# EDI 837 Health Care Claim: 837P, 837I, 837D
> EDI 837 explained: 837P, 837I and 837D claims, the 2000A/2000B/2300/2400 loops, CLM, HI, SV1, SV2 and SV3 segments, validation and matching to the 835.
The EDI 837 Health Care Claim is the HIPAA X12 transaction providers use to bill health plans. It comes in three variants: 837P for professional claims, 837I for institutional (hospital and facility) claims and 837D for dental. Each file nests billing provider, subscriber, claim and service line loops, and payers answer with a 999, a 277CA and later an 835.
**The EDI 837 is how almost every US health care claim reaches a payer.** A physician's office visit, a hospital emergency department stay and a dental cleaning all travel as 837s, usually through a clearinghouse. The three variants share one loop structure and differ in the claim and service line detail, which is why one guide can cover all three and why a validator has to know which variant it is reading.
This guide covers what the 837 carries, the HL loop structure (2000A, 2000B, 2000C, 2300, 2400), the segments billing and health IT teams map, live examples of an 837P, an 837I and an 837D, how 837s are validated and acknowledged, and how each claim is matched to its 835 payment. It explains the file format only. It is not coding, billing or legal advice; code sets, payer companion guides and your compliance team govern what goes on a claim.
## What Is an EDI 837?
**An EDI 837 is the Health Care Claim transaction set defined by [ASC X12](https://x12.org/products/transaction-sets), used by health care providers (or billing services and clearinghouses acting for them) to submit claims and encounter information to health plans.** It is the HIPAA standard for health care claims. [45 CFR 162.1102](https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-162/subpart-K/section-162.1102) names three X12 technical reports, one per variant:
| Variant | Used for | Technical report named by HIPAA | Version commonly sent in `GS08` / `ST03` |
|---|---|---|---|
| **837P** Professional | Physicians, therapists, labs, ambulance, other non-facility services (the electronic counterpart of the CMS-1500 form) | `005010X222` | `005010X222A1` |
| **837I** Institutional | Hospitals, skilled nursing, home health, hospice and other facilities (the counterpart of the UB-04) | `005010X223`, with errata `005010X223A1` | `005010X223A2` |
| **837D** Dental | Dental services (the counterpart of the ADA dental claim form) | `005010X224`, with errata `005010X224A1` | `005010X224A2` |
Authoritative references for 837 work:
- [45 CFR Part 162](https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-C/part-162), administered by CMS, lists the adopted HIPAA claim standards and the National Provider Identifier (NPI) requirement
- The X12 `005010X222A1`, `X223A2` and `X224A2` technical reports (TR3s) define every loop, segment and code for each variant
- Payer and state companion guides, such as the Indiana Department of Health [837I](https://www.in.gov/health/cshcs/files/837I_Companion_Guide_5010.pdf) and [837D](https://www.in.gov/health/cshcs/files/ISDH_Companion_Guide_837D_V2_2__3_.pdf) companion guides, say which situational segments a receiver requires
**Who sends it?** The provider's practice management or hospital billing system, usually through a clearinghouse.
**Who receives it?** The health plan, either directly or through the clearinghouse. Coordination-of-benefits claims also go from one payer or provider to a secondary payer.
**When is it sent?** After the service, once the claim is coded and checked. Most systems batch claims and send files daily.
**Why does it matter?** A claim the payer cannot accept is a claim that is not paid. Rejections at the 999 or 277CA stage cost days; claims that never arrive cost timely filing.
## How the 837 Claim Cycle Works
1. **Eligibility.** Before or at the visit, the provider checks coverage with a [270 eligibility inquiry](/guides/edi/270-eligibility-benefit-inquiry) and gets a [271 response](/guides/edi/271-eligibility-benefit-response).
2. **Coding and charge entry.** Diagnoses (ICD-10-CM), procedures (CPT/HCPCS, CDT for dental, revenue codes for facilities) and charges are entered.
3. **Claim build and scrub.** The billing system builds the 837 and the clearinghouse runs edits against the TR3 and payer rules.
4. **Submission.** The 837 file goes to the payer.
5. **Acknowledgments.** A [999](/guides/edi/999-implementation-acknowledgment) reports whether the file passed X12 and TR3 validation. A 277CA (claim acknowledgment, `005010X214`) reports which claims were accepted into adjudication and which were rejected.
6. **Status.** While a claim is pending, a [276 claim status request](/guides/edi/276-claim-status-request) returns a [277 status response](/guides/edi/277-claim-status-response).
