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837 Institutional Section - PM

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Set default 837 Institutional billing file values.

  1. In the Submitter Name (1000A-NM1-03) field, type the submitter name to populate the 1000A-NM1-03 segment.
  2. In the Submitter Contact Name (1000A-PER-02) field, enter the contact name, which will populate the 1000A-PER-02 segment.
  3. In the Submitter Telephone Number (1000A-PER-04) field, type the submitter phone number to populate the 1000A-PER-04 segment.
  4. In the Submitter Primary Identification # (1000A-NM1-09) field, type the primary identification number to populate the 1000A-NM1-09 segment.
  5. In the Receiver Name (1000B-NM1-03) field, type the receiver name to populate the 1000B-NM1-03 segment.
  6. In the Receiver Primary Identification # (1000B-NM1-09) field, type the receiver primary identification number to populate the 1000B-NM1-09 segment.
  7. In the Provider Code (2000A-PRV-01) field, enter the value that populates the 2000A-PRV-01 segment.
  8. In the Reference Identification (2000A-PRV-03) field, type the reference identification to include in the 837 Institutional filing. This value populates the 2000A-PRV-03 segment.
  9. In the Billing Provider Name (2010AA-NM1-03) field, type the agency name. This value populates the 2010AA-NM1-03 segment.
  10. In the Billing Provider Primary Identification Code Qualifier (2010AA-NM1-08) field, select the qualifier, which populates the 2010AA-NM1-08 segment.
  11. In the Billing Provider Primary Identification # (2010AA-NM1-09) field, type the agency Primary Identification number. This value populates the 2010AA-NM1-09 segment.
  12. In the Billing Provider Address 1 (2010AA-N3-01) field, type the agency street location information . This value populates the 2010AA-N3-01 segment.
  13. In the Billing Provider Address 2 (2010AA-N3-02) field, type any additional street location information . This value populates the 2010AA-N3-02 segment.
  14. In the Billing Provider ZIP Code (2010AA-N4-03) field, type the agency ZIP Code information. This value populates the 2010AA-N4-03 segment.
  15. In the Billing Provider City (2010AA-N4-01) field, type the agency city information. This value populates the 2010AA-N4-01 segment.
  16. In the Billing Provider State (2010AA-N4-01) field, select the state from the list. This value populates the 2010AA-N4-01 segment.
  17. In the Billing Provider Secondary Identification Code Qualifier field, select the value from the list. The value selected populates the 2010AA-REF-01 segment.
  18. In the Billing Provider Secondary Identification # (2010AA-REF-02) field, type the agency Secondary Identification number. This value populates the 2010AA-REF-02 segment.
  19. In the Billing Provider Secondary Identification Code Qualifier - 2 (2010AA-REF-01) field, enter the value that populates the 2010AA-REF-01 segment.
  20. In the Billing Provider Secondary Identification # - 2 (2010AA-REF-01) field, type the agency Secondary Identification number. This value populates the 2010AA-REF-01 segment.
  21. In the Billing Provider Secondary Identification Code Qualifier - 3 (2010AA-REF-01) field, enter the value that populates the 2010AA-REF-01 segment.
  22. In the Billing Provider Secondary Identification # - 3 (2010AA-REF-02) field, type the agency Secondary Identification number. This value populates the 2010AA-REF-02 segment.
  23. In the Billing Provider Contact Name (2010AA-PER-02) field, enter the contact name. This value populates the 2010AA-PER-02 segment.
  24. In the Billing Provider Phone # (2010AA-PER-04) field, type the contact phone number. This value populates the 2010AA-PER-04 segment.
  25. In the Payer Identification Code Qualifier (2010BB/2330B-NM1-08) field, select the value from the list. This value populates the 2010BB/2330B-NM1-08 segments.
  26. In the Payer Identification Number (2010BB/2330B-NM1-09) field, type the agency Payer Identification number. This value populates the 2010BB/ 2330B-NM1-09 segments.
  27. In the Patient Amount Due Information To Display In 2300-AMT field, select the information to display in the 2300-AMT segment.
  28. In the Patient Paid Amount Information To Display In 2300-AMT field, select the information to display in the 2300-AMT segment.
  29. In the Suppress AMT Segments When AMT-02 Is Zero field, select Yes to suppress AMT segments when AMT-02 is zero; select No to disable this function.
  30. In the Service Authorization Exception Code Reference Identification (2300-REF-02) field, enter the value that populates the 2300-REF-02 segment.
  31. In the Determine Managed Care Authorizations (2300-REF-02) field, select the value that populates the 2300-REF-02 segment.
  32. In the Include Un-Authorized Services (2300-REF-02) field, select Yes to include unauthorized services in the 2300-REF-02 segment; select No to exclude unauthorized services.
  33. In the Enable Demonstration Project Identifier (2300-REF) field, select whether or not to populate the 2300-REF segment in both the 837I.

