837D Health Care Claim: Dental (004010X097A1)
Dental practices send the 837D to submit dental claims and predeterminations to payers and clearinghouses. This is the standard X12 HIPAA 004010 spec, with 43 loops and 203 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.
Use the 837D 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 837D files into TS837D objects. See ediFabric .NET.
ediFabric Native
Map version 004010X097A1 to the Native model with set_map, then parse 837D 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 837D classes in Python, Java, Node.js, Go, Rust or C
ediFabric Native returns each 837D 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 TS837D. 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.
For a sample file, the same data as JSON, and code to parse, validate and generate the 837D, see the 837D transaction guide.
837D structure
Loops and segments of the standard 837D, 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 | Transmission Type Identification | Mandatory | 1 |
| Loop NM1 | Submitter Name | Mandatory | 1 |
| NM1 | Submitter Name | Mandatory | 1 |
| PER | Submitter Contact Information | Mandatory | 2 |
| Loop NM1 | Receiver Name | Mandatory | 1 |
| NM1 | Receiver Name | Mandatory | 1 |
| Loop HL | Billing Payto Provider Hierarchical Level | Mandatory | >1 |
| HL | Billing Payto Provider Hierarchical Level | Mandatory | 1 |
| PRV | Billing Payto Provider Specialty Information | Optional | 1 |
| CUR | Foreign Currency Information | Optional | 1 |
| Loop NM1 | Billing Provider Name 2010AA | Mandatory | 1 |
| NM1 | Billing Provider Name 2010AA | Mandatory | 1 |
| N3 | Billing Provider Address 2010AA | Mandatory | 1 |
| N4 | Billing Provider City State ZIP Code 2010AA | Mandatory | 1 |
| REF | Billing Provider Secondary Identification Number 2010AA | Optional | 5 |
| REF | Claim Submitter Credit Debit Card Information 2010AA | Optional | 8 |
| Loop NM1 | Payto Providers Name 2010AB | Optional | 1 |
| NM1 | Payto Providers Name 2010AB | Mandatory | 1 |
| N3 | Payto Providers Address 2010AB | Mandatory | 1 |
| N4 | Payto Provider City State Zip 2010AB | Mandatory | 1 |
| REF | Payto Provider Secondary Identification Number 2010AB | Optional | 5 |
| Loop HL | Subscriber Hierarchical Level | Mandatory | >1 |
| HL | Subscriber Hierarchical Level | Mandatory | 1 |
| SBR | Subscriber Information | Mandatory | 1 |
| Loop NM1 | Subscriber Name 2010BA | Mandatory | 1 |
| NM1 | Subscriber Name 2010BA | Mandatory | 1 |
| N3 | Subscriber Address 2010BA | Optional | 1 |
| N4 | Subscriber City State ZIP Code 2010BA | Optional | 1 |
| DMG | Subscriber Demographic Information 2010BA | Optional | 1 |
| REF | Subscriber Secondary Identification 2010BA | Optional | 4 |
| REF | Property And Casualty Claim Number 2010BA | Optional | 1 |
| Loop NM1 | Payer Name 2010BB | Mandatory | 1 |
| NM1 | Payer Name 2010BB | Mandatory | 1 |
| N3 | Payer Address 2010BB | Optional | 1 |
| N4 | Payer City State ZIP Code 2010BB | Optional | 1 |
| REF | Payer Secondary Identification Number 2010BB | Optional | 3 |
| Loop NM1 | Credit Debit Card Holder Name 2010BC | Optional | 1 |
| NM1 | Credit Debit Card Holder Name 2010BC | Mandatory | 1 |
| REF | Credit Debit Card Information 2010BC | Optional | 3 |
| Loop CLM | Claim Information | Optional | 100 |
| CLM | Claim Information | Mandatory | 1 |
| DTP | Date Admission | Optional | 1 |
| DTP | Date Discharge | Optional | 1 |
| DTP | Date Referral | Optional | 1 |
| DTP | Date Accident | Optional | 1 |
| DTP | Date Appliance Placement | Optional | 5 |
| DTP | Date Service | Optional | 1 |
