837 Professional Billing Method

Configure the 837 Professional

In Configuration - Services/Payers > Payers > Billing Methods, users can configure data to be populated in generated 837P forms for the specific payer. The process to configure an 837P form is straightforward. 

NOTE:  The specifications for both the 837 Professional (837P) and the 837 Institutional (837I) are similar. The difference between the two is in claim-specific data that pertains to a single transaction. Both contain ISA, GS, and ST segments, but some of the data and qualifying codes that populate the fields within these segments are specific to the type of 837. For example, the GS08 field in an 837P would use "005010X222" while an 837I would use "005010X223". See the 837 Institutional Billing Method article for more information on the 837I. 

Select the 837 Professional tab from the left side of the screen. 

If no configuration has been completed, the screen will display as follows:

To start, click the blue +Configure 837 Professional button. The blank form will display. The fields are labeled with the Loop/Segment values from the ANSI ASCX12N 837P format.

Required fields are indicated by an asterisk. The blue Save button becomes available once all required fields have been populated. 

The 837P configuration screen is divided into the reporting segments: Header, Providers and Subscribers, Claims and Services, and File Configuration.

Jump to Section:
 

Header 

Acorns - Acorns are specific to the product and hold state-specific billing and reporting information. Use the dropdown list to select. This field will not likely be populated for private payers.

Authorization Info (ISA02) - If entered, report the Authorization Info from the 837P otherwise, spaces display. This is a 10-character maximum length field.

Security Information (ISA04) - If entered, report the Security Information from the 837P otherwise, spaces display. This is a 10-character maximum length field.

Submitter ID Qualifier (ISA05) - This required field is mutually defined by the submitter and carrier. This is a 2-character maximum length field.

Submitter ID (ISA06) - This ID is typically assigned by the carrier to the submitter. Refer to the carrier companion guide. This is a 15-character maximum length field.

Receiver ID Qualifier (ISA07) - This required field is mutually defined by the submitter and carrier. This is a 2-character maximum length field.

Receiver ID (ISA08) - Refer to the companion guide. This is a 15-character maximum length field.

Acknowledgement is Requested (ISA14) - Enabling the checkbox displays as "1" on the 837 file. Otherwise, a "0" displays.

Sender Code (GS02) - This is the sending trading partner ID or the application sender's code. This is a 15-character maximum length field.

Receiver Code (GS03) - This is the receiving trading partner ID or the application receiver's code. This is a 15-character maximum length field.

Transaction Status (BHT02) - This is the Transaction Set Purpose Code. Use the dropdown field to select "Original" or "Reissue". The 837 file will display a "00" for an Original and an "18" for a Reissue.

Transaction Type (BHT06) - This is the Claim/Encounter identifier. Use the dropdown field to select either "Chargeable" or "Encounter".

Submitter Name (Loop 1000A, NM103) - Enter the Submitter name. This may be the organization's name or the provider's last name. The submitter must be authorized for electronic claim submission. This is a 35-character maximum length field.

Submitter ID Code (Loop 1000A, NM109) - The Submitter ID Code is specified by the carrier and identifies the submitter of the file. This is the billing provider's primary identification entered on the 837P form. NPI and Tax ID# are examples of this type of code. This is a 20-character maximum length field.

Submitter Contact (Loop 1000A, PER02) - Entry is recommended. Providing a submission contact is useful if claims submittal to the payer is not possible. This is a 60-character maximum length field.

Communication Qualifier (Loop 1000A, PER03) - This code identifies the type of communication for the number entered on Loop 1000A, PER04. Selections include:

• Telephone, reported as "TE".
• Email, reported as "EM".
• Fax, reported as "FX".

Comm. Number (Loop 1000A, PER04) - Enter the communication specified in Loop 1000A, PER03. For telephone and fax entries, format the number as "1112223333". This is an 80-character maximum length field.

Receiver Name (Loop 1000B, NM103) - Enter the transmission receiver's name. This is a 35-character maximum length field.

Receiver ID Code (Loop 1000B, NM109) - Enter the transmission receiver's code. This is a 20-character maximum length field.

