837 Institutional Section

Populate 837I files. Fields display the associated loop and segment that will be populated.

• Billing Provider Secondary Identification Code Qualifier- 3 (2010AA-REF-01)

• Payer Identification Code Qualifier

• Service Authorization Exception Code Reference Identification (2300-REF-02)

• Determine Managed Care Authorizations (2300-REF-02)

• Attending Physician Identification Code Qualifier (2310A-NM1-08)

• Provider Code (2310A-PRV-01)

• Entity Type Qualifier (2310C-NM1-02)

• Other Physician Identification Code Qualifier (2310C-NM1-08)

• Reference Identification Qualifier (2310C-REF-01)

• Referring Provider Entity Type Qualifier

• Referring Provider ID Code Qualifier

• Laboratory Or Facility Identification Code Qualifier (2310E-NM1-08)

• Facility Reference Identification Qualifier (2310E-REF-01)

• Facility Reference Identification Qualifier 2 (2310E-REF-01)

• Facility Reference Identification Qualifier 3 (2310E-REF-01)

• Claim Note Reference Code (837I-2300-NTE-01)

• Billing Note Reference Code (837I-2300-NTE-01)

• Other Payee Insurance Type Code (2320-SBR-05)

• Other Payee Claim Filing Indicator Code (2320-SBR-09)

• Other Payee Patient Signature Source Code (2320-OI-04)

• Other Payee Release of Information Code (2320-OI-06)