__OtherPayerPatientSecond~
    NM1*DN*1******NM*NM109*NM*NM1~
    REF*1B*REF02__OtherPayerReferringProv~
    NM1*82*1******NM*NM109*NM*NM1~
    REF*1B*REF02__OtherPayerRenderingProv~
    NM1*QB*1******NM*NM109*NM*NM1~
    REF*1A*REF02__OtherPayerPurchasedServ~
    NM1*77*2******NM*NM109*NM*NM1~
    REF*1A*REF02__OtherPayerServiceFacili~
    NM1*DQ*1******NM*NM109*NM*NM1~
    REF*1B*REF02__OtherPayerSupervisingPr~
    LX*1008~
    SV1*HC:SV101_C00302U949_ProcedureCode*1009*F2*1010***1011~
    SV5*HC:SV501_C00302U5969_ProcedureCode*DA*1012*1013**1~
    PWK*CT*AB***PW*PWK06~
    CR1*LB*1014*I*A*DH*1015~
    CR2*1016*1017*CR2*CR2*CR*1018**A~
    CR3*I*MO*1019~
    CR5*I*1020**********E~
    CRC*07*N*01~
    CRC*70*N*65~
    CRC*09*N*37~
    DTP*472*D8*DTP03__ServiceDate~
    DTP*607*D8*DTP03__CertificationRevisionDate~
    DTP*463*D8*DTP03__BeginTherapyDate~
    DTP*461*D8*DTP03__LastCertificationDate~
    DTP*304*D8*DTP03__LastSeenDate~
    DTP*738*D8*DTP03__TestPerformedDate~
    DTP*119*D8*DTP03__OxygenSaturationTestDate~
    DTP*011*D8*DTP03__ShippedDate~
    DTP*431*D8*DTP03__OnsetDate~
    DTP*455*D8*DTP03__LastXRayDate~
    DTP*453*D8*DTP03__AcuteManifestationDate~
    DTP*454*D8*DTP03__InitialTreatmentDate~
    DTP*438*D8*DTP03__SimilarIllnessOrSymptomDate~
    MEA*OG*GRA*1021*M*1022*1023*ME~
    CN1*01~
    REF*9B*REF02__RepricedLineItemReferen~
    REF*9D*REF02__AdjustedRepricedLineIte~
    REF*9F*REF02__PriorAuthorizationOrRef~
    REF*6R*REF02__LineItemControlNumber~
    REF*EW*REF02__MammographyCertificatio~
    REF*X4*REF02__ClinicalLaboratoryImpro~
    REF*F4*REF02__ReferringCLIANumber~
    REF*BT*REF02__ImmunizationBatchNumber~
    REF*1S*REF02__AmbulatoryPatientGroupN~
    REF*TP*REF02__OxygenFlowRate~
    REF*OZ*REF02__UniversalProductNumber~
    AMT*T*1024~
    AMT*AAE*1025~
    AMT*F4*1026~
    K3*K301__FixedFormatInformation~
    NTE*ADD*NTE02__LineNoteText~
    PS1*PS101__PurchasedServiceProvide*1027~
    HSD*VS*1028***34*1029~
    HCP*00*1030*******HC*HCP10__ProcedureCode*DA*1031~
    LIN**N4*LIN03__NationalDrugCode*LI*LIN05*LI*LIN07*LI*LIN09*LI*LIN11*LI*LIN13*LI*LIN15*LI*LIN17*LI*LIN19*LI*LIN21*LI*LIN23*LI*LIN25*LI*LIN27*LI*LIN29*LI*LIN31~
    CTP**CTP*1032*1033*F2*CTP*1034**CT*CTP10*1035~
    REF*XZ*REF02__PrescriptionNumber~
    NM1*82*1*NM103__RenderingProviderLastOrOrgan*****24*NM109__RenderingProviderIdentifier*NM*NM1~
    PRV*PE*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__RenderingProviderSecond~
    NM1*QB*1******24*NM109__PurchasedServiceProviderIdentifier*NM*NM1~
    REF*0B*REF02__PurchasedServiceProvide~
    NM1*77*2******24*NM109__LaboratoryOrFacilityPrimaryIdentifier*NM*NM1~
    N3*N301__LaboratoryOrFacilityAddressLine~
    N4*N401__LaboratoryOrFacilityCity*N4*N403__Laborator**N4*N406~
    REF*0B*REF02__ServiceFacilityLocation~
    NM1*DQ*1*NM103__SupervisingProviderLastName*NM104__SupervisingProvide****24*NM109__SupervisingProviderIdentifier*NM*NM1~
    REF*0B*REF02__SupervisingProviderSeco~
    NM1*DK*1*NM103__OrderingProviderLastName*NM104__OrderingProviderFi****24*NM109__OrderingProviderIdentifier*NM*NM1~
    N3*N301__OrderingProviderAddressLine~
    N4*N401__OrderingProviderCityName*N4*N403__OrderingP**N4*N406~
    REF*0B*REF02__OrderingProviderSeconda~
    PER*IC*PER02__OrderingProviderContactName*EM*PER04__CommunicationNumber*EM*PER06__CommunicationNumber*EM*PER08__CommunicationNumber~
    NM1*DN*1*NM103__ReferringProviderLastName*NM104__ReferringProviderF****24*NM109__ReferringProviderIdentifier*NM*NM1~
    PRV*RF*ZZ*PRV03__ProviderTaxonomyCode~
    REF*0B*REF02__ReferringProviderSecond~
    NM1*PR*2*NM103__PayerName*****PI*NM109__OtherPayerIdentificationNumber*NM*NM1~
    REF*9F*REF02__OtherPayerPriorAuthoriz~
    SVD*SVD01__OtherPayerPrimaryIdentifier*1036*HC:SVD03_C00302U987_ProcedureCode**1037~
    CAS*CO*CAS02*1038**CAS05*1039*1040*CAS08*1041*1042*CAS11*1043*1044*CAS14*1045*1046*CAS17*1047*1048~
    DTP*573*D8*DTP03__AdjudicationOrPaymentDate~
    LQ*AS*LQ02__FormIdentifier~
    FRM*FRM01__QuestionNumbe*N~
    SE*390*ST02~
    GE*1*122~
    IEA*1*000000065~


    Look into your error message if it is resolving to the wrong schema. Please do see that GS08 should be 004010X098A1 for 837_P.


    Thanks
    Gyan

    If this answers your question, please mark it as "Answered".
    Monday, June 15, 2009 2:09 PM
  • Gyan,

    Fabulous post for the 4010 version of the 837P.  Do you have any examples of the 5010 version?  I'm just starting to wander into the deep end of the pool on creating these transactions an am really in need of help.

    Thanks for the consideration in advance.

    Thursday, February 21, 2013 9:52 PM