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Providers and Subscribers 

Report Organization Taxonomy (Loop 200A, PRV) - If reporting is mandated, enable the checkbox to report the ten-digit provider alphanumeric code.

Payer ID Code (Loop 2010BB, NM109) - This is the destination payer. Enter the insurance company's Payer ID Code. This is a 20-character maximum length field.

Claims and Services

Adjudication Level - Select from the dropdown field list.

Subsequent Payers Reporting - Select from the dropdown field list. Defaults to "Include all subsequent payers".

Staff Provider Number Reporting - Select from the dropdown field list. Defaults to "Report if present".

Authorization Level - Select from the dropdown field list.

Supervisor Reporting - Select from the dropdown field list. 

Claims per Subscriber Loop - Enter the number (1-50) of services to report for the claim loop.

Services per Claim Loop - Enter the number (1-100) of claims to report for the subscriber loop.

Limit 1 Claim Per Transaction Set - Select the checkbox to enable a Transaction Set to be generated for each Claim.

NOTE:  If an acorn is selected in the configuration, this option cannot be selected or saved. 

Select all that apply:

• Report Staff (Loop 2310B)
• Defined Filter
•  IMPORTANT:  This field can only be selected if the Report Staff (Loop 2310B) field has been selected. It will be disabled if not. 
  • This dropdown field is auto populated with all configured Defined Filters. Staff will only be reported for services that match the selected defined filter. This field can be left blank to apply to all services. 
• Report Staff Taxonomy (Loop 2310B PRV)
  •  IMPORTANT:  This field can only be selected if the Report Staff (Loop 2310B) field has been selected. It will be disabled if not. 
• Report Service Facility Location (Loop 2310C)
• Provider Signature on File (CLM06)
• Report Referring Provider (Loop 2310A)
• Provider Accepts Assignment (CLM07)
• Assignment of Benefits Indicator (CLM08)
• Report COB Non-Covered Amount (Loop 2320 AMT*A8)
  • When this checkbox is selected, the Total Non-Covered Amount when a payer is skipped due to a non-billable service will be reported in Loop 2320 AMT*A8. The payer will be reported within the segment reporting the full claim charge. 
• Payer Accepts Corrected Claims
  • When this checkbox is selected, corrected claims can be processed using the 837P billing method.
  • When a claim is a corrected claim:
    • If the payment has a PCCN:
      • CLM05-3 is a "7" instead of a "1".
      • REF*F8 is reported after the Prior Authorization segment but before Claim Diagnoses.
      • REF*F8 includes the PCCN from the prior Payment.
    • If there is no PCCN:
      • A warning will be logged and the claim will be billed as an original claim.
• Payer Accepts Voided Claims
  • When this checkbox is selected, voided claims can be processed using the 837P billing method.
• Report Claim Note - Select the checkbox to report the Claim Note segment (Loop 2300 NTE) within the 837P. 

  • IMPORTANT:  The Note Qualifier and Note Text fields are only available when the Report Claim Note field is selected and are required to save the configuration. If the Report Claim Note field is deselected, the Note fields will clear. 

    
  • Note Qualifier - Select the criteria for reporting a Claim Note on the 837P from the dropdown field list.
    • 
  • Note Text - Enter an individual note about the selected qualifier value for further information, up to 80 characters. 

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File Configuration

The 837P contains five configurations. Each separator and terminator have a standard character default listed below:

• Component Element Separator - ":" (colon)
• Data Element Separator - "*" (asterisk)
• Repetition Separator - "^" (carat)
• Segment Terminator -"~" (tilde)
• Filename Prefix - Enter a name up to 60 characters that identify the 837 files in the application. The agency may define the naming convention.

Once all required fields are completed, click the blue text Save button at the bottom of the form screen. 

Changes may be made at any time to the saved 837P form. This will display the completed 837P Configuration. Click on any field to make the required edits. The blue Save button is enabled again when the required fields are completed. If any required field is deleted and not repopulated, an on-screen message will display informing the user of required fields without valid entries. 

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