M.D. Complete 837 File Crosswalk
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LOOP	SEGMENT	FIELD	DATA	Editable	Required	COMMENTS
	ISA	01	03 or 00	n	y	03 if a vendor ID is defined - otherwise 00.  Vendor ID is defined in the Insurance Payer screen
		02	vendor id	y	y	Defined in the insurance payer screen
		03	00	n	y
		04	blank	n	y
		05	ZZ	y	y	Defined in the insurance payer screen - ZZ is the default if not defined
		06	sender id	y	y	Defined in the e-filing setup screen
		07	ZZ	y	y	Defined in the insurance payer screen - ZZ is the default if not defined
		08	receiver id	y	y	Defined in the e-filing setup screen
		09	date/time	n	y	Automatic Time Stamp
		10	U	n	y
		11	00401	n	y
		12	batch id	n	y	Automatic batch number
		13	T or P	n	y	Test Mode or Production Mode - Set this in Edit - Preference - Electronic Filing Setup
	GS	01	HC	n	y
		02	sender id	y	y	Defined in the e-filing setup screen
		03	receiver id	y	y	Defined in the e-filing setup screen
		04	date	n	y	Automatic Time Stamp
		05	time	n	y
		06	batch id	n	y	Automatic batch number
		07	X	n	y
		08	004010X098A1	n	y
	ST	01	837	n	y
		02	batch id	n	y	Automatic batch number
	BHT	01	0019	n	y
		02	00	n	y
		03	batch id	n	y	Automatic batch number
		04	date	n	y	Automatic Time Stamp
		05	time	n	y
		06	CH	n	y
	REF	01	87	n	y
		02	004010X098A1	n	y
1000A	NM1	01	41	n	y
		02	2	n	y
		03	practice name	y	y	Name of Practice
		04		n	y
		05		n	y
		06		n	y
		07		n	y
		08	46	n	y
		09	sender id	y	y	Defined in the e-filing setup screen
	PER	01	IC	n	y
		02	contact	y	y	Billing Contact Name
		03	TE	n	y
		04	phone number	y	y	Billing Phone Number
		05	EX	n	y
		06	extension	y	y	Billing Phone Extension
1000B	NM1	01	40	n	y
		02	2	n	y
		03	receiver name	y	y	Defined in the e-filing setup screen
		04		n	y
		05		n	y
		06		n	y
		07		n	y
		08	46	n	y
		09	receiver id	y	y	Defined in the e-filing setup screen
2000A	HL	01	loop counter	n	n	HL loop counter - only required when the payer is different from the previous payer
		02		n	n
		03	20	n	n
		04	1	n	n
	PRV	01	PE	n	n	Taxonomy code or Provider specialty code - This segment is only used if the option to show provider specialty code in loop 2000A is specified
		02	ZZ	n	y
		03	taxonomy code	y	y	from e-file setup screen or provider specialty code from provider screen
2010AA	NM1	01	85	n	y
		02	2	n	y
		03	practice name	y	y
		04		n	y
		05		n	y
		06		n	y
		07		n	y
		08	24	n	y
		09	practice tax id	y	y
	N3	01	practice address	y	y
	N4	01	practice city	y	y
		02	practice state	y	y
		03	practice zip	y	y
	REF	01	payer type	n	y	Medicare = 1C;Medicaid=1D;BCBS=1B;other=G2
		02	group number	y	y	Group number defined in Insurance Payer screen
	REF	01	secondary payer type	n	y	Medicare = 1C;Medicaid=1D;BCBS=1B;other=G2
		02	secondary group number	y	y	only sent if sending extended secondary information
2010AB	NM1	01	87	n	y	This loop is only used when the Pay-to-Provider is set to Facility Name (Payer Filing Setup)
		02	2	n	y
		03	facility name	y	y
		04		n	y
		05		n	y
		06		n	y
		07		n	y
		08	24	n	y
		09	practice tax id	y	y
	N3	01	facility address	y	y
	N4	01	facility city	y	y
		02	facility state	y	y
		03	facility zip	y	y
	REF	01	payer type	n	y	Medicare = 1C;Medicaid=1D;BCBS=1B;other=G2
		02	provider pin	y	y	Provider Pin
2000B	HL	01	loop counter	n	y	HL loop counter
		02	subloop counter	n	y	HL subloop counter
		03	22	n	y
