X12 837D dental claim: format and example

837D structure

The full X12 837D layout from its OpenEDI definition, the same model ediFabric uses to parse, validate and generate it: 53 loops and 254 segment positions, in file order. Loops are shaded and their segments indented; Max use is how many times a segment or loop may repeat.

Segment / loop	Name	Usage	Max use
`ST`	Transaction Set Header	Required	1
`BHT`	Beginning of Hierarchical Transaction	Required	1
Any order	The loops below can appear in any order	Required	1
Loop 1000A	Submitter Name	Required	1
`NM1`	Submitter Name	Required	1
`PER`	Submitter EDI Contact Information	Required	2
Loop 1000B	Receiver Name	Required	1
`NM1`	Receiver Name	Required	1
Loop 2000A	Billing Provider Hierarchical Level	Required	>1
`HL`	Billing Provider Hierarchical Level	Required	1
`PRV`	Billing Provider Specialty Information	Situational	1
`CUR`	Foreign Currency Information	Situational	1
Any order	The loops below can appear in any order	Required	1
Loop 2010AA	Billing Provider Name	Required	1
`NM1`	Billing Provider Name	Required	1
`N3`	Billing Provider Address	Required	1
`N4`	Billing Provider City State ZIP Code	Required	1
Any order	The loops below can appear in any order	Required	1
`REF`	Billing Provider Tax Identification	Required	1
`REF`	Billing Provider UPIN License Information	Situational	2
`PER`	Billing Provider Contact Information	Situational	2
Loop 2010AB	Pay Address Name	Situational	1
`NM1`	Pay Address Name	Required	1
`N3`	Pay Address ADDRESS	Required	1
`N4`	Pay Address City State ZIP Code	Required	1
Loop 2010AC	Pay to Plan Name	Situational	1
`NM1`	Pay to Plan Name	Required	1
`N3`	Pay to Plan Address	Required	1
`N4`	Pay to Plan City State Zip Code	Required	1
Any order	The loops below can appear in any order	Required	1
`REF`	Pay to Plan Secondary Identification	Situational	1
`REF`	Pay to Plan Tax Identification Number	Required	1
Loop 2000B	Subscriber Hierarchical Level	Required	>1
`HL`	Subscriber Hierarchical Level	Required	1
`SBR`	Subscriber Information	Required	1
Any order	The loops below can appear in any order	Required	1
Loop 2010BA	Subscriber Name	Required	1
`NM1`	Subscriber Name	Required	1
`N3`	Subscriber Address	Situational	1
`N4`	Subscriber City State ZIP Code	Situational	1
`DMG`	Subscriber Demographic Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Subscriber Secondary Identification	Situational	1
`REF`	Propertyand Casualty Claim Number	Situational	1
Loop 2010BB	Payer Name	Required	1
`NM1`	Payer Name	Required	1
`N3`	Payer Address	Situational	1
`N4`	Payer City State ZIP Code	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Payer Secondary Identification	Situational	3
`REF`	Billing Provider Secondary Identification	Situational	1
Loop 2300	Claim Information	Situational	100
`CLM`	Claim Information	Required	1
Any order	The loops below can appear in any order	Situational	1
`DTP`	Date Accident	Situational	1
`DTP`	Date Appliance Placement	Situational	1
`DTP`	Date Service Date	Situational	1
`DTP`	Date Repricer Received Date	Situational	1
`DN1`	Orthodontic Total Monthsof Treatment	Situational	1
`DN2`	Tooth Status	Situational	35
`PWK`	Claim Supplemental Information	Situational	10
`CN1`	Contract Information	Situational	1
`AMT`	Patient Amount Paid	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Predetermination Identification	Situational	1
`REF`	Service Authorization Exception Code	Situational	1
`REF`	Payer Claim Control Number	Situational	1
`REF`	Referral Number	Situational	1
`REF`	Prior Authorization	Situational	1
`REF`	Repriced Claim Number	Situational	1
`REF`	Adjusted Repriced Claim Number	Situational	1
`REF`	Claim Identifier for Transmission Intermediaries	Situational	1
`K3`	File Information	Situational	10
`NTE`	Claim Note	Situational	5
`HI`	Health Care Diagnosis Code	Situational	1
`HCP`	Claim Pricing Repricing Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2310A	Referring Provider Name	Situational	2
`NM1`	Referring Provider Name	Required	1
`PRV`	Referring Provider Specialty Information	Situational	1
`REF`	Referring Provider Secondary Identification	Situational	3
Loop 2310B	Rendering Provider Name	Situational	1
`NM1`	Rendering Provider Name	Required	1
`PRV`	Rendering Provider Specialty Information	Required	1
`REF`	Rendering Provider Secondary Identification	Situational	4
Loop 2310C	Service Facility Location Name	Situational	1
`NM1`	Service Facility Location Name	Required	1
`N3`	Service Facility Location Address	Required	1
`N4`	Service Facility Location City State Zip Code	Required	1
`REF`	Service Facility Location Secondary Identification	Situational	3
Loop 2310D	Assistant Surgeon Name	Situational	1
`NM1`	Assistant Surgeon Name	Required	1
`PRV`	Assistant Surgeon Specialty Information	Required	1
`REF`	Assistant Surgeon Secondary Identification	Situational	4
Loop 2310E	Supervising Provider Name	Situational	1
`NM1`	Supervising Provider Name	Required	1
`REF`	Supervising Provider Secondary Identification	Situational	4
Loop 2320	Other Subscriber Information	Situational	10
`SBR`	Other Subscriber Information	Required	1
`CAS`	Claim Level Adjustments	Situational	5
Any order	The loops below can appear in any order	Situational	1
`AMT`	Coordinationof Benefits COB Payer Paid Amount	Situational	1
`AMT`	Remaining Patient Liability	Situational	1
`AMT`	Coordinationof Benefits COB Total Non Amount	Situational	1
`OI`	Other Insurance Coverage Information	Required	1
`MOA`	Outpatient Adjudication Information	Situational	1
Any order	The loops below can appear in any order	Required	1
Loop 2330A	Other Subscriber Name	Required	1
`NM1`	Other Subscriber Name	Required	1
`N3`	Other Subscriber Address	Situational	1
`N4`	Other Subscriber City State Zip Code	Situational	1
`REF`	Other Subscriber Secondary Identification	Situational	2
Loop 2330B	Other Payer Name	Required	1
`NM1`	Other Payer Name	Required	1
`N3`	Other Payer Address	Situational	1
`N4`	Other Payer City State ZIP Code	Situational	1
`DTP`	Claim Check or Remittance Date	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Other Payer Secondary Identifier	Situational	3
`REF`	Other Payer Prior Authorization Number	Situational	1
`REF`	Other Payer Referral Number	Situational	1
`REF`	Other Payer Claim Adjustment Indicator	Situational	1
`REF`	Other Payer Predetermination Identification	Situational	1
`REF`	Other Payer Claim Control Number	Situational	1
Loop 2330C	Other Payer Referring Provider	Situational	2
`NM1`	Other Payer Referring Provider	Required	1
`REF`	Other Payer Referring Provider Secondary Identification	Required	3
Loop 2330D	Other Payer Rendering Provider	Situational	1
`NM1`	Other Payer Rendering Provider	Required	1
`REF`	Other Payer Rendering Provider Secondary Identification	Required	3
Loop 2330E	Other Payer Supervising Provider	Situational	1
`NM1`	Other Payer Supervising Provider	Required	1
`REF`	Other Payer Supervising Provider Identification	Required	3
Loop 2330F	Other Payer Billing Provider	Situational	1
`NM1`	Other Payer Billing Provider	Required	1
`REF`	Other Payer Billing Provider Secondary Identification	Required	2
Loop 2330G	Other Payer Service Facility Location	Situational	1
`NM1`	Other Payer Service Facility Location	Required	1
`REF`	Other Payer Service Facility Location Secondary Identification	Required	3
Loop 2330H	Other Payer Assistant Surgeon	Situational	1
`NM1`	Other Payer Assistant Surgeon	Required	1
`REF`	Other Payer Assistant Surgeon Secondary Identifier	Required	3
Loop 2400	Service Line Number	Required	50
`LX`	Service Line Number	Required	1
`SV3`	Dental Service	Required	1
`TOO`	Tooth Information	Situational	32
Any order	The loops below can appear in any order	Situational	1
`DTP`	Date Service Date	Situational	1
`DTP`	Date Prior Placement	Situational	1
`DTP`	Date Appliance Placement	Situational	1
`DTP`	Date Replacement	Situational	1
`DTP`	Date Treatment Start	Situational	1
`DTP`	Date Treatment Completion	Situational	1
`CN1`	Contract Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Service Predetermination Identification	Situational	5
`REF`	Prior Authorization	Situational	5
`REF`	Line Item Control Number	Situational	1
`REF`	Repriced Claim Number	Situational	1
`REF`	Adjusted Repriced Claim Number	Situational	1
`REF`	Referral Number	Situational	5
`AMT`	Sales Tax Amount	Situational	1
`K3`	File Information	Situational	10
`HCP`	Line Pricing Repricing Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2420A	Rendering Provider Name	Situational	1
