837 Health Care Claim (006030)

This is the standard X12 006030 spec, with 13 loops and 121 segment positions, as OpenEDI JSON, an ediFabric C# template and an ediFabric Native model. To change it for a trading partner, customize it in the EDI Spec Builder.

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The spec as an OpenAPI 3 schema with x-openedi-* extensions, for ediFabric Native, ediFabric Cloud and the EDI Spec Builder. Download OpenEDI (202 KB) Generate classes

The ediFabric .NET template, class TS837. It needs the common segments, composites and codes of X12 006030, one download for every transaction in the version. Download C# (2 KB) Common files (274 KB)

The intermediary model ediFabric Native loads with set_map. Download Native (162 KB)

Use the 837 spec in your code

ediFabric .NET

Add the C# template and its common files to your project, or reference the template NuGet package, and read 837 files into TS837 objects. See ediFabric .NET.

ediFabric Native

Map version 006030 to the Native model with set_map, then parse 837 files to JSON from Python, Java, C or C#. See Convert between EDI and JSON.

OpenEDI

Select Customize in Spec Builder to copy the spec under your own name, change it for your partner, and parse files against it in EdiNation, ediFabric Native or ediFabric Cloud. Read about OpenEDI.

Generate 837 classes in Python, Java, Node.js, Go, Rust or C

ediFabric Native returns each 837 as JSON, with the property names of the OpenEDI schema. To work with that JSON as typed objects, generate classes from the OpenEDI file in your language and deserialize the JSON into TS837. Serialize the objects back to JSON to build EDI with ediFabric Native. The classes keep the loops, segments, lengths and code lists, but not the EDI data formats, so validate files with ediFabric Native. Read more in Generate a class from OpenEDI.

Python: datamodel-code-generator. Node.js: openapi-typescript. Java, Go, Rust and C: OpenAPI Generator.

837 structure

Loops and segments of the standard 837, with their usage and maximum repeats.