7. **Payment.** The payer pays and explains with an [835 remittance advice](/guides/edi/835-health-care-claim-payment-advice). `CLP01` on the 835 echoes `CLM01` from the 837.
8. **Correction.** Denied or incorrect claims go back as replacement (`7`) or void (`8`) claims referencing the payer's claim number.
## The 837 Loop Structure
Every 837 variant uses the same HL (hierarchical level) tree. Understanding it is most of the work in reading one.
```
ST / BHT Transaction header
1000A NM1*41 Submitter (with PER contact)
1000B NM1*40 Receiver
2000A HL*n**20*1 Billing provider level
2010AA NM1*85 Billing provider name, address, tax ID
2010AB NM1*87 Pay-to address (when different)
2000B HL*n*p*22*0|1 Subscriber level, SBR
2010BA NM1*IL Subscriber
2010BB NM1*PR Payer
2000C HL*n*p*23*0 Patient level, PAT (only when the patient is not the subscriber)
2010CA NM1*QC Patient
2300 CLM Claim (under 2000B, or under 2000C when present)
2310x NM1 Claim-level providers (referring, rendering, attending, facility)
2320 SBR Other payers (coordination of benefits)
2400 LX + SV1|SV2|SV3 Service lines
2410 LIN Drug identification
2420x NM1 Line-level providers
2430 SVD + CAS Prior payer's line adjudication (secondary claims)
SE
```
| Loop | Level code (`HL03`) | What it holds |
|---|---|---|
| **2000A** | `20` | The billing provider: who is billing, with NPI and tax ID. One 2000A can hold many subscribers and claims |
| **2000B** | `22` | The subscriber: the person who holds the coverage, the payer, and the group number in `SBR` |
| **2000C** | `23` | The patient, when different from the subscriber and the payer does not identify the patient with their own member ID |
| **2300** | (not an HL) | One claim: `CLM`, dates, diagnoses, claim-level providers and notes |
| **2400** | (not an HL) | One service line: procedure, charge, units and date |
`HL04` (hierarchical child code) is `1` when the level has children and `0` when it does not. A subscriber who is also the patient has `HL04` = `0` on the 2000B, and the claim sits directly under it.
**Patient or subscriber?** In 5010, a dependent who can be uniquely identified by the payer, usually through their own member ID, is treated as the subscriber. X12's published [interpretation on subscriber versus dependent](https://x12.org/resources/requests-for-interpretation/rfi-2117-sub-vs-dependent-270271) states this for eligibility and says "the same logic exists in the 837 Claims". So that dependent is reported in 2000B, and the 2000C patient loop is used only when the payer identifies the patient through the subscriber. Payer companion guides can tighten this further.
## Interactive Example: 837P Professional Claim
A fictional family practice bills an office visit and a rapid strep test for a patient who is also the subscriber. `CLM05` = `11:B:1` is place of service 11 (office), qualifier B, frequency 1 (original claim). The principal diagnosis is in `HI` with qualifier `ABK`, and each line is an `SV1`. The total in `CLM02` ($160.00) equals the sum of the lines. This claim's `CLM01` is the `CLP01` in the [835 guide's sample remittance](/guides/edi/835-health-care-claim-payment-advice). All people, providers and IDs are fictional; NPI `1999999992` is a check-digit-valid test value.
## Interactive Example: 837I Institutional Claim
A fictional hospital bills an outpatient emergency department visit. `CLM05` = `13:A:1` gives the type of bill as facility type 13 with frequency 1 (bill type 131). The claim adds statement dates (`DTP*434`), institutional codes in `CL1`, a principal diagnosis and a patient's reason for visit (`HI` with `ABK` and `APR`), an attending provider (`NM1*71`) and three `SV2` lines, each with a revenue code and a procedure code. NPIs `1999999976` and `1999999984` are check-digit-valid test values.
## Interactive Example: 837D Dental Claim
A fictional dental group bills a periodic evaluation, an adult prophylaxis and a one-surface posterior resin filling. Dental lines use `SV3` with the `AD` (ADA) qualifier, and the filling adds a `TOO` segment identifying tooth 30 and the occlusal surface. NPI `1999999968` is a check-digit-valid test value.