`NM1`	Rendering Provider Name	Required	1
`PRV`	Rendering Provider Specialty Information	Required	1
`REF`	Rendering Provider Secondary Identification	Situational	20
Loop 2420B	Assistant Surgeon Name	Situational	1
`NM1`	Assistant Surgeon Name	Required	1
`PRV`	Assistant Surgeon Specialty Information	Situational	1
`REF`	Assistant Surgeon Secondary Identification	Situational	20
Loop 2420C	Supervising Provider Name	Situational	1
`NM1`	Supervising Provider Name	Required	1
`REF`	Supervising Provider Secondary Identification	Situational	20
Loop 2420D	Service Facility Location Name	Situational	1
`NM1`	Service Facility Location Name	Required	1
`N3`	Service Facility Location Address	Required	1
`N4`	Service Facility Location City State ZIP Code	Required	1
`REF`	Service Facility Location Secondary Identification	Situational	20
Loop 2430	Line Adjudication Information	Situational	15
`SVD`	Line Adjudication Information	Required	1
`CAS`	Line Adjustment	Situational	5
`DTP`	Line Checkor Remittance Date	Required	1
`AMT`	Remaining Patient Liability	Situational	1
Loop 2000C	Patient Hierarchical Level	Situational	>1
`HL`	Patient Hierarchical Level	Required	1
`PAT`	Patient Information	Required	1
Loop 2010CA	Patient Name	Required	1
`NM1`	Patient Name	Required	1
`N3`	Patient Address	Required	1
`N4`	Patient City State ZIP Code	Required	1
`DMG`	Patient Demographic Information	Required	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Propertyand Casualty Claim Number	Situational	1
`REF`	Propertyand Casualty Patient Identifier	Situational	1
Loop 2300	Claim Information	Required	100
`CLM`	Claim Information	Required	1
Any order	The loops below can appear in any order	Situational	1
`DTP`	Date Accident	Situational	1
`DTP`	Date Appliance Placement	Situational	1
`DTP`	Date Service Date	Situational	1
`DTP`	Date Repricer Received Date	Situational	1
`DN1`	Orthodontic Total Monthsof Treatment	Situational	1
`DN2`	Tooth Status	Situational	35
`PWK`	Claim Supplemental Information	Situational	10
`CN1`	Contract Information	Situational	1
`AMT`	Patient Amount Paid	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Predetermination Identification	Situational	1
`REF`	Service Authorization Exception Code	Situational	1
`REF`	Payer Claim Control Number	Situational	1
`REF`	Referral Number	Situational	1
`REF`	Prior Authorization	Situational	1
`REF`	Repriced Claim Number	Situational	1
`REF`	Adjusted Repriced Claim Number	Situational	1
`REF`	Claim Identifier for Transmission Intermediaries	Situational	1
`K3`	File Information	Situational	10
`NTE`	Claim Note	Situational	5
`HI`	Health Care Diagnosis Code	Situational	1
`HCP`	Claim Pricing Repricing Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2310A	Referring Provider Name	Situational	2
`NM1`	Referring Provider Name	Required	1
`PRV`	Referring Provider Specialty Information	Situational	1
`REF`	Referring Provider Secondary Identification	Situational	3
Loop 2310B	Rendering Provider Name	Situational	1
`NM1`	Rendering Provider Name	Required	1
`PRV`	Rendering Provider Specialty Information	Required	1
`REF`	Rendering Provider Secondary Identification	Situational	4
Loop 2310C	Service Facility Location Name	Situational	1
`NM1`	Service Facility Location Name	Required	1
`N3`	Service Facility Location Address	Required	1
`N4`	Service Facility Location City State Zip Code	Required	1
`REF`	Service Facility Location Secondary Identification	Situational	3
Loop 2310D	Assistant Surgeon Name	Situational	1
`NM1`	Assistant Surgeon Name	Required	1
`PRV`	Assistant Surgeon Specialty Information	Required	1
`REF`	Assistant Surgeon Secondary Identification	Situational	4
Loop 2310E	Supervising Provider Name	Situational	1
`NM1`	Supervising Provider Name	Required	1
`REF`	Supervising Provider Secondary Identification	Situational	4
Loop 2320	Other Subscriber Information	Situational	10
`SBR`	Other Subscriber Information	Required	1
`CAS`	Claim Level Adjustments	Situational	5
Any order	The loops below can appear in any order	Situational	1
`AMT`	Coordinationof Benefits COB Payer Paid Amount	Situational	1
`AMT`	Remaining Patient Liability	Situational	1
`AMT`	Coordinationof Benefits COB Total Non Amount	Situational	1
`OI`	Other Insurance Coverage Information	Required	1
`MOA`	Outpatient Adjudication Information	Situational	1
Any order	The loops below can appear in any order	Required	1
Loop 2330A	Other Subscriber Name	Required	1
`NM1`	Other Subscriber Name	Required	1
`N3`	Other Subscriber Address	Situational	1
`N4`	Other Subscriber City State Zip Code	Situational	1
`REF`	Other Subscriber Secondary Identification	Situational	2
Loop 2330B	Other Payer Name	Required	1
`NM1`	Other Payer Name	Required	1
`N3`	Other Payer Address	Situational	1
`N4`	Other Payer City State ZIP Code	Situational	1
`DTP`	Claim Check or Remittance Date	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Other Payer Secondary Identifier	Situational	3
`REF`	Other Payer Prior Authorization Number	Situational	1
`REF`	Other Payer Referral Number	Situational	1
`REF`	Other Payer Claim Adjustment Indicator	Situational	1
`REF`	Other Payer Predetermination Identification	Situational	1
`REF`	Other Payer Claim Control Number	Situational	1
Loop 2330C	Other Payer Referring Provider	Situational	2
`NM1`	Other Payer Referring Provider	Required	1
`REF`	Other Payer Referring Provider Secondary Identification	Required	3
Loop 2330D	Other Payer Rendering Provider	Situational	1
`NM1`	Other Payer Rendering Provider	Required	1
`REF`	Other Payer Rendering Provider Secondary Identification	Required	3
Loop 2330E	Other Payer Supervising Provider	Situational	1
`NM1`	Other Payer Supervising Provider	Required	1
`REF`	Other Payer Supervising Provider Identification	Required	3
Loop 2330F	Other Payer Billing Provider	Situational	1
`NM1`	Other Payer Billing Provider	Required	1
`REF`	Other Payer Billing Provider Secondary Identification	Required	2
Loop 2330G	Other Payer Service Facility Location	Situational	1
`NM1`	Other Payer Service Facility Location	Required	1
`REF`	Other Payer Service Facility Location Secondary Identification	Required	3
Loop 2330H	Other Payer Assistant Surgeon	Situational	1
`NM1`	Other Payer Assistant Surgeon	Required	1
`REF`	Other Payer Assistant Surgeon Secondary Identifier	Required	3
Loop 2400	Service Line Number	Required	50
`LX`	Service Line Number	Required	1
`SV3`	Dental Service	Required	1
`TOO`	Tooth Information	Situational	32
Any order	The loops below can appear in any order	Situational	1
`DTP`	Date Service Date	Situational	1
`DTP`	Date Prior Placement	Situational	1
`DTP`	Date Appliance Placement	Situational	1
`DTP`	Date Replacement	Situational	1
`DTP`	Date Treatment Start	Situational	1
`DTP`	Date Treatment Completion	Situational	1
`CN1`	Contract Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
`REF`	Service Predetermination Identification	Situational	5
`REF`	Prior Authorization	Situational	5
`REF`	Line Item Control Number	Situational	1
`REF`	Repriced Claim Number	Situational	1
`REF`	Adjusted Repriced Claim Number	Situational	1
`REF`	Referral Number	Situational	5
`AMT`	Sales Tax Amount	Situational	1
`K3`	File Information	Situational	10
`HCP`	Line Pricing Repricing Information	Situational	1
Any order	The loops below can appear in any order	Situational	1
Loop 2420A	Rendering Provider Name	Situational	1
`NM1`	Rendering Provider Name	Required	1
`PRV`	Rendering Provider Specialty Information	Required	1
`REF`	Rendering Provider Secondary Identification	Situational	20
Loop 2420B	Assistant Surgeon Name	Situational	1
`NM1`	Assistant Surgeon Name	Required	1
`PRV`	Assistant Surgeon Specialty Information	Situational	1
`REF`	Assistant Surgeon Secondary Identification	Situational	20
Loop 2420C	Supervising Provider Name	Situational	1
`NM1`	Supervising Provider Name	Required	1
`REF`	Supervising Provider Secondary Identification	Situational	20
Loop 2420D	Service Facility Location Name	Situational	1
`NM1`	Service Facility Location Name	Required	1
`N3`	Service Facility Location Address	Required	1
`N4`	Service Facility Location City State ZIP Code	Required	1
`REF`	Service Facility Location Secondary Identification	Situational	20
Loop 2430	Line Adjudication Information	Situational	15
`SVD`	Line Adjudication Information	Required	1
`CAS`	Line Adjustment	Situational	5
`DTP`	Line Checkor Remittance Date	Required	1
`AMT`	Remaining Patient Liability	Situational	1
`SE`	Transaction Set Trailer	Required	1