| DN1 | Orthodontic Total Months Of Treatment | Optional | 1 |
| DN2 | Tooth Status | Optional | 35 |
| PWK | Claim Supplemental Information | Optional | 10 |
| AMT | Patient Amount Paid | Optional | 1 |
| AMT | Credit Debit Card Maximum Amount | Optional | 1 |
| REF | Predetermination Identification | Optional | 5 |
| REF | Service Authorization Exception Code | Optional | 1 |
| REF | Original Reference Number ICNDCN | Optional | 1 |
| REF | Prior Authorization Or Referral Number | Optional | 2 |
| REF | Claim Identification Number For Clearinghouses And Other Transmission Intermediaries | Optional | 1 |
| NTE | Claim Note | Optional | 20 |
| Loop NM1 | Referring Provider Name | Optional | 2 |
| NM1 | Referring Provider Name | Mandatory | 1 |
| PRV | Referring Provider Specialty Information | Optional | 1 |
| REF | Referring Provider Secondary Identification | Optional | 5 |
| Loop NM1 | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| PRV | Rendering Provider Specialty Information | Optional | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 5 |
| Loop NM1 | Service Facility Location | Optional | 1 |
| NM1 | Service Facility Location | Mandatory | 1 |
| REF | Service Facility Location Secondary Identification | Optional | 5 |
| Loop NM1 | Assistant Surgeon Name | Optional | 1 |
| NM1 | Assistant Surgeon Name | Mandatory | 1 |
| PRV | Assistant Surgeon Specialty Information | Optional | 1 |
| REF | Assistant Surgeon Secondary Identification | Optional | 1 |
| Loop SBR | Other Subscriber Information | Optional | 10 |
| SBR | Other Subscriber Information | Mandatory | 1 |
| CAS | Claim Adjustment | Optional | 5 |
| AMT | Coordination Of Benefits COB Payer Paid Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Approved Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Allowed Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Patient Responsibility Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Covered Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Discount Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Patient Paid Amount | Optional | 1 |
| DMG | Other Insured Demographic Information | Optional | 1 |
| OI | Other Insurance Coverage Information | Mandatory | 1 |
| Loop NM1 | Other Subscriber Name | Mandatory | 1 |
| NM1 | Other Subscriber Name | Mandatory | 1 |
| N3 | Other Subscriber Address | Optional | 1 |
| N4 | Other Subscriber City State Zip Code | Optional | 1 |
| REF | Other Subscriber Secondary Identification | Optional | 3 |
| Loop NM1 | Other Payer Name | Mandatory | 1 |
| NM1 | Other Payer Name | Mandatory | 1 |
| PER | Other Payer Contact Information | Optional | 2 |
| DTP | Claim Paid Date | Optional | 1 |
| REF | Other Payer Secondary Identifier | Optional | 3 |
| REF | Other Payer Prior Authorization Or Referral Number | Optional | 2 |
| REF | Other Payer Claim Adjustment Indicator | Optional | 1 |
| Loop NM1 | Other Payer Patient Information | Optional | 1 |
| NM1 | Other Payer Patient Information | Mandatory | 1 |
| REF | Other Payer Patient Identification | Optional | 3 |
| Loop NM1 | Other Payer Referring Provider | Optional | 1 |
| NM1 | Other Payer Referring Provider | Mandatory | 1 |
| REF | Other Payer Referring Provider Identification | Optional | 3 |
| Loop NM1 | Other Payer Rendering Provider | Optional | 1 |
| NM1 | Other Payer Rendering Provider | Mandatory | 1 |
| REF | Other Payer Rendering Provider Identification | Optional | 3 |
| Loop LX | Line Counter | Mandatory | 50 |
| LX | Line Counter | Mandatory | 50 |
| SV3 | Dental Service | Mandatory | 1 |
| TOO | Tooth Information | Optional | 32 |