  • If Yes, enter the Demonstration Project Identifier (2300-REF-02) number.

  1. In the Claim Note Reference Code (837I-2300-NTE-01) field, select the value from the list. This value populates the 2300-NTE-01 segment.

  2. In the Claim Note Text (837I-2300-NTE-02) field, type the claim note text. This value populates the 2300-NTE-02 segment.

  3. In the Billing Note Reference Code (837I-2300-NTE-01) field, enter the value that populates the 2300-NTE-01 segment.

  4. In the Billing Note Text (837I-2300-NTW-02) Enter the claim note text. This value populates the 2300-NTE-02 segment.

  5. In the Include Discharge Date In Occurrence Information (2300-Hi:Occurrence Information-01) field, select Coverage Expiration Date - Medicare A to use the Medicare coverage expiration date in the occurrence information; select Discharge Date to instead use the discharge date.

  6. In the Include Claim Quantity Segment (QTY) For Covered Days field, select Yes to include the claim quantity segment for covered days.

  7. In the Specify Rendering Practitioner As Attending Practitioner In Loop 2310A (Attending Physician Name) field, select Yes to specify the rendering practitioner as the attending physician in loop 2310A.

  8. In the Select Type Of Information To Include In Loop 2310C field, select the type of information to include in the 2310 loop.

  9. In the Suppress Rendering Provider Name if Practitioner is Not Required to be Enrolled With Guarantor (2310D/2420C) field:

    • Select Suppress 2310D to suppress all non-required rendering practitioners from the CLM loop, segment 2310D.

    • Select Suppress 2420C to suppress all non-required rendering practitioners from the SV2 loop, segment 2420C .
      Note: Required rendering practitioners are defined by the selections made in the Practitioner Categories for Coverage Needing Enrollment with Guarantor field on the 837 section of the Guarantors/Payors form.

  10. In the Facility Identification Code Qualifier (2310E-NM1-08) field, enter the value that populates the 2310E-NM1-08 segment.

  11. In the Facility Identification Code (2310E-NM1-09) field, type the value to populate the 2310E-REF-01 segment.

  12. In the Facility Reference Identification Qualifier (2310E-REF-01) fields, enter the values that populate the corresponding iterations of the 2310E-REF-01 segment.

  13. In the Facility Reference Identification (2310E-REF-02) fields, type the agency Facility Reference Identification for the corresponding iterations. This value populates the 2310E-REF-02 segment.

  14. In the Facility Reference Identification Qualifier - 2 (2310E-REF-01) field, select the value that populates the 2310E-REF-01 segment.

  15. In the Facility Reference Identification - 2 (2310E-REF-02) field, type the agency Facility Reference Identification . This value populates the 2310E-REF-02 segment.

  16. In the Facility Reference Identification Qualifier - 3 (2310E-REF-01) field, select the value that populates the 2310E-REF-01 segment.

  17. In the Facility Reference Identification - 3 (2310E-REF-02) field, type the agency Facility Reference Identification. This value populates the 2310E-REF-02 segment.

  18. In the Include Transfers In Claim Level Adjustments/Service Level Adjustments (2320/2430-CAS) field, select Yes to include transfers within loops 2320 and 2430-CAS.

  19. In the Suppress Claim Level Adjustments/Service Level Adjustments When Total is Zero field, select whether or not to remove from 2320-CAS/2430-CAS any claim adjustment group/reason code pairs that have a total of zero.

