HIPAA 837 Professional

HIPAA 837 Professional Claim Requirements (Oklahoma Health Care Authority)

The ASC X12N 837 Professional transaction is the electronic equivalent for the 1500 paper claim form. Key Notes:

  • No more than 50 service lines are allowed per claim.
  • Typical Providers must use the 10-digit NPI as the billing/pay-to, referring and rendering provider ID.
  • For atypical providers that are not eligible for an NPI, the REF segment (Bill-to Provider’s Secondary ID #) in Loop 2010AA must be included and must have the “EI” field qualifier and the provider’s Tax Identification Number. The Provider’s Legacy Id Number must be in the Ref*G2 segment in loop 2010BB.
  • The PAT segment, Loop 2000C and 2010CA is no longer needed. All SoonerCare subscribers have their own SoonerCare ID number. When the subscriber and the patient are the same person, omit the PAT information in Loop 2000C and 2010CA.
  • SoonerCare numbers sent on all claims:
    • Atypical Providers must use Identification.
    • Typical Providers must use NPI# as primary identification.
    • Subscribers – 123456789 (nine digits).
  • No more than 5,000 claims per transaction set are allowed.

To learn more about HIPAA EDI and become a certified EDI Professional, please visit our course schedule page.

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