## 837P vs 837I vs 837D
| | 837P Professional | 837I Institutional | 837D Dental |
|---|---|---|---|
| **Paper equivalent** | CMS-1500 | UB-04 | ADA dental claim form |
| **Implementation guide** | `005010X222A1` | `005010X223A2` | `005010X224A2` |
| **`CLM05` composite** | Place of service : `B` : frequency | Facility type : `A` : frequency (the type of bill) | Place of service : `B` : frequency |
| **Service line segment** | `SV1` | `SV2` | `SV3` |
| **Procedure codes** | CPT/HCPCS (`HC`) | Revenue code in `SV201`, plus CPT/HCPCS where required | CDT (`AD`) |
| **Diagnosis codes** | ICD-10-CM in `HI`, pointed to from `SV107` | ICD-10-CM in `HI`, with admitting and reason-for-visit qualifiers | `HI` where the payer requires it |
| **Facility detail** | | Statement dates, `CL1` admission and discharge codes, value, condition and occurrence codes in `HI` | |
| **Dental detail** | | | `TOO` tooth and surface, oral cavity area in `SV304` |
| **Key provider roles** | Billing, rendering, referring | Billing, attending, operating, other | Billing, rendering |
## Key Segments Explained
### BHT: Beginning of Hierarchical Transaction
```
BHT*0019*00*EFP20261103A*20261103*1015*CH~
```
| Element | Name | Example | What it means |
|---|---|---|---|
| **BHT01** | Hierarchical Structure Code | `0019` | Information source, subscriber, dependent structure |
| **BHT02** | Transaction Set Purpose Code | `00` | Original |
| **BHT03** | Reference Identification | `EFP20261103A` | The submitter's batch reference |
| **BHT04 / BHT05** | Date and time | `20261103`, `1015` | When the file was created |
| **BHT06** | Claim or Encounter Identifier | `CH` | `CH` chargeable (a claim for payment), `RP` reporting (encounters), `31` subrogation demand |
### NM1: Submitter, Receiver, Providers, Subscriber, Payer
The 837 uses `NM1` for every party. `NM101` says which one, and `NM108`/`NM109` carry the identifier.
| `NM101` | Party | Loop | Typical ID (`NM108`) |
|---|---|---|---|
| `41` | Submitter | 1000A | `46` electronic transmitter ID |
| `40` | Receiver | 1000B | `46` |
| `85` | Billing provider | 2010AA | `XX` NPI |
| `87` | Pay-to provider | 2010AB | Address only |
| `IL` | Subscriber | 2010BA | `MI` member ID |
| `PR` | Payer | 2010BB | `PI` payer ID |
| `QC` | Patient | 2010CA | |
| `82` | Rendering provider | 2310B (837P, 837D) / 2420A | `XX` NPI |
| `71` | Attending provider (837I) | 2310A | `XX` NPI |
| `DN` | Referring provider | 2310A (837P) | `XX` NPI |
The billing provider's NPI must pass the NPI check digit, and its address in `N3`/`N4` must be a street address with a nine-digit ZIP code in 5010. The tax ID follows in `REF*EI` (or `REF*SY` for an individual's SSN, where allowed).
### SBR: Subscriber Information
```
SBR*P*18*GRP778899******CI~
```
| Element | Name | Example | What it means |
|---|---|---|---|
| **SBR01** | Payer Responsibility Sequence | `P` | `P` primary, `S` secondary, `T` tertiary for this payer |
| **SBR02** | Individual Relationship Code | `18` | `18` (self) when the subscriber is the patient; empty when a 2000C patient loop follows |
| **SBR03** | Group or Policy Number | `GRP778899` | The group number from the member's card |
| **SBR09** | Claim Filing Indicator Code | `CI` | Type of coverage, for example `CI` commercial, `MB` Medicare Part B, `MC` Medicaid, `HM` HMO |
### CLM: Claim Information
```
CLM*EFP26110301*160***11:B:1*Y*A*Y*Y~
```
| Element | Name | Example | What it means |
|---|---|---|---|
| **CLM01** | Patient Control Number | `EFP26110301` | Your claim ID. Returned as `CLP01` on the 835 and in 277 responses, so keep it unique |
| **CLM02** | Total Claim Charge | `160` | Must equal the sum of the service line charges |
| **CLM05-1** | Place of service or facility type | `11` | 837P/837D: place of service code. 837I: facility type code (first two digits of the type of bill) |
| **CLM05-2** | Facility Code Qualifier | `B` | `B` place of service (837P/837D), `A` uniform billing claim form bill type (837I) |
| **CLM05-3** | Claim Frequency Type Code | `1` | `1` original, `7` replacement of a prior claim, `8` void of a prior claim |
| **CLM06** | Provider Signature Indicator | `Y` | 837P/837D only |
| **CLM07** | Assignment or Plan Participation Code | `A` | Whether the provider accepts assignment |
| **CLM08** | Benefits Assignment Certification | `Y` | Whether the patient assigned benefits to the provider |
| **CLM09** | Release of Information Code | `Y` | Whether the provider has the patient's authorization to release information |
Replacement and void claims also carry the payer's original claim number in `REF*F8` in loop 2300. That number comes from `CLP07` on the 835.