  20. In the Amount To Display (2320-AMT:Other Payer Paid Amount-02) field, select:

    • Zero to allow the display of zeroes in the amount.

    • Other Payer Patient Paid Amount to display the amount paid by the payer.

  21. In the Suppress Payer Paid Amount (2320-AMT) field:

  • Select No to exclude zero dollar services.
  • Select When Amount Is Zero to exclude services when the amount is zero.
  • Select When Total Liability for Other Payers Is Zero to exclude services when the total liability for the other payers is zero.

  1. In the Specify Number of Digits for Service Line Revenue Code (2400-SV2-01) field, select the number of digits to use for the service line revenue code. myAvatar will add leading zeroes to shorter codes so that the number of digits meets the required length.

  2. In the Add Leave Revenue To Sort For No-Pay ##0 Claims field, select whether or not to enable the following no-pay ##0 claim logic for clients with leave periods within the statement dates. When set to Yes, the 837 Institutional bill generated via the Electronic Billing form will be updated to sort by leave periods.
    Note: This field is enabled when Yes is selected in the Include Non-Covered Amout In The Service Line Non-Covered Charge Amount (2400-SV2-07) For Room & Board Services field, which is enabled by the Include Svc Line Non-Covered Charge Amt registry setting.
    1. Multiple Institutional Service Line (2400-SV2) segments may be produced for room and board services per claim.
    2. The consecutive days check used to determine if a room and board service can be rolled up into one particular Institutional Service Line (2400-SV2) will not be suppressed.
    3. Leave days will generate a new Institutional Service Line (2400-SV2) segment. Service Line Charge Amount (2400-SV2-03) will be 0, Service Line Units (2400-SV2-05) will be equal to the number of leave days, Service Line Non-Covered Charge Amount (2400-SV2-07) will be 0.
    4. Service Line Charge Amount (2400-SV2-03) will be equal to the total non-covered charge amounts.
    5. Service Line Units (2400-SV2-05) will be equal to the number of non-covered days.
    6. Service Line Non-Covered Charge Amount (2400-SV2-07) will be equal to the non-covered charge amount.

  3. In the Authorization Information Qualifier (ISA-01) field, select the value that populates the ISA-01 segment.

  4. In the Authorization Information (ISA-02) field, type the authorization information. This field requires 10 digits.

  5. In the Security Information Qualifier (ISA-03) field, select the value that populates the ISA-03 segment.

  6. In the Security Information (ISA-04) field, type the security information. This value populates the ISA-04 segment and requires 10 digits.

  7. In the Interchange Sender ID Qualifier (ISA-05) field, enter the value that populates the ISA-05 segment.

  8. In the Interchange Sender ID (ISA-06) field, type the information. This value populates the ISA-06 segment and requires 15 digits.

  9. In the Interchange Receiver ID Qualifier (ISA-07) field, select the value that populates the ISA-07 segment.

  10. In the Interchange Receiver ID (ISA-08) field, enter the value that populates the ISA-08 segment and requires 15 digits.

  11. In the Repetition Separator (ISA-11) field, enter a character to serve as a separator for the ISA-11 segment.

    • The pipe/vertical bar character [ | ] is not permitted as a value in this field. To enable the vertical bar as the separator character, enter another character and then select Vertical Bar in the Repetition Separator Override field.

  12. In the Acknowledgement Requested (ISA-14) field, designate whether acknowledgement will be requested.

  13. In the Usage Indicator (ISA-15) field, select the value that populates the ISA-15 segment.

  14. In the Application Sender's Code (GS-02) field, enter the value that populates the GS-02 segment. This field requires between 2 and 15 digits.

  15. In the Application Receiver's Code (GS-03) field, enter the value that populates the GS-03 segment. This field requires between 2 and 15 digits.

  16. In the Include Zero Dollar Services field, select Yes to include zero dollar services. Select No to exclude zero dollar services.

  17. In the Allow Periods In Diagnosis Codes (837I) field, select Yes to allow periods in diagnosis codes.

  18. In the If the Loop/Segment Information At The Service Level... field, choose Yes to exclude the Loop/Segment information at the service level. Choose No to include the Loop/Segment information at the service level.

