837 Health Care Claim (workers' compensation) (005010I20)
The IAIABC 837 is the health care claim for workers' compensation medical bills. This is the standard X12 IAIABC 2.0 spec, with 21 loops and 96 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 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 005010I20 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 | BHT | Mandatory | 1 |
| Loop 1000A | Submiter Information | Mandatory | 1 |
| NM1 | Submiter Information | Mandatory | 1 |
| Loop 1000B | Receiver Information | Mandatory | 1 |
| NM1 | Receiver Information | Mandatory | 1 |
| Loop 2000A | HL | Mandatory | >1 |
| HL | HL | Mandatory | 1 |
| DTP | Reporting Period | Optional | 1 |
| Loop 2010AA | Insurer Name | Mandatory | 1 |
| NM1 | Insurer Name | Mandatory | 1 |
| N4 | N4 | Mandatory | 1 |
| Loop 2010AB | Claim Administrator Name | Optional | 1 |
| NM1 | Claim Administrator Name | Mandatory | 1 |
| N4 | N4 | Optional | 1 |
| Loop 2000B | HL | Mandatory | >1 |
| HL | HL | Mandatory | 1 |
| Loop 2010BA | Employer Name | Mandatory | 1 |
| NM1 | Employer Name | Mandatory | 1 |
| N3 | Employer Address | Optional | 1 |
| N4 | N4 | Optional | 1 |
| Loop 2000C | HL | Mandatory | >1 |
| HL | HL | Mandatory | 1 |
| DTP | Injury Date | Mandatory | 1 |
| Loop 2010CA | Patient Name | Mandatory | 1 |
| NM1 | Patient Name | Mandatory | 1 |
| N3 | Claimant Address | Optional | 1 |
| N4 | N4 | Optional | 1 |
| DMG | Claimant Demographic Information | Optional | 1 |
| REF | Claim Administrator Claim Number | Mandatory | 1 |
| REF | Jurisdiction Assigned Claim Number | Optional | 1 |
| REF | Claimant Telephone Number | Optional | 1 |
| PER | Claimant Contact Information | Optional | 1 |
| Loop 2300 | Bill Record Information | Mandatory | 100 |
| CLM | Bill Record Information | Mandatory | 1 |
| DTP | Date Insurer Received Bill | Mandatory | 1 |
| DTP | Date And Time Of Admission | Optional | 1 |
| DTP | Date And Time Of Discharge | Optional | 1 |
| DTP | Service Date Range | Optional | 1 |
| DTP | Date Of Prescription | Optional | 1 |
| DTP | Date Of Bill | Mandatory | 1 |
| DTP | Date Insurer Paid Bill | Mandatory | 1 |
| CL1 | Admission Type | Optional | 1 |
| CN1 | Contract Information | Optional | 1 |
| AMT | Patient Amount Paid | Mandatory | 1 |
| REF | Unique Bill Identification Number | Mandatory | 1 |
| REF | Record Transmission Tracking Number | Mandatory | 1 |
| REF | Treatment Authorization Number | Optional | 1 |
| REF | Settlement Or Award Identifier | Optional | 1 |
| HI | Institutional Bill Principal Diagnosis | Optional | 1 |
| HI | Institutional Bill Admitting Diagnosis | Optional | 1 |
| HI | Institutional Bill Other Diagnosis | Optional | 1 |
| HI | Outpatient Reason For Visit | Optional | 1 |
| HI | Non Institutional Diagnosis Codes | Optional | 1 |
| HI | Institutional Bill Principal Procedure | Optional | 1 |
| HI | Institutional Bill Other Procedure Codes | Optional | 1 |
| HI | Condition Codes | Optional | 1 |
| HI | Diagnosis Related Group Information | Optional | 1 |
| Loop 2310A | Billing Provider Name | Optional | 1 |
| NM1 | Billing Provider Name | Mandatory | 1 |
| PRV | Billing Provider Specialty Information | Optional | 1 |
| N3 | Billing Provider Address | Mandatory | 1 |
| N4 | N4 | Mandatory | 1 |
| REF | Billing Provider Tax Identification Number | Mandatory | 1 |
| REF | Billing Provider State License Number | Optional | 1 |
| Loop 2310B | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| PRV | Rendering Provider Specialty Information | Optional | 1 |
| REF | Rendering Provider Secondary Identification | Optional | 1 |
| Loop 2310C | Supervising Provider Name | Optional | 1 |
| NM1 | Supervising Provider Name | Mandatory | 1 |
| PRV | Supervising Provider Specialty Information | Optional | 1 |
| REF | Supervising Provider State License Number | Optional | 1 |
| Loop 2310D | Service Facility Location Name | Optional | 1 |
| NM1 | Service Facility Location Name | Mandatory | 1 |
| N3 | Party Location | Optional | 1 |
| N4 | Geographic Location | Optional | 1 |
| REF | Service Facility Location Secondary Identification | Optional | 2 |
| Loop 2310E | Referring Provider Name | Optional | 2 |
| NM1 | Referring Provider Name | Mandatory | 1 |
| REF | Referring Provider State License Number | Optional | 1 |
| Loop 2310F | Managed Care Organization Name | Optional | 1 |
| NM1 | Managed Care Organization Name | Mandatory | 1 |
| REF | Managed Care Organization Secondary Identification | Optional | 1 |
| Loop 2320 | Subscriber Information | Optional | 1 |
| SBR | Subscriber Information | Mandatory | 1 |
| CAS | Claim Level Adjustments | Optional | 5 |
| AMT | Prior Payment Amount | Optional | 1 |
| Loop 2400 | Service Line Number | Optional | 999 |
| LX | Service Line Number | Mandatory | 1 |
| SV1 | Professional Service | Optional | 1 |
| SV2 | Institutional Service Information | Optional | 1 |
| SV3 | Dental Service | Optional | 1 |
| SV4 | Drug Service | Optional | 1 |
| DTP | Service Date | Mandatory | 1 |
| DTP | Prescription Date | Optional | 1 |
| QTY | Prescription Quantity | Optional | 2 |
| CN1 | Contract Information | Optional | 1 |
| REF | Treatment Authorization Number | Optional | 2 |
| AMT | Pharmacy Dispensing Fee Amount | Optional | 1 |
| AMT | Pharmacy Billedd Amount | Optional | 1 |
| AMT | Line Item Tax Charged Amount | Optional | 1 |
| K3 | File Information | Optional | 10 |
| Loop 2410 | Drug Identification | Optional | >1 |
| LIN | Drug Identification | Mandatory | 1 |
| CTP | Drug Quantity | Optional | 1 |
| REF | Prescriptionor Compound Drug Association Number | Optional | 1 |
| Loop 2420 | Rendering Provider Name | Optional | 1 |
| NM1 | Rendering Provider Name | Mandatory | 1 |
| PRV | Rendering Provider Specialty Information | Optional | 1 |
| REF | Rendering Provider Secondary Information | Optional | 1 |
| Loop 2430 | Line Adjudication Information | Optional | 15 |
| SVD | Line Adjudication Information | Mandatory | 1 |
| CAS | Line Adjustment | Optional | 99 |
| AMT | Line Item Prior Payment Amount | Optional | 1 |
| AMT | Line Item Tax Paid Amount | Optional | 1 |
| SE | Transaction Set Trailer | Optional | 1 |