### HI: Health Care Diagnosis and Other Codes
```
HI*ABK:J029~
```
`HI` carries up to 12 codes per segment as composites: a qualifier and a code. ICD-10-CM codes are sent without the decimal point (`J029` is J02.9).
| Qualifier | Meaning |
|---|---|
| `ABK` | Principal diagnosis (ICD-10-CM) |
| `ABF` | Other diagnosis (ICD-10-CM) |
| `ABJ` | Admitting diagnosis (837I) |
| `APR` | Patient's reason for visit (837I) |
837I claims use further `HI` qualifiers for condition, occurrence, value and procedure codes; the 837I TR3 and the payer's guide list them. In an 837P, `SV107` points from each line to the diagnoses in `HI` by position (1 to 12).
### SV1: Professional Service (837P)
```
SV1*HC:99213*125*UN*1***1~
DTP*472*D8*20261103~
```
| Element | Name | Example | What it means |
|---|---|---|---|
| **SV101** | Composite Procedure Code | `HC:99213` | `HC` (HCPCS, which includes CPT) and the code, then up to four modifiers |
| **SV102** | Line Item Charge | `125` | Billed amount for the line |
| **SV103** | Unit of Measure | `UN` | `UN` units, `MJ` minutes (anesthesia) |
| **SV104** | Service Unit Count | `1` | Number of units |
| **SV105** | Place of Service Code | | Only when different from `CLM05-1` |
| **SV107** | Diagnosis Code Pointer | `1` | Which `HI` diagnoses support this line |
### SV2: Institutional Service (837I)
```
SV2*0450*HC:99284*950*UN*1~
```
| Element | Name | Example | What it means |
|---|---|---|---|
| **SV201** | Revenue Code | `0450` | The facility revenue code for the department or service |
| **SV202** | Composite Procedure Code | `HC:99284` | CPT/HCPCS, where the payer or the revenue code requires it |
| **SV203** | Line Item Charge | `950` | Billed amount |
| **SV204** | Unit of Measure | `UN` | `UN` units or `DA` days |
| **SV205** | Service Unit Count | `1` | Number of units or days |
### CL1: Institutional Claim Codes (837I)
```
CL1*1*1*01~
```
`CL101` is the admission type, `CL102` the point of origin (admission source) and `CL103` the patient status (discharge status). The codes come from the National Uniform Billing Committee's UB-04 code sets. Inpatient claims need this segment; whether a payer also requires it on outpatient claims is set by its companion guide.
### SV3 and TOO: Dental Service (837D)
```
SV3*AD:D2391*140****1~
TOO*JP*30*O~
```
| Element | Name | Example | What it means |
|---|---|---|---|
| **SV301** | Composite Procedure Code | `AD:D2391` | `AD` (American Dental Association codes, CDT) and the procedure |
| **SV302** | Line Item Charge | `140` | Billed amount |
| **SV303** | Place of Service Code | | Only when different from the claim |
| **SV304** | Oral Cavity Designation | | Area of the mouth, for procedures that apply to an area rather than a tooth |
| **SV305** | Prosthesis, Crown or Inlay Code | | Initial placement or replacement |
| **SV306** | Procedure Count | `1` | Number of times performed |
| **TOO01** | Code List Qualifier | `JP` | Universal National Tooth Designation System |
| **TOO02** | Tooth Number | `30` | The tooth treated |
| **TOO03** | Tooth Surface | `O` | Surface codes, as a composite when more than one surface |
`TOO` can repeat (up to 32 times) when a line covers several teeth.
### LX and DTP: Service Line Number and Date
Each 2400 loop starts with `LX` (a line counter starting at 1) and carries the service date in `DTP*472`, as a single date (`D8`) or a range (`RD8`). Many payers also want a line item control number in `REF*6R`, which the payer returns on the 835 for line-level matching.