ID	Name	Usage	Max use
ST	Transaction Set Header	Optional	1
BHT	Beginning of Hierarchical Transaction	Mandatory	1
REF	Reference Information	Optional	3
Loop NM1	Individual or Organizational Name	Optional	10
NM1	Individual or Organizational Name	Mandatory	1
N2	Additional Name Information	Optional	2
N3	Party Location	Optional	2
N4	Geographic Location	Optional	1
REF	Reference Information	Optional	2
PER	Administrative Communications Contact	Optional	2
Loop HL	Hierarchical Level	Mandatory	>1
HL	Hierarchical Level	Mandatory	1
PRV	Provider Information	Optional	1
SBR	Subscriber Information	Optional	1
PAT	Patient Information	Optional	1
DTP	Date or Time or Period	Optional	5
CUR	Currency	Optional	1
Loop NM1	Individual or Organizational Name	Optional	10
NM1	Individual or Organizational Name	Mandatory	1
N2	Additional Name Information	Optional	2
N3	Party Location	Optional	2
N4	Geographic Location	Optional	1
DMG	Demographic Information	Optional	1
REF	Reference Information	Optional	20
PER	Administrative Communications Contact	Optional	2
LUI	Language Use	Optional	1
Loop CLM	Health Claim	Optional	100
CLM	Health Claim	Mandatory	1
DTP	Date or Time or Period	Optional	150
CL1	Claim Codes	Optional	1
DN1	Orthodontic Information	Optional	1
DN2	Tooth Summary	Optional	35
PWK	Paperwork	Optional	10
CN1	Contract Information	Optional	1
DSB	Disability Information	Optional	1
UR	Peer Review Organization or Utilization Review	Optional	1
AMT	Monetary Amount Information	Optional	40
REF	Reference Information	Optional	30
K3	File Information	Optional	10
NTE	Note/Special Instruction	Optional	20
CR1	Ambulance Certification	Optional	1
CR2	Chiropractic Certification	Optional	1
CR3	Durable Medical Equipment Certification	Optional	1
CR4	Enteral or Parenteral Therapy Certification	Optional	3
CR5	Oxygen Therapy Certification	Optional	1
CR6	Home Health Care Certification	Optional	1
CR8	Pacemaker Certification	Optional	9
CRC	Conditions Indicator	Optional	100
HI	Health Care Information Codes	Optional	25
QTY	Quantity Information	Optional	10
HCP	Health Care Pricing	Optional	1
Loop CR7	Home Health Treatment Plan Certification	Optional	6
CR7	Home Health Treatment Plan Certification	Mandatory	1
HSD	Health Care Services Delivery	Optional	12
Loop NM1	Individual or Organizational Name	Optional	9
NM1	Individual or Organizational Name	Mandatory	1
PRV	Provider Information	Optional	1
N2	Additional Name Information	Optional	2
N3	Party Location	Optional	2
N4	Geographic Location	Optional	1
REF	Reference Information	Optional	20
PER	Administrative Communications Contact	Optional	2
Loop SBR	Subscriber Information	Optional	10
SBR	Subscriber Information	Mandatory	1
CAS	Claims Adjustment	Optional	99
RAS	Reason Adjustment	Optional	99
AMT	Monetary Amount Information	Optional	15
DMG	Demographic Information	Optional	1
OI	Other Health Insurance Information	Optional	1
MIA	Inpatient Adjudication	Optional	1
MOA	Outpatient Adjudication	Optional	1
Loop NM1	Individual or Organizational Name	Optional	10
NM1	Individual or Organizational Name	Mandatory	1
N2	Additional Name Information	Optional	2
N3	Party Location	Optional	2
N4	Geographic Location	Optional	1
PER	Administrative Communications Contact	Optional	2
DTP	Date or Time or Period	Optional	9
REF	Reference Information	Optional	>1
Loop LX	Transaction Set Line Number	Optional	>1
LX	Transaction Set Line Number	Mandatory	1
SV1	Professional Service	Optional	1
SV2	Institutional Service	Optional	1
SV3	Dental Service	Optional	1
TOO	Tooth Identification	Optional	32
SV4	Drug Service	Optional	1
SV5	Durable Medical Equipment Service	Optional	1
SV6	Anesthesia Service	Optional	1
SV7	Drug Adjudication	Optional	1
HI	Health Care Information Codes	Optional	25
PWK	Paperwork	Optional	10
CR1	Ambulance Certification	Optional	1
CR2	Chiropractic Certification	Optional	5
CR3	Durable Medical Equipment Certification	Optional	1
CR4	Enteral or Parenteral Therapy Certification	Optional	3
CR5	Oxygen Therapy Certification	Optional	1
CRC	Conditions Indicator	Optional	3
DTP	Date or Time or Period	Optional	15
QTY	Quantity Information	Optional	5
MEA	Measurements	Optional	20
CN1	Contract Information	Optional	1
REF	Reference Information	Optional	30
AMT	Monetary Amount Information	Optional	15
K3	File Information	Optional	10
NTE	Note/Special Instruction	Optional	10
PS1	Purchase Service	Optional	1
IMM	Immunization Status	Optional	>1
HSD	Health Care Services Delivery	Optional	1
HCP	Health Care Pricing	Optional	1
Loop LIN	Item Identification	Optional	>1
LIN	Item Identification	Mandatory	1
CTP	Pricing Information	Optional	1
REF	Reference Information	Optional	1
SV4	Drug Service	Optional	1
SV7	Drug Adjudication	Optional	1
Loop NM1	Individual or Organizational Name	Optional	10
NM1	Individual or Organizational Name	Mandatory	1
PRV	Provider Information	Optional	1
N2	Additional Name Information	Optional	2
N3	Party Location	Optional	2
N4	Geographic Location	Optional	1
REF	Reference Information	Optional	20
PER	Administrative Communications Contact	Optional	2
Loop SVD	Service Line Adjudication	Optional	>1
SVD	Service Line Adjudication	Mandatory	1
CAS	Claims Adjustment	Optional	99
RAS	Reason Adjustment	Optional	99
DTP	Date or Time or Period	Optional	9
AMT	Monetary Amount Information	Optional	20
III	Information	Optional	99
Loop LQ	Industry Code Identification	Optional	>1
LQ	Industry Code Identification	Mandatory	1
FRM	Supporting Documentation	Mandatory	99
SE	Transaction Set Trailer	Optional	1