		04	0 or 1	n	y	1 = relation is self; 0 = relation is other
	SBR	01	S or P	n	y	Secondary Payer or Primary Payer
		02	18 or ''	n	y	18 if relation is self
		03	group number	y	n	Group number defined in Insurance Payer screen
		04	employer	y	n	not used for Medicare or Medicaid
		05		n	y
		06		n	y
		07		n	y
		08		n	y
		09	payer type	n	y	MB=Medicare;MC=Medicaid;BL=Blue Cross;CH=Champus;CI=Commerical
2010BA	NM1	01	IL	n	y	insured information.  Might be Primary or Secondary
		02	1	n	y
		03	insured last name	y	y
		04	first name		y
		05	initial		y
		06			y
		07			y
		08	MI		y
		09	id number	y	y	id number from patient demographic screen insured id number
	N3	01	address	y	y
	N4	01	city	y	y
		02	state	y	y
		03	zip code	y	y
	DMG	01	DMG	n	y
		02	birth date	y	y
		03	sex	n	y	F=Female;M=Male
	REF	01	SY	n	n	Only used when payer type is not Medicare
		02	patient ssn	y	n
2010BB	NM1	01	PR	n	y
		02	2	n	y
		03	payer name	y	y	Name of Payer
		04		n	y
		05		n	y
		06		n	y
		07		n	y
		08	PI	n	y
		09	payer code	y	y	Payer code from Insurance Payer screen
	N3	01	payer address	y	y
	N4	01	payer city	y	y
		02	payer state	y	y
		03	payer zip code	y	y
2000C	HL	01	loop counter	n	n	HL loop counter - This HL is only required if the Insured is not the Patient
		02	subloop counter	n	y	HL subloop counter
		03	23	n	y
		04	0	n	y	0 = relation is other
	PAT	01	01;19;G8	n	y	01=Spouse;19=Child;G8=Other
2010CA	NM1	01	QC	n	y	Patient Name/Address
		02	1	n	y
		03	last name	y	y
		04	first name	y	y
		05	initial	y	y
		06		n	y
		07		n	y
		08	MI	n	y
		09	id number	y	y	id number from patient demographic screen insured id number
	N3	01	address	y	y
	N4	01	city	y	y
		02	state	y	y
		03	zip code	y	y
	DMG	01	D8	n	y
		02	birth date	y	y
		03	sex	n	y	F=Female;M=Male
2300	CLM	01	claim number	n	y
		02	charge amount	n	y
		03		n	y
		04		n	y
		05	pos::1	y	y	POS
		06	Y	n	y
		07	A	n	y
		08	Y	n	y
		09	Y	n	y
		10	B	n	y
		11	EM;AA;OA	n	y	related to employment, auto, other - blank if none
	DTP	01	469	n	n	ILMCD (Illinois public aid) required DTP*469
		02	D8	n	y
		03	service date	y	y	Box 14 (Date of Onset)
	DTP	01	431	n	y
		02	D8	n	y
		03	service date	y	y	Box 14 (Date of Onset)
	DTP	01	438	n	n	Date of similar illness
		02	D8	n	y
		03	service date	y	y
	DTP	01	297	n	n	Patient unable to work from date
		02	D8	n	y
		03	service date	y	y
	DTP	01	296	n	n	Patient unable to work to date
		02	D8	n	y
		03	service date	y	y
	DTP	01	435	n	n	Patient hospitalization to work from date
		02	D8	n	y
		03	service date	y	y
	DTP	01	096	n	n	Patient hospitalization to work to date
		02	D8	n	y
		03	service date	y	y
	REF	01	X4	y	n	if prior authorization number or clia exists
		02	box 23 data	y	y
	NTE	01	ADD	n	y	if claim notes are present and they are not to print on the service line
		02	notes	y	y
	HI	01	BK:code	y	y	Diagnosis code 1
		02	BF:code	y	n	Diagnosis code 2
		03	BF:code	y	n	Diagnosis code 3
		04	BF:code	y	n	Diagnosis code 4
2310A	NM1	01	DN	n	n	if a referring physician has been defined
		02	1	n	y
		03	last name	y	y
		04	first name	y	y
	REF	01	1G or 0B	n	y	1G = UPIN;0B=State License
		02	reference number	y	y	Upin is normally used.  If filing IDPA2360 then the State License is used
2310B	NM1	01	82	n	y	Provider name/address
		02	1	n	y
		03	last name	y	y
		04	first name	y	y
		05	initial	y	y
		06		n	y
		07	credentials	y	y
		08	24 or 34	n	y	24=taxid;34=ssn