Sample 837D file

A dental claim with CDT procedure codes and tooth information on the service lines. Paste it into EdiNation to see every element named and validated.

ISA*00*          *00*          *ZZ*1234567        *ZZ*11111          *170508*1141*^*00501*000000101*1*P*:~
GS*HC*XXXXXXX*XXXXX*20170617*1741*101*X*005010X224A2~
ST*837*3456*005010X224A2~
BHT*0019*00*0123*20061123*1023*CH~
NM1*41*2*PREMIER BILLING SERVICE*****46*TGJ23~
PER*IC*JERRY*TE*7176149999~
NM1*40*2*INSURANCE COMPANY XYZ*****46*66783JJT~
HL*1**20*1~
NM1*85*2*DENTAL ASSOCIATES*****XX*1234567890~
N3*234 SEAWAY ST~
N4*MIAMI*FL*33111~
REF*EI*587654321~
HL*2*1*22*1~
SBR*P********CI~
NM1*IL*1*SMITH*JANE****MI*111223333~
NM1*PR*2*INSURANCE COMPANY XYZ*****PI*66783JJT~
HL*3*2*23*0~
PAT*19~
NM1*QC*1*SMITH*TED~
N3*236 N MAIN ST~
N4*MIAMI*FL*33413~
DMG*D8*19920501*M~
CLM*26403774*150***11:B:1*Y*A*Y*I~
DTP*472*D8*20061029~
REF*D9*17312345600006351~
NM1*82*1*KILDARE*BEN****XX*9876543210~
PRV*PE*PXC*1223G0001X~
LX*1~
SV3*AD:D2150*100****1~
TOO*JP*12*M:O~
LX*2~
SV3*AD:D1110*50****1~
SE*31*3456~
GE*1*101~
IEA*1*000000101~

The same 837D as JSON

ediFabric turns every loop, segment and element into a named field. This is the transaction from the sample, in the JSON that ediFabric Native and Cloud return and accept.