| DTP | Date Service | Optional | 1 |
| DTP | Date Prior Placement | Optional | 1 |
| DTP | Date Appliance Placement | Optional | 1 |
| DTP | Date Replacement | Optional | 1 |
| QTY | Anesthesia Quantity | Optional | 5 |
| REF | Service Predetermination Identification | Optional | 1 |
| REF | Prior Authorization Or Referral Number | Optional | 2 |
| REF | Line Item Control Number | Optional | 1 |
| AMT | Approved Amount | Optional | 1 |
| AMT | Sales Tax Amount | Optional | 1 |
| NTE | Line Note | Optional | 10 |
| Loop NM1 | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| PRV | Rendering Provider Specialty Information | Optional | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 5 |
| Loop NM1 | Other Payer Referral Number | Optional | 1 |
| NM1 | Other Payer Referral Number | Mandatory | 1 |
| REF | Other Payer Prior Authorization Or Referral Number | Optional | 2 |
| Loop NM1 | Assistant Surgeon Name | Optional | 1 |
| NM1 | Assistant Surgeon Name | Mandatory | 1 |
| PRV | Assistant Surgeon Specialty Information | Optional | 1 |
| REF | Assistant Surgeon Secondary Identification | Optional | 1 |
| Loop SVD | Line Adjudication Information | Optional | 25 |
| SVD | Line Adjudication Information | Mandatory | 1 |
| CAS | Service Adjustment | Optional | 99 |
| DTP | Line Adjudication Date | Mandatory | 1 |
| Loop HL | Patient Hierarchical Level | Optional | >1 |
| HL | Patient Hierarchical Level | Mandatory | 1 |
| PAT | Patient Information | Mandatory | 1 |
| Loop NM1 | Patient Name 2010CA | Mandatory | 1 |
| NM1 | Patient Name 2010CA | Mandatory | 1 |
| N3 | Patient Address 2010CA | Mandatory | 1 |
| N4 | Patient City State ZIP Code 2010CA | Mandatory | 1 |
| DMG | Patient Demographic Information 2010CA | Mandatory | 1 |
| REF | Subscriber Secondary Identification 2010BA | Optional | 4 |
| REF | Property And Casualty Claim Number 2010BA | Optional | 1 |
| Loop CLM | Claim Information | Mandatory | 100 |
| CLM | Claim Information | Mandatory | 1 |
| DTP | Date Admission | Optional | 1 |
| DTP | Date Discharge | Optional | 1 |
| DTP | Date Referral | Optional | 1 |
| DTP | Date Accident | Optional | 1 |
| DTP | Date Appliance Placement | Optional | 5 |
| DTP | Date Service | Optional | 1 |
| DN1 | Orthodontic Total Months Of Treatment | Optional | 1 |
| DN2 | Tooth Status | Optional | 35 |
| PWK | Claim Supplemental Information | Optional | 10 |
| AMT | Patient Amount Paid | Optional | 1 |
| AMT | Credit Debit Card Maximum Amount | Optional | 1 |
| REF | Predetermination Identification | Optional | 5 |
| REF | Service Authorization Exception Code | Optional | 1 |
| REF | Original Reference Number ICNDCN | Optional | 1 |
| REF | Prior Authorization Or Referral Number | Optional | 2 |
| REF | Claim Identification Number For Clearinghouses And Other Transmission Intermediaries | Optional | 1 |
| NTE | Claim Note | Optional | 20 |
| Loop NM1 | Referring Provider Name | Optional | 2 |
| NM1 | Referring Provider Name | Mandatory | 1 |
| PRV | Referring Provider Specialty Information | Optional | 1 |
| REF | Referring Provider Secondary Identification | Optional | 5 |
| Loop NM1 | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| PRV | Rendering Provider Specialty Information | Optional | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 5 |
| Loop NM1 | Service Facility Location | Optional | 1 |
| NM1 | Service Facility Location | Mandatory | 1 |
| REF | Service Facility Location Secondary Identification | Optional | 5 |
| Loop NM1 | Assistant Surgeon Name | Optional | 1 |
| NM1 | Assistant Surgeon Name | Mandatory | 1 |
| PRV | Assistant Surgeon Specialty Information | Optional | 1 |