  19. In the If The Begin/From Date Is The Same As The End/To Date... field, choose Yes to use the D8 format when the begin and end dates are the same. Choose No to use the RD8 format when the begin and end dates are the same.

  20. In the Additional Sort To LX Segment Based On... field, choose how to employ an additional sort in the LX segment.

  21. In the Only Include HCPCS For The Following Revenue field, select the revenue codes.

  22. In the Select Segments To Suppress field, select the loops/segments to suppress.

  23. In the Enable Daily Claim Logic field, select whether or not to create a new claim for each day of the client's stay.
    The DTP-435 (Admission Date/Hour) for each claim will be the service date and the admission or return from leave time of the service date. The time will be '0000' for full days. 
    The DTP-096 (Discharge Hour) segment will be the discharge or leave time of the service date. It will be '0000' for full days.

  24. In the Type Of Bill (First Two Digits) field, select the Bill Type Code to be used for the 2300-CLM-05 segment of the 837I electronic bill.

► Registry Settings
  • 837I Loops/Segments To Suppress
  • 837I-Dates To Populate 2300 DTP
  • Allow Extended Character Set In File
  • Allow For Inpatient Bill To Compile As Outpatient
  • Allow Policy Number By Date Sort
  • Bill Component Services When A Roll Up Service Is Found
  • Claim Code Override For Transfer Program
  • Claim Statement Dates
  • Claim Statement Dates Format (RD8)
  • Cost Avoidance Override/Zero Fill Logic
  • Enable Claim Frequency Code Override
  • Enable Contract Information
  • Enable Coordination Of Benefits Allowed Amount
  • Enable Coordination Of Benefits Total Medicare Paid Amount (2320-AMT)
  • Enable DRG Codes For Non-PPS Bills
  • Enable Drug Identification (2410)
  • Enable No-Pay ##0 Claim Overrides
  • Enable Patient Status Code And Service Line Revenue Code Override
  • Enable Pay-To-Provider Name (2010AB)
  • Enable PPS Billing
  • Enable Pricing/Re-Pricing Information
  • Enable Service Suppression For 837 File
  • Enable Subscriber Policy Number Override
  • Enable Support For Crossover Claims
  • Fields to Include in Client Charge Input
  • Include Billing Guarantor In Other Subscriber Information
  • Include Billing Leave Amt In Svc Amt
  • Include CLIA Numbers
  • Include First Billing Date
  • Include Patient Remaining Liability
  • Include Payer Secondary Id
  • Include Present On Admission Indicator
  • Include Secondary Submitter EDI Contact Information (1000A-PER)
  • Include Service Level Adjudication Info
  • Include Special Program Indicator Code (2300-CLM-12)
  • Include Svc Line Non-Covered Charge Amt
  • Limit Number of Claim Numbers Generated
  • Modify Occurrence Span Through Date For Leaves
  • Other Payer Name Information Override (2300B)
  • Referring Provider Determination Method
  • Service Panel Charge Input - Fields To Include
  • Sort Claim By Medicaid Rate Code
  • Specify A Prefix Value For Patient Account Number
  • Specify Claim or Encounter Indicator (BHT-06)
  • Specify Claim Sorting Parameters
  • Specify Default Discharge Hour (2300-DTP)
  • Specify Default Patient Status Code
  • Specify Functional Group Time Format
  • Specify Loops/Segments To Suppress
  • Specify Number Of Digits For Service Line Revenue Code (2400-SV2-01)
  • Specify Occurrence Span Code For Leaves
  • Specify Other Subscriber Primary ID
  • Specify Rendering/Attending Provider At Guarantor/Program Level
  • Specify Revenue Code For Leaves
  • Suppress Admission Date/Diagnosis
  • Suppress Attending Physician Name
  • Suppress Non-Billable Leaves
  • Suppress Non-Covered Days
  • Suppress Service Line Date (2400-DTP)
  • Use Admission Program For Bill Sorting
  • Use Claim First/Last Dates Of Service
  • Use Coverage Effective/Expiration Dates
  • Use Per Diem Rate For Outpatient Billing
► SQL Tables
  • SYSTEM.table_837_i_facility_prov_num