{
  "ST": {
    "TransactionSetIdentifierCode_01": "837",
    "TransactionSetControlNumber_02": "3456",
    "ImplementationConventionPreference_03": "005010X224A2"
  },
  "BHT_BeginningOfHierarchicalTransaction": {
    "HierarchicalStructureCode_01": "0019",
    "TransactionSetPurposeCode_02": "00",
    "SubmitterTransactionIdentifier_03": "0123",
    "TransactionSetCreationDate_04": "20061123",
    "TransactionSetCreationTime_05": "1023",
    "TransactionTypeCode_06": "CH"
  },
  "AllNM1": {
    "Loop1000A": {
      "NM1_SubmitterName": {
        "EntityIdentifierCode_01": "41",
        "EntityTypeQualifier_02": "2",
        "ResponseContactLastorOrganizationName_03": "PREMIER BILLING SERVICE",
        "IdentificationCodeQualifier_08": "46",
        "ResponseContactIdentifier_09": "TGJ23"
      },
      "PER_SubmitterEDIContactInformation": [
        {
          "ContactFunctionCode_01": "IC",
          "ResponseContactName_02": "JERRY",
          "CommunicationNumberQualifier_03": "TE",
          "ResponseContactCommunicationNumber_04": "7176149999"
        }
      ]
    },
    "Loop1000B": {
      "NM1_ReceiverName": {
        "EntityIdentifierCode_01": "40",
        "EntityTypeQualifier_02": "2",
        "ResponseContactLastorOrganizationName_03": "INSURANCE COMPANY XYZ",
        "IdentificationCodeQualifier_08": "46",
        "ResponseContactIdentifier_09": "66783JJT"
      }
    }
  },
  "Loop2000A": [
    {
      "HL_BillingProviderHierarchicalLevel": {
        "HierarchicalIDNumber_01": "1",
        "HierarchicalLevelCode_03": "20",
        "HierarchicalChildCode_04": "1"
      },
      "AllNM1": {
        "Loop2010AA": {
          "NM1_BillingProviderName": {
            "EntityIdentifierCode_01": "85",
            "EntityTypeQualifier_02": "2",
            "ResponseContactLastorOrganizationName_03": "DENTAL ASSOCIATES",
            "IdentificationCodeQualifier_08": "XX",
            "ResponseContactIdentifier_09": "1234567890"
          },
          "N3_BillingProviderAddress": {
            "ResponseContactAddressLine_01": "234 SEAWAY ST"
          },
          "N4_BillingProviderCity_State_ZIPCode": {
            "AdditionalPatientInformationContactCityName_01": "MIAMI",
            "AdditionalPatientInformationContactStateCode_02": "FL",
            "AdditionalPatientInformationContactPostalZoneorZIPCode_03": "33111"
          },
          "AllREF": {
            "REF_BillingProviderTaxIdentification": {
              "ReferenceIdentificationQualifier_01": "EI",
              "MemberGrouporPolicyNumber_02": "587654321"
            }
          }
        }
      },
      "Loop2000B": [
        {
          "HL_SubscriberHierarchicalLevel": {
            "HierarchicalIDNumber_01": "2",
            "HierarchicalParentIDNumber_02": "1",
            "HierarchicalLevelCode_03": "22",
            "HierarchicalChildCode_04": "1"
          },
          "SBR_SubscriberInformation": {
            "PayerResponsibilitySequenceNumberCode_01": "P",
            "ClaimFilingIndicatorCode_09": "CI"
          },
          "AllNM1": {
            "Loop2010BA": {
              "NM1_SubscriberName": {
                "EntityIdentifierCode_01": "IL",
                "EntityTypeQualifier_02": "1",
                "ResponseContactLastorOrganizationName_03": "SMITH",
                "ResponseContactFirstName_04": "JANE",
                "IdentificationCodeQualifier_08": "MI",
                "ResponseContactIdentifier_09": "111223333"
              }
            },
            "Loop2010BB": {
              "NM1_PayerName": {
                "EntityIdentifierCode_01": "PR",
                "EntityTypeQualifier_02": "2",
                "ResponseContactLastorOrganizationName_03": "INSURANCE COMPANY XYZ",
                "IdentificationCodeQualifier_08": "PI",
                "ResponseContactIdentifier_09": "66783JJT"
              }
            }
          },
          "Loop2000C": [
            {
              "HL_PatientHierarchicalLevel": {
                "HierarchicalIDNumber_01": "3",
                "HierarchicalParentIDNumber_02": "2",
                "HierarchicalLevelCode_03": "23",
                "HierarchicalChildCode_04": "0"
              },
              "PAT_PatientInformation": {
                "IndividualRelationshipCode_01": "19"
              },
              "Loop2010CA": {
                "NM1_PatientName": {
                  "EntityIdentifierCode_01": "QC",
                  "EntityTypeQualifier_02": "1",
                  "ResponseContactLastorOrganizationName_03": "SMITH",
                  "ResponseContactFirstName_04": "TED"
                },
                "N3_PatientAddress": {
                  "ResponseContactAddressLine_01": "236 N MAIN ST"
                },
                "N4_PatientCity_State_ZIPCode": {
                  "AdditionalPatientInformationContactCityName_01": "MIAMI",
                  "AdditionalPatientInformationContactStateCode_02": "FL",
                  "AdditionalPatientInformationContactPostalZoneorZIPCode_03": "33413"
                },
                "DMG_PatientDemographicInformation": {
                  "DateTimePeriodFormatQualifier_01": "D8",
                  "DependentBirthDate_02": "19920501",
                  "DependentGenderCode_03": "M"
                }
              },
              "Loop2300": [
                {
                  "CLM_ClaimInformation": {
                    "PatientControlNumber_01": "26403774",
                    "TotalClaimChargeAmount_02": "150",
                    "HealthCareServiceLocationInformation_05": {
                      "FacilityTypeCode_01": "11",
                      "FacilityCodeQualifier_02": "B",
                      "ClaimFrequencyTypeCode_03": "1"
                    },
                    "ProviderorSupplierSignatureIndicator_06": "Y",
                    "AssignmentorPlanParticipationCode_07": "A",
                    "BenefitsAssignmentCertificationIndicator_08": "Y",
                    "ReleaseofInformationCode_09": "I"
                  },
                  "AllDTP": {
                    "DTP_Date_ServiceDate": {
                      "DateTimeQualifier_01": "472",
                      "DateTimePeriodFormatQualifier_02": "D8",
                      "DateTimePeriod_03": "20061029"
                    }
                  },
                  "AllREF": {
                    "REF_ClaimIdentifierForTransmissionIntermediaries": {
                      "ReferenceIdentificationQualifier_01": "D9",
                      "MemberGrouporPolicyNumber_02": "17312345600006351"
                    }
                  },
                  "AllNM1": {
                    "Loop2310B": {
                      "NM1_RenderingProviderName": {
                        "EntityIdentifierCode_01": "82",
                        "EntityTypeQualifier_02": "1",
                        "ResponseContactLastorOrganizationName_03": "KILDARE",
                        "ResponseContactFirstName_04": "BEN",
                        "IdentificationCodeQualifier_08": "XX",
                        "ResponseContactIdentifier_09": "9876543210"
                      },
                      "PRV_RenderingProviderSpecialtyInformation": {
                        "ProviderCode_01": "PE",
                        "ReferenceIdentificationQualifier_02": "PXC",
                        "ProviderTaxonomyCode_03": "1223G0001X"
                      }
                    }
                  },
                  "Loop2400": [
                    {
                      "LX_ServiceLineNumber": {
                        "AssignedNumber_01": "1"
                      },
                      "SV3_DentalService": {
                        "CompositeMedicalProcedureIdentifier_01": {
                          "ProductorServiceIDQualifier_01": "AD",
                          "ProcedureCode_02": "D2150"
                        },
                        "LineItemChargeAmount_02": "100",
                        "ProcedureCount_06": "1"
                      },
                      "TOO_ToothInformation": [
                        {
                          "CodeListQualifierCode_01": "JP",
                          "ToothCode_02": "12",
                          "ToothSurface_03": {
                            "ToothSurfaceCode_01": "M",
                            "ToothSurfaceCode_02": "O"
                          }
                        }
                      ]
                    },
                    {
                      "LX_ServiceLineNumber": {
                        "AssignedNumber_01": "2"
                      },
                      "SV3_DentalService": {
                        "CompositeMedicalProcedureIdentifier_01": {
                          "ProductorServiceIDQualifier_01": "AD",
                          "ProcedureCode_02": "D1110"
                        },
                        "LineItemChargeAmount_02": "50",
                        "ProcedureCount_06": "1"
                      }
                    }
                  ]
                }
              ]
            }
          ]
        }
      ]
    }
  ],
  "SE": {
    "NumberofIncludedSegments_01": "31",
    "TransactionSetControlNumber_02": "3456"
  }
}

Parse and validate an 837D file

Read the file into typed objects with ediFabric .NET, convert it to JSON in process with the ediFabric Native bindings for Python, Java and C, or post it to the ediFabric Cloud REST API from any language.

.NET
Python
Java
C
Cloud

using EdiFabric.Templates.Hipaa5010;

License.SetSerial("YOUR_SERIAL_KEY");

using (var stream = File.OpenRead(@"C:\edi\DentalClaim.txt"))
using (var reader = new X12Reader(stream, "EdiFabric.Templates.Hipaa"))
{
    var items = await reader.ReadToEndAsync();
    foreach (var transaction in items.OfType<TS837D>())
    {
        if (transaction.IsValid(out MessageErrorContext errors))
            Console.WriteLine($"{transaction.ST.TransactionSetControlNumber_02} is valid");
        else
            Console.WriteLine(string.Join(Environment.NewLine, errors.Flatten()));
    }
} Install and get started 837D example project Walkthrough
import json
import edifabric_x12 as ef

serial = "YOUR_SERIAL_KEY"
ef.load_library()
ef.set_serial(serial)
ef.set_map(json.dumps({"default": serial, "maps": {}}))

edi = open("DentalClaim.txt", "rb").read()
output, offset = ef.parse(edi, ef.ParseMode.JSON_VALIDATE)
transactions = output[:offset]
report = json.loads(output[offset:])
print(report["errors_count"]) Python bindingsediFabric Native
import com.edifabric.nativex12.EdiFabricX12;
import com.edifabric.nativex12.ParseMode;
import com.edifabric.nativex12.ParseResult;

String serial = "YOUR_SERIAL_KEY";
EdiFabricX12.loadLibrary();
EdiFabricX12.setSerial(serial);
EdiFabricX12.setMap("{\"default\":\"" + serial + "\",\"maps\":{}}");

String edi = Files.readString(Path.of("DentalClaim.txt"));
ParseResult result = EdiFabricX12.parse(edi, ParseMode.JSON_VALIDATE);
System.out.println(result.getTransactions());
System.out.println(result.getReport()); Java bindingsediFabric Native
#include "edifabric_x12.h"

const char *serial = "YOUR_SERIAL_KEY";
ef_parse_result result;

if (ef_load_library(NULL) != 0)
    return 1;
ef_set_serial(serial);
ef_set_map("{\"default\":\"YOUR_SERIAL_KEY\",\"maps\":{}}");

char *edi = read_file("DentalClaim.txt", NULL);   /* helper in example_all_functions.c */
if (ef_parse(edi, EF_PARSE_JSON_VALIDATE, NULL, &result) == 0) {
    /* transactions = output[0 .. offset), report = output[offset .. length) */
    fwrite(result.output.data, 1, (size_t)result.output.length, stdout);
    ef_free(result.output.data);
} C bindingsediFabric Native
curl -X POST 'https://api.edination.com/v2/x12/read' \
-H 'Ocp-Apim-Subscription-Key: YOUR_SERIAL_KEY' \
-H 'Content-Type: application/octet-stream' \
--data-binary '@DentalClaim.txt' TranslateValidateediFabric Cloud

Generate an 837D file

Populate a TS837D object in .NET, or pass JSON in the shape shown above to ediFabric Native or ediFabric Cloud, and get a valid 837D file back.