| REF | Assistant Surgeon Secondary Identification | Optional | 1 |
| Loop SBR | Other Subscriber Information | Optional | 10 |
| SBR | Other Subscriber Information | Mandatory | 1 |
| CAS | Claim Adjustment | Optional | 5 |
| AMT | Coordination Of Benefits COB Payer Paid Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Approved Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Allowed Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Patient Responsibility Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Covered Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Discount Amount | Optional | 1 |
| AMT | Coordination Of Benefits COB Patient Paid Amount | Optional | 1 |
| DMG | Other Insured Demographic Information | Optional | 1 |
| OI | Other Insurance Coverage Information | Mandatory | 1 |
| Loop NM1 | Other Subscriber Name | Mandatory | 1 |
| NM1 | Other Subscriber Name | Mandatory | 1 |
| N3 | Other Subscriber Address | Optional | 1 |
| N4 | Other Subscriber City State Zip Code | Optional | 1 |
| REF | Other Subscriber Secondary Identification | Optional | 3 |
| Loop NM1 | Other Payer Name | Mandatory | 1 |
| NM1 | Other Payer Name | Mandatory | 1 |
| PER | Other Payer Contact Information | Optional | 2 |
| DTP | Claim Paid Date | Optional | 1 |
| REF | Other Payer Secondary Identifier | Optional | 3 |
| REF | Other Payer Prior Authorization Or Referral Number | Optional | 2 |
| REF | Other Payer Claim Adjustment Indicator | Optional | 1 |
| Loop NM1 | Other Payer Patient Information | Optional | 1 |
| NM1 | Other Payer Patient Information | Mandatory | 1 |
| REF | Other Payer Patient Identification | Optional | 3 |
| Loop NM1 | Other Payer Referring Provider | Optional | 1 |
| NM1 | Other Payer Referring Provider | Mandatory | 1 |
| REF | Other Payer Referring Provider Identification | Optional | 3 |
| Loop NM1 | Other Payer Rendering Provider | Optional | 1 |
| NM1 | Other Payer Rendering Provider | Mandatory | 1 |
| REF | Other Payer Rendering Provider Identification | Optional | 3 |
| Loop LX | Line Counter | Mandatory | 50 |
| LX | Line Counter | Mandatory | 50 |
| SV3 | Dental Service | Mandatory | 1 |
| TOO | Tooth Information | Optional | 32 |
| DTP | Date Service | Optional | 1 |
| DTP | Date Prior Placement | Optional | 1 |
| DTP | Date Appliance Placement | Optional | 1 |
| DTP | Date Replacement | Optional | 1 |
| QTY | Anesthesia Quantity | Optional | 5 |
| REF | Service Predetermination Identification | Optional | 1 |
| REF | Prior Authorization Or Referral Number | Optional | 2 |
| REF | Line Item Control Number | Optional | 1 |
| AMT | Approved Amount | Optional | 1 |
| AMT | Sales Tax Amount | Optional | 1 |
| NTE | Line Note | Optional | 10 |
| Loop NM1 | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| PRV | Rendering Provider Specialty Information | Optional | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 5 |
| Loop NM1 | Other Payer Referral Number | Optional | 1 |
| NM1 | Other Payer Referral Number | Mandatory | 1 |
| REF | Other Payer Prior Authorization Or Referral Number | Optional | 2 |
| Loop NM1 | Assistant Surgeon Name | Optional | 1 |
| NM1 | Assistant Surgeon Name | Mandatory | 1 |
| PRV | Assistant Surgeon Specialty Information | Optional | 1 |
| REF | Assistant Surgeon Secondary Identification | Optional | 1 |
| Loop SVD | Line Adjudication Information | Optional | 25 |
| SVD | Line Adjudication Information | Mandatory | 1 |
| CAS | Service Adjustment | Optional | 99 |
| DTP | Line Adjudication Date | Mandatory | 1 |
| SE | Transaction Set Trailer | Optional | 1 |