		09	taxid or ssn	y	y
	PRV	01	PE	n	n	Taxonomy code or Provider specialty code
		02	ZZ	n	y
		03	taxonomy code	y	y	from e-file setup screen or provider specialty code from provider screen
	REF	01	payer type	n	y	Medicare = 1C;Medicaid=1D;BCBS=1B;other=G2
		02	provider number	y	y
	REF	01	0B	n	y	only for BCBS when a license number is defined
		02	state license	y	y
2310D	NM1	01	FA	n	y	Facility Name
		02	2	n	y
		03	Name of Facility	y	y
		04		n	n
		05		n	n
		06		n	n
		07		n	n
		08	24	n	n
		09	facility id	y	n	facility id if entered
	N3	01	address	y	y
	N4	01	city	y	y
		02	state	y	y
		03	zip code	y	y
	REF	01	1C	n	n	ID Qualifier is always 1C - Only included for Medicare claims that are not POS 11
		02	facility secondary id	y	n	Secondary ID Number from Hospital/Facility Screen
2320	SBR	01	P or S	n	y	Other Insured information P = Primary Information; S=Secondary Information
		02	18,01,19,G8	n	y	18=self;01=spouse;19=child;G8=other
		03		n	y
		04		n	y
		05	payer type	n	y	MB=Medicare;MC=Medicaid;SP=other
		06		n	y
		07		n	y
		08		n	y
		09	payer type	n	y	MB=Medicare;MC=Medicaid;BL=Blue Cross;CI=Commerical
	CAS	01	PR	n	n	balance remaining on claim
		02	1	n	y
		03	amount	n	y	balance remaining on claim if no copay was paid otherwise it’s the balance less the copay
		04		n	n
		05	3	n	n
		06	amount	n	n	amount of copay - blank otherwise
	AMT	01	D	n	y	amount paid on claim
		02	amount	n	n
	AMT	01	F2	n	n	balance remaining
		02	amount	n	y
	DMG	01	D8	n	y
		02	birth date	y	y
		03	sex	n	y	F=Female;M=Male
	OI	01		n	y
		02		n	y
		03		n	y
		04	Y/N	y	y	Accept Assignment
		05	B,S,M,P	y	y	Signature signed
		06		y	y
		06	Y/N	y	y	Release signed
2330A	NM1	01	IL	n	y	Other Insured Information (if patient has secondary)
		02	1	n	y
		03	last name	y	y
		04	first name	y	y
		05	initial	y	y
		06		n	y
		07		n	y
		08	MI	n	y
		09	insured id	y	y
2330B	NM1	01	PR	n	n	Other Payer Information (if patient has secondary)
		02	2	n	y
		03	Payer name	y	y
		04		n	y
		05		n	y
		06		n	y
		07		n	y
		08	PI	n	y
		09	medigap number or payer code	y	y	if option to send extended secondary information then payer code is used
	N3	01	secondary payer address	y	y	only sent if sending extended secondary information
	N4	01	secondary payer city	y	y	only sent if sending extended secondary information
		02	secondary payer state	y	y
		03	secondary payer zip code	y	y
2400	LX	01	service line number	y	y
	SV1	01	HC:procedure:modifier1:modifierN	y	y	procedure and modifier up to 4 modifiers
		02	amount	y	y	amount of charge
		03	UN	n	y
		04	# of units	y	y
		05	place of service	y	y
		06	type of service code	y	n	only prints for ILMCD payer (illinois medicaid)
		07	diagnosis codes	y	y
	DTP	01	472	n	y
		02	RD8	n	y
		03	service from date	y	y
	NTE	01	ADD	n	n	claim notes if claim notes on service line option is checked
		02	claim notes	y	y
2410	LIN	01	blank	n	n	National Drug Code
		02	L4	n	n
		03	NDC	y	n	11 digit national drug code
2420	NM1	01	82	n	n	service level identifier (box 24K)
		02	1	n	y
		03	provider last name	y	y
		04	first name	y	y
		05	initial	y	y
		06		n	y
		07	credentials	y	y
		08	24 or 34	n	y	24=taxid;34=ssn
		09	taxid or ssn	y	y
	REF	01	payer type	n	y	Medicare = 1C;Medicaid=1D;BCBS=1B;other=G2;0B=state license number
		02	provider number	y	y
	SE	01	line counter	n	y
		02	batch id	n	y
	GE	01	1	n	y
		02	batch id	n	y
	IEA	01	1	n	y
		02	batch id	n	y