.NET
Python
Java
C
Cloud

using EdiFabric.Templates.Hipaa5010;

License.SetSerial("YOUR_SERIAL_KEY");

var transaction = new TS837D();

//  ST TRANSACTION SET HEADER
transaction.ST = new ST();
transaction.ST.TransactionSetIdentifierCode_01 = "837";
transaction.ST.TransactionSetControlNumber_02 = "0001";
transaction.ST.ImplementationConventionPreference_03 = "005010X224A2";

//  BHT TRANSACTION SET HIERARCHY AND CONTROL INFORMATION
transaction.BHT_BeginningOfHierarchicalTransaction = new BHT_BeginningOfHierarchicalTransaction_8();
transaction.BHT_BeginningOfHierarchicalTransaction.HierarchicalStructureCode_01 = "0019";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetPurposeCode_02 = "00";
transaction.BHT_BeginningOfHierarchicalTransaction.SubmitterTransactionIdentifier_03 = "0123";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationDate_04 = "20061123";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationTime_05 = "1023";
transaction.BHT_BeginningOfHierarchicalTransaction.TransactionTypeCode_06 = "CH";

//  Occurrence of NM1 Loops in any order
transaction.AllNM1 = new All_NM1_837D_6();

//  Begin 1000A Loop SUBMITTER NAME
transaction.AllNM1.Loop1000A = new Loop_1000A_837D();

// ... set the remaining loops and segments the same way

// SegmentBuilders is in the Common project of the example repository
using (var stream = new MemoryStream())
{
    using (var writer = new X12Writer(stream))
    {
        writer.Write(SegmentBuilders.BuildIsa("1"));
        writer.Write(SegmentBuilders.BuildGs("1", "SENDER1", "RECEIVER1", "005010X224A2"));
        writer.Write(transaction);
    }
    Console.WriteLine(Encoding.UTF8.GetString(stream.ToArray()));
} Install and get started Full 837D build methodExample repository
import json
import edifabric_x12 as ef

serial = "YOUR_SERIAL_KEY"
ef.load_library()
ef.set_serial(serial)
ef.set_map(json.dumps({"default": serial, "maps": {}}))

# the transactions JSON returned by ef.parse, edited or produced by your application
transactions = open("DentalClaim.json", "rb").read()
edi = ef.build(transactions, postfix="\r\n")
print(edi) Python bindings
import com.edifabric.nativex12.EdiFabricX12;

String serial = "YOUR_SERIAL_KEY";
EdiFabricX12.loadLibrary();
EdiFabricX12.setSerial(serial);
EdiFabricX12.setMap("{\"default\":\"" + serial + "\",\"maps\":{}}");

// the transactions JSON returned by parse, edited or produced by your application
String transactions = Files.readString(Path.of("DentalClaim.json"));
String edi = EdiFabricX12.build(transactions, "\r\n");
System.out.println(edi); Java bindings
#include "edifabric_x12.h"

ef_buffer edi;

if (ef_load_library(NULL) != 0)
    return 1;
ef_set_serial("YOUR_SERIAL_KEY");
ef_set_map("{\"default\":\"YOUR_SERIAL_KEY\",\"maps\":{}}");

/* the transactions JSON returned by ef_parse, edited or produced by your application */
char *transactions = read_file("DentalClaim.json", NULL);
if (ef_build(transactions, "\r\n", &edi) == 0) {
    fwrite(edi.data, 1, (size_t)edi.length, stdout);
    ef_free(edi.data);
} C bindings
# the JSON returned by /read, edited or produced by your application
curl -X POST 'https://api.edination.com/v2/x12/write' \
-H 'Ocp-Apim-Subscription-Key: YOUR_SERIAL_KEY' \
-H 'Content-Type: application/json' \
--data-binary '@DentalClaim.json' \
-o 'DentalClaim.txt' How-tosediFabric Cloud

Complete ediFabric .NET example

A complete C# program for the X12 837D, built on TS837D in EdiFabric.Templates.Hipaa. The same code is in the ediFabric .NET examples on GitHub.

using EdiFabric.Framework.Readers;
using EdiFabric.Framework.Writers;
using EdiFabric.Templates.Hipaa5010;
using System.Collections.Generic;
using System.IO;
using System.Linq;
using EdiFabric.Core.Model.Edi;
using EdiFabric.Core.Model.Edi.X12;
using EdiFabric.Examples.X12.Common;

namespace EdiFabric.Examples.X12.T837D
{
    class Program
    {
        static void Main(string[] args)
        {
            SerialKey.Set(Common.SerialKey.Get());
            Read();
            Write();
        }

        ///
        /// Read Dental Claim
        ///
        static void Read()
        {
            var ediStream = File.OpenRead(Directory.GetCurrentDirectory() + @"\..\..\..\Files\Hipaa\DentalClaim.txt");

            List ediItems;
            using (var ediReader = new X12Reader(ediStream, "EdiFabric.Templates.Hipaa"))
                ediItems = ediReader.ReadToEnd().ToList();

            var transactions = ediItems.OfType();

            foreach (var transaction in transactions)
            {
                if (transaction.HasErrors)
                {
                    //  partially parsed
                    var errors = transaction.ErrorContext.Flatten();
                }
            }
        }

        ///
        /// Write Dental Claim
        ///
        static void Write()
        {
            var transaction = BuildDentalClaim("3456");

            using (var stream = new MemoryStream())
            {
                using (var writer = new X12Writer(stream))
                {
                    writer.Write(SegmentBuilders.BuildIsa("1"));
                    writer.Write(SegmentBuilders.BuildGs("1", "SENDER1", "RECEIVER1", "005010X224A2"));
                    writer.Write(transaction);
                }

                var ediString = stream.LoadToString();
            }
        }

        ///
        /// Build dental claim.
        /// Original from http://www.x12.org/examples/005010X224/commercial-health-insurance/
        /// The patient is a different person than the subscriber. The payer is a commercial health insurance company.
        /// Scenario:
        /// SUBSCRIBER: Jane Smith
        /// KEY INSURANCE COMPANY ID #: SSN
        /// SSN: 111-22-3333
        /// PATIENT: Ted Smith
        /// PATIENT ADDRESS: 236 N.Main St., Miami, Fl, 33413
        /// SEX: M
        /// DOB: 05/01/1992
        /// PATIENT RELATIONSHIP: Child
        /// DESTINATION PAYER: Insurance Company XYZ
        /// RECEIVER: Insurance Company XYZ
        /// ETIN#: 66783JJT
        /// SUBMITTER: Premier Billing Service
        /// ETIN#: TGJ23
        /// BILLING PROVIDER: Dental Associates
        /// NPI: 1234567890
        /// TIN: 587654321
        /// ADDRESS: 234 Seaway St., Miami, FL, 33111
        /// RENDERING PROVIDER: Dr.Ben Kildare
        /// NPI: 9876543210
        /// PATIENT ACCOUNT NUMBER: 2-640-3774
        /// DOS: 20061029
        /// POS= Office
        /// SERVICES RENDERED: Two surface amalgam on tooth #12 (mesial and occlusal surfaces) and prophy.
        /// CHARGES: amalgam = $100.00, prophy = $50.00.
        /// ELECTRONIC ROUTE: VAN submits claim on behalf of billing provider (submitter) to Insurance Company XYZ (receiver).
        /// VAN CLAIM IDENTIFICATION NUMBER: 17312345600006351.
        ///
        static TS837D BuildDentalClaim(string controlNumber)
        {
            var result = new TS837D();

            //  ST TRANSACTION SET HEADER
            result.ST = new ST();
            result.ST.TransactionSetIdentifierCode_01 = "837";
            result.ST.TransactionSetControlNumber_02 = controlNumber.PadLeft(9, '0');
            result.ST.ImplementationConventionPreference_03 = "005010X224A2";

            //  BHT TRANSACTION SET HIERARCHY AND CONTROL INFORMATION
            result.BHT_BeginningOfHierarchicalTransaction = new BHT_BeginningOfHierarchicalTransaction_8();
            result.BHT_BeginningOfHierarchicalTransaction.HierarchicalStructureCode_01 = "0019";
            result.BHT_BeginningOfHierarchicalTransaction.TransactionSetPurposeCode_02 = "00";
            result.BHT_BeginningOfHierarchicalTransaction.SubmitterTransactionIdentifier_03 = "0123";
            result.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationDate_04 = "20061123";
            result.BHT_BeginningOfHierarchicalTransaction.TransactionSetCreationTime_05 = "1023";
            result.BHT_BeginningOfHierarchicalTransaction.TransactionTypeCode_06 = "CH";

            //  Occurrence of NM1 Loops in any order
            result.AllNM1 = new All_NM1_837D_6();

            //  Begin 1000A Loop SUBMITTER NAME
            result.AllNM1.Loop1000A = new Loop_1000A_837D();

            //  NM1 SUBMITTER
            result.AllNM1.Loop1000A.NM1_SubmitterName = new NM1_InformationReceiverName_4();
            result.AllNM1.Loop1000A.NM1_SubmitterName.EntityIdentifierCode_01 = "41";
            result.AllNM1.Loop1000A.NM1_SubmitterName.EntityTypeQualifier_02 = "2";
            result.AllNM1.Loop1000A.NM1_SubmitterName.ResponseContactLastorOrganizationName_03 = "PREMIER BILLING SERVICE";
            result.AllNM1.Loop1000A.NM1_SubmitterName.IdentificationCodeQualifier_08 = "46";
            result.AllNM1.Loop1000A.NM1_SubmitterName.ResponseContactIdentifier_09 = "TGJ23";

            //  Repeating PER Patient information
            result.AllNM1.Loop1000A.PER_SubmitterEDIContactInformation = new List();

            //  PER SUBMITTER EDI CONTACT INFORMATION
            var per1 = new PER_BillingProviderContactInformation();
            per1.ContactFunctionCode_01 = "IC";
            per1.ResponseContactName_02 = "JERRY";
            per1.CommunicationNumberQualifier_03 = "TE";
            per1.ResponseContactCommunicationNumber_04 = "7176149999";
            result.AllNM1.Loop1000A.PER_SubmitterEDIContactInformation.Add(per1);

            //  End 1000A Loop

            //  Begin 1000B Loop RECEIVER NAME
            result.AllNM1.Loop1000B = new Loop_1000B_837D();

            //  NM1 RECEIVER
            result.AllNM1.Loop1000B.NM1_ReceiverName = new NM1_ReceiverName();
            result.AllNM1.Loop1000B.NM1_ReceiverName.EntityIdentifierCode_01 = "40";
            result.AllNM1.Loop1000B.NM1_ReceiverName.EntityTypeQualifier_02 = "2";
            result.AllNM1.Loop1000B.NM1_ReceiverName.ResponseContactLastorOrganizationName_03 = "INSURANCE COMPANY XYZ";
            result.AllNM1.Loop1000B.NM1_ReceiverName.IdentificationCodeQualifier_08 = "46";
            result.AllNM1.Loop1000B.NM1_ReceiverName.ResponseContactIdentifier_09 = "66783JJT";

            //  End 1000B Loop

            //  Repeating 2000A Loops
            result.Loop2000A = new List();

            //  Begin 2000A Loop BILLING PROVIDER
            var loop2000A = new Loop_2000A_837D();

            //  HIERARCHAL LEVEL 1
            loop2000A.HL_BillingProviderHierarchicalLevel = new HL_BillingProviderHierarchicalLevel();
            loop2000A.HL_BillingProviderHierarchicalLevel.HierarchicalIDNumber_01 = "1";
            loop2000A.HL_BillingProviderHierarchicalLevel.HierarchicalLevelCode_03 = "20";
            loop2000A.HL_BillingProviderHierarchicalLevel.HierarchicalChildCode_04 = "1";

            //  Occurrence of NM1 Loops in any order
            loop2000A.AllNM1 = new All_NM1_837D();

            //  Begin 2010AA Loop BILLING PROVIDER NAME
            loop2000A.AllNM1.Loop2010AA = new Loop_2010AA_837D();

            //  NM1 BILLING PROVIDER NAME
            loop2000A.AllNM1.Loop2010AA.NM1_BillingProviderName = new NM1_BillingProviderName_2();
            loop2000A.AllNM1.Loop2010AA.NM1_BillingProviderName.EntityIdentifierCode_01 = "85";
            loop2000A.AllNM1.Loop2010AA.NM1_BillingProviderName.EntityTypeQualifier_02 = "2";
            loop2000A.AllNM1.Loop2010AA.NM1_BillingProviderName.ResponseContactLastorOrganizationName_03 = "DENTAL ASSOCIATES";
            loop2000A.AllNM1.Loop2010AA.NM1_BillingProviderName.IdentificationCodeQualifier_08 = "XX";
            loop2000A.AllNM1.Loop2010AA.NM1_BillingProviderName.ResponseContactIdentifier_09 = "1234567890";

            //  N3 BILLING PROVIDER ADDRESS
            loop2000A.AllNM1.Loop2010AA.N3_BillingProviderAddress = new N3_AdditionalPatientInformationContactAddress();
            loop2000A.AllNM1.Loop2010AA.N3_BillingProviderAddress.ResponseContactAddressLine_01 = "234 SEAWAY ST";

            //  N4 BILLING PROVIDER LOCATION
            loop2000A.AllNM1.Loop2010AA.N4_BillingProviderCity_State_ZIPCode = new N4_AdditionalPatientInformationContactCity();
            loop2000A.AllNM1.Loop2010AA.N4_BillingProviderCity_State_ZIPCode.AdditionalPatientInformationContactCityName_01 = "MIAMI";
            loop2000A.AllNM1.Loop2010AA.N4_BillingProviderCity_State_ZIPCode.AdditionalPatientInformationContactStateCode_02 = "FL";
            loop2000A.AllNM1.Loop2010AA.N4_BillingProviderCity_State_ZIPCode.AdditionalPatientInformationContactPostalZoneorZIPCode_03 = "33111";

            //  Occurrence of REF Segments in any order
            loop2000A.AllNM1.Loop2010AA.AllREF = new All_REF_837D_8();

            //  REF BILLING PROVIDER'S TAX IDENTIFICATION
            loop2000A.AllNM1.Loop2010AA.AllREF.REF_BillingProviderTaxIdentification = new REF_BillingProviderTaxIdentification();
            loop2000A.AllNM1.Loop2010AA.AllREF.REF_BillingProviderTaxIdentification.ReferenceIdentificationQualifier_01 = "EI";
            loop2000A.AllNM1.Loop2010AA.AllREF.REF_BillingProviderTaxIdentification.MemberGrouporPolicyNumber_02 = "587654321";

            //  Repeating PER billing provider contact information
            loop2000A.AllNM1.Loop2010AA.PER_BillingProviderContactInformation = new List();

            //  End 2010AA Loop

            //  Repeating 2000B Loops
            loop2000A.Loop2000B = new List();

            //  Begin 2000B Loop SUBSCRIBER HL LOOP
            var loop2000B = new Loop_2000B_837D();

            //  HIERARCHAL LEVEL 2
            loop2000B.HL_SubscriberHierarchicalLevel = new HL_SubscriberHierarchicalLevel();
            loop2000B.HL_SubscriberHierarchicalLevel.HierarchicalIDNumber_01 = "2";
            loop2000B.HL_SubscriberHierarchicalLevel.HierarchicalParentIDNumber_02 = "1";
            loop2000B.HL_SubscriberHierarchicalLevel.HierarchicalLevelCode_03 = "22";
            loop2000B.HL_SubscriberHierarchicalLevel.HierarchicalChildCode_04 = "1";

            //  SBR SUBSCRIBER INFORMATION
            loop2000B.SBR_SubscriberInformation = new SBR_SubscriberInformation();
            loop2000B.SBR_SubscriberInformation.PayerResponsibilitySequenceNumberCode_01 = "P";
            loop2000B.SBR_SubscriberInformation.ClaimFilingIndicatorCode_09 = "CI";

            //  Occurrence of NM1 Loops in any order
            loop2000B.AllNM1 = new All_NM1_837D_2();

            //  Begin 2010BA Loop SUBSCRIBER NAME LOOP
            loop2000B.AllNM1.Loop2010BA = new Loop_2010BA_837D();

            //  NM1 SUBSCRIBER'S NAME
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName = new NM1_SubscriberName_5();
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName.EntityIdentifierCode_01 = "IL";
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName.EntityTypeQualifier_02 = "1";
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName.ResponseContactLastorOrganizationName_03 = "SMITH";
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName.ResponseContactFirstName_04 = "JANE";
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName.IdentificationCodeQualifier_08 = "MI";
            loop2000B.AllNM1.Loop2010BA.NM1_SubscriberName.ResponseContactIdentifier_09 = "111223333";

            //  End 2010BA Loop

            //  Begin 2010BB Loop PAYER NAME LOOP
            loop2000B.AllNM1.Loop2010BB = new Loop_2010BB_837D();

            //  NM1 PAYER'S NAME
            loop2000B.AllNM1.Loop2010BB.NM1_PayerName = new NM1_OtherPayerName();
            loop2000B.AllNM1.Loop2010BB.NM1_PayerName.EntityIdentifierCode_01 = "PR";
            loop2000B.AllNM1.Loop2010BB.NM1_PayerName.EntityTypeQualifier_02 = "2";
            loop2000B.AllNM1.Loop2010BB.NM1_PayerName.ResponseContactLastorOrganizationName_03 = "INSURANCE COMPANY XYZ";
            loop2000B.AllNM1.Loop2010BB.NM1_PayerName.IdentificationCodeQualifier_08 = "PI";
            loop2000B.AllNM1.Loop2010BB.NM1_PayerName.ResponseContactIdentifier_09 = "66783JJT";

            //  End 2010BB Loop

            //  Repeating 2000C Loops
            loop2000B.Loop2000C = new List();

            //  Begin 2000C Loop PATIENT'S HL LOOP
            var loop2000C = new Loop_2000C_837D();

            //  HIERARCHAL LEVEL 3
            loop2000C.HL_PatientHierarchicalLevel = new HL_DependentLevel();
            loop2000C.HL_PatientHierarchicalLevel.HierarchicalIDNumber_01 = "3";
            loop2000C.HL_PatientHierarchicalLevel.HierarchicalParentIDNumber_02 = "2";
            loop2000C.HL_PatientHierarchicalLevel.HierarchicalLevelCode_03 = "23";
            loop2000C.HL_PatientHierarchicalLevel.HierarchicalChildCode_04 = "0";

            //  PAT PATIENT INFORMATION
            loop2000C.PAT_PatientInformation = new PAT_PatientInformation_2();
            loop2000C.PAT_PatientInformation.IndividualRelationshipCode_01 = "19";

            //  Begin 2010CA Loop PATIENT
            loop2000C.Loop2010CA = new Loop_2010CA_837D();

            //  NM1 PATIENT'S NAME
            loop2000C.Loop2010CA.NM1_PatientName = new NM1_PatientName_3();
            loop2000C.Loop2010CA.NM1_PatientName.EntityIdentifierCode_01 = "QC";
            loop2000C.Loop2010CA.NM1_PatientName.EntityTypeQualifier_02 = "1";
            loop2000C.Loop2010CA.NM1_PatientName.ResponseContactLastorOrganizationName_03 = "SMITH";
            loop2000C.Loop2010CA.NM1_PatientName.ResponseContactFirstName_04 = "TED";

            //  N3 PATIENT'S ADDRESS
            loop2000C.Loop2010CA.N3_PatientAddress = new N3_AdditionalPatientInformationContactAddress();
            loop2000C.Loop2010CA.N3_PatientAddress.ResponseContactAddressLine_01 = "236 N MAIN ST";

            //  N4 PATIENT'S CITY
            loop2000C.Loop2010CA.N4_PatientCity_State_ZIPCode = new N4_AdditionalPatientInformationContactCity();
            loop2000C.Loop2010CA.N4_PatientCity_State_ZIPCode.AdditionalPatientInformationContactCityName_01 = "MIAMI";
            loop2000C.Loop2010CA.N4_PatientCity_State_ZIPCode.AdditionalPatientInformationContactStateCode_02 = "FL";
            loop2000C.Loop2010CA.N4_PatientCity_State_ZIPCode.AdditionalPatientInformationContactPostalZoneorZIPCode_03 = "33413";

            //  DMG PATIENT DEMOGRAPHIC INFORMATION
            loop2000C.Loop2010CA.DMG_PatientDemographicInformation = new DMG_PatientDemographicInformation();
            loop2000C.Loop2010CA.DMG_PatientDemographicInformation.DateTimePeriodFormatQualifier_01 = "D8";
            loop2000C.Loop2010CA.DMG_PatientDemographicInformation.DependentBirthDate_02 = "19920501";
            loop2000C.Loop2010CA.DMG_PatientDemographicInformation.DependentGenderCode_03 = "M";

            //  End 2010CA Loop

            //  Repeating 2300 Loops
            loop2000C.Loop2300 = new List();

            //  Begin 2300 Loop CLAIM
            var loop2300 = new Loop_2300_837D();

            //  CLM HEALTH CLAIM INFORMATION
            loop2300.CLM_ClaimInformation = new CLM_ClaimInformation();
            loop2300.CLM_ClaimInformation.PatientControlNumber_01 = "26403774";
            loop2300.CLM_ClaimInformation.TotalClaimChargeAmount_02 = "150";
            loop2300.CLM_ClaimInformation.HealthCareServiceLocationInformation_05 = new C023_HealthCareServiceLocationInformation_2();
            loop2300.CLM_ClaimInformation.HealthCareServiceLocationInformation_05.FacilityTypeCode_01 = "11";
            loop2300.CLM_ClaimInformation.HealthCareServiceLocationInformation_05.FacilityCodeQualifier_02 = "B";
            loop2300.CLM_ClaimInformation.HealthCareServiceLocationInformation_05.ClaimFrequencyTypeCode_03 = "1";
            loop2300.CLM_ClaimInformation.ProviderorSupplierSignatureIndicator_06 = "Y";
            loop2300.CLM_ClaimInformation.AssignmentorPlanParticipationCode_07 = "A";
            loop2300.CLM_ClaimInformation.BenefitsAssignmentCertificationIndicator_08 = "Y";
            loop2300.CLM_ClaimInformation.ReleaseofInformationCode_09 = "I";

            //  Occurrence of DTP Segments in any order
            loop2300.AllDTP = new All_DTP_837D_2();

            //  DTP DATE - SERVICE DATE
            loop2300.AllDTP.DTP_Date_ServiceDate = new DTP_ClaimLevelServiceDate();
            loop2300.AllDTP.DTP_Date_ServiceDate.DateTimeQualifier_01 = "472";
            loop2300.AllDTP.DTP_Date_ServiceDate.DateTimePeriodFormatQualifier_02 = "D8";
            loop2300.AllDTP.DTP_Date_ServiceDate.DateTimePeriod_03 = "20061029";

            //  Occurrence of REF Segments in any order
            loop2300.AllREF = new All_REF_837D_6();

            //  REF VAN CLAIM NUMBER
            loop2300.AllREF.REF_ClaimIdentifierForTransmissionIntermediaries = new REF_ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries();
            loop2300.AllREF.REF_ClaimIdentifierForTransmissionIntermediaries.ReferenceIdentificationQualifier_01 = "D9";
            loop2300.AllREF.REF_ClaimIdentifierForTransmissionIntermediaries.MemberGrouporPolicyNumber_02 = "17312345600006351";

            //  Occurrence of NM1 Loops in any order
            loop2300.AllNM1 = new All_NM1_837D_3();

            //  Begin 2310B Loop RENDERING PROVIDER
            loop2300.AllNM1.Loop2310B = new Loop_2310B_837D();

            //  NM1 RENDERING PROVIDER’S NAME
            loop2300.AllNM1.Loop2310B.NM1_RenderingProviderName = new NM1_RenderingProviderName();
            loop2300.AllNM1.Loop2310B.NM1_RenderingProviderName.EntityIdentifierCode_01 = "82";
            loop2300.AllNM1.Loop2310B.NM1_RenderingProviderName.EntityTypeQualifier_02 = "1";
            loop2300.AllNM1.Loop2310B.NM1_RenderingProviderName.ResponseContactLastorOrganizationName_03 = "KILDARE";
            loop2300.AllNM1.Loop2310B.NM1_RenderingProviderName.ResponseContactFirstName_04 = "BEN";
            loop2300.AllNM1.Loop2310B.NM1_RenderingProviderName.IdentificationCodeQualifier_08 = "XX";
            loop2300.AllNM1.Loop2310B.NM1_RenderingProviderName.ResponseContactIdentifier_09 = "9876543210";

            loop2300.AllNM1.Loop2310B.PRV_RenderingProviderSpecialtyInformation = new PRV_RenderingProviderSpecialtyInformation();
            loop2300.AllNM1.Loop2310B.PRV_RenderingProviderSpecialtyInformation.ProviderCode_01 = "PE";
            loop2300.AllNM1.Loop2310B.PRV_RenderingProviderSpecialtyInformation.ReferenceIdentificationQualifier_02 = "PXC";
            loop2300.AllNM1.Loop2310B.PRV_RenderingProviderSpecialtyInformation.ProviderTaxonomyCode_03 = "1223G0001X";

            //  End 2310B Loop

            //  Repeating 2400 Loops
            loop2300.Loop2400 = new List();

            //  Begin 2400 Loop 1 SERVICE LINE
            var loop24001 = new Loop_2400_837D();

            //  LX SERVICE LINE NUMBER
            loop24001.LX_ServiceLineNumber = new LX_HeaderNumber();
            loop24001.LX_ServiceLineNumber.AssignedNumber_01 = "1";

            //  SV3 DENTAL SERVICE
            loop24001.SV3_DentalService = new SV3_DentalService();
            loop24001.SV3_DentalService.CompositeMedicalProcedureIdentifier_01 = new C003_CompositeMedicalProcedureIdentifier_11();
            loop24001.SV3_DentalService.CompositeMedicalProcedureIdentifier_01.ProductorServiceIDQualifier_01 = "AD";
            loop24001.SV3_DentalService.CompositeMedicalProcedureIdentifier_01.ProcedureCode_02 = "D2150";
            loop24001.SV3_DentalService.LineItemChargeAmount_02 = "100";
            loop24001.SV3_DentalService.ProcedureCount_06 = "1";

            //  Repeating TOO
            loop24001.TOO_ToothInformation = new List();

            //  TOO TOOTH NUMBER/SURFACES
            var too = new TOO_ToothInformation();
            too.CodeListQualifierCode_01 = "JP";
            too.ToothCode_02 = "12";
            too.ToothSurface_03 = new C005_ToothSurface();
            too.ToothSurface_03.ToothSurfaceCode_01 = "M";
            too.ToothSurface_03.ToothSurfaceCode_02 = "O";
            loop24001.TOO_ToothInformation.Add(too);

            //  End 2400 Loop 1
            loop2300.Loop2400.Add(loop24001);

            //  Begin 2400 Loop 2 SERVICE LINE
            var loop24002 = new Loop_2400_837D();

            //  LX SERVICE LINE NUMBER
            loop24002.LX_ServiceLineNumber = new LX_HeaderNumber();
            loop24002.LX_ServiceLineNumber.AssignedNumber_01 = "2";

            //  SV3 DENTAL SERVICE
            loop24002.SV3_DentalService = new SV3_DentalService();
            loop24002.SV3_DentalService.CompositeMedicalProcedureIdentifier_01 = new C003_CompositeMedicalProcedureIdentifier_11();
            loop24002.SV3_DentalService.CompositeMedicalProcedureIdentifier_01.ProductorServiceIDQualifier_01 = "AD";
            loop24002.SV3_DentalService.CompositeMedicalProcedureIdentifier_01.ProcedureCode_02 = "D1110";
            loop24002.SV3_DentalService.LineItemChargeAmount_02 = "50";
            loop24002.SV3_DentalService.ProcedureCount_06 = "1";

            //  End 2400 Loop 2
            loop2300.Loop2400.Add(loop24002);

            //  End 2300 Loop
            loop2000C.Loop2300.Add(loop2300);

            //  End 2000C Loop
            loop2000B.Loop2000C.Add(loop2000C);

            //  End 2000B Loop
            loop2000A.Loop2000B.Add(loop2000B);

            //  End 2000A Loop
            result.Loop2000A.Add(loop2000A);

            return result;
        }
    }
}

More operations in ediFabric .NET

837D questions

How does the 837D identify teeth and surfaces?

Each service line (loop 2400) can repeat the TOO segment. TOO02 holds the tooth number from the ADA Universal/National Tooth Designation System and TOO03 the tooth surfaces, such as M, O, D, B or L.

Which procedure codes does an 837D use?

Dental procedures are reported with CDT codes in the SV3 segment, qualified with AD (American Dental Association codes).

Is the 837D answered like the 837P?

Yes. The payer returns a 999 for syntax, a 277CA for claim acceptance and an 835 with the payment.

How do I parse and generate X12 837D files in .NET, Python, Java and C?

In .NET, install EdiFabric and EdiFabric.Templates.Hipaa, read the file with X12Reader into TS837D objects and write them back with X12Writer. From Python, Java or C, use ediFabric Native, which converts 837D files to JSON and JSON back to X12 inside your process. From any other language, post the file to the ediFabric Cloud REST API.

Related transactions

X12 837P - Health Care Claim: Professional
X12 837I - Health Care Claim: Institutional
X12 835 - Health Care Claim Payment/Advice
X12 277CA - Health Care Claim Acknowledgment
All EDI transactions →

X12 837D Health Care Claim: Dental Last updated: 2026-09-29