## 837 Validation: What an "EDI 837 Validator" Actually Checks
Claim files are checked in layers. The industry commonly describes them as the WEDI SNIP validation types:
| Layer | What it checks | Example failure |
|---|---|---|
| **1. Integrity** | X12 syntax: envelopes, segment terminators, control numbers, counts | `SE01` does not equal the segment count |
| **2. Requirement** | TR3 rules: required segments and elements, element lengths and values | Missing `REF*EI` on the billing provider |
| **3. Balancing** | Amounts that must add up | `CLM02` does not equal the sum of line charges |
| **4. Situation** | Situational rules ("required when...") | Patient loop sent although the patient is the subscriber |
| **5. External code sets** | Codes valid in the external lists on the date of service | Invalid or deleted ICD-10-CM, CPT or place of service code |
| **6. Product or service type** | Rules specific to 837P, 837I or 837D | Revenue code missing on an institutional line |
| **7. Trading partner** | The payer's companion guide | A payer-specific REF or payer ID |
Layers 1 and 2 surface on the [999](/guides/edi/999-implementation-acknowledgment); claims that pass the file but fail payer edits are rejected on the 277CA. A free X12 parser handles layer 1 and makes layers 2 to 4 readable. Code set and payer rules (layers 5 to 7) need the clearinghouse's or payer's edits, because they depend on licensed code sets, dates of service and contracts.
## How the 837 Connects to the 835
| 837 | 835 | Notes |
|---|---|---|
| `CLM01` patient control number | `CLP01` | The primary match |
| `CLM02` total charge | `CLP03` | What you billed |
| `CLM05-1` place of service or facility type | `CLP08` | Echoed back |
| `CLM05-3` frequency | `CLP09` | Echoed back |
| `REF*6R` line item control number | `REF*6R` in loop 2110 | Line-level match |
| `SV101` / `SV202` / `SV301` procedure | `SVC01` | `SVC06` shows the original code if the payer changed it |
| `DTP*472` service date | `DTM*472` | Line date |
| `REF*F8` on a replacement | `CLP07` from the earlier 835 | Ties a corrected claim to the original |
See the [835 guide](/guides/edi/835-health-care-claim-payment-advice) for how the payer reports each adjustment with CAS group codes (CO, PR, OA, PI), CARCs and RARCs.
## Common 837 Errors and How to Prevent Them
| Error | Where it surfaces | Prevention |
|---|---|---|
| **Invalid NPI check digit or NPI not matching the payer's enrollment** | 999 or 277CA | Validate the Luhn check digit and keep the NPI on file with each payer |
| **Billing provider address is a PO box, or ZIP is five digits** | 277CA | Use a street address and nine-digit ZIP in 2010AA; put a PO box in the pay-to loop |
| **`CLM02` does not equal the sum of line charges** | 999 or 277CA | Compute the total from the lines when the file is built |
| **Patient loop used for a dependent with their own member ID** | 277CA | Report that member as the subscriber in 2000B |
| **Wrong `GS08`/`ST03` for the variant** | 999 | `005010X222A1` for 837P, `X223A2` for 837I, `X224A2` for 837D, unless the payer's guide says otherwise |
| **Diagnosis sent with a decimal point** | 999 | Strip the decimal: `J02.9` is sent as `J029` |
| **Replacement claim without `REF*F8`** | 277CA or 835 denial | Send the payer claim control number from the 835's `CLP07` |
| **Duplicate `CLM01` across claims** | 835 posting | Generate unique patient control numbers per claim |
| **Missing diagnosis pointer in `SV107`** | 999 | Point every 837P line at one or more `HI` codes |
| **Unchecked 999 and 277CA** | Silent | Claims rejected at either stage never reach adjudication. Work both every day |
## 837 Implementation Checklist
- Get the clearinghouse and payer companion guides for each variant you send
- Confirm `GS08`/`ST03` values for 837P, 837I and 837D
- Confirm payer IDs (`NM1*PR`) and submitter and receiver IDs with the clearinghouse
- Validate NPIs, tax IDs and the billing provider's street address and nine-digit ZIP
- Decide subscriber versus patient loops using the payer's member ID rules
- Keep `CLM01` unique and send `REF*6R` on lines if you want line-level 835 matching
- Build replacement and void claim workflows using `CLM05-3` and `REF*F8`
- Set up daily review of 999s, 277CAs and 277 status responses
- Reconcile 835 payments back to claims on `CLP01`
- Test each variant, including a secondary claim with 2320 and 2430 loops if you bill secondary payers
For background on X12 envelopes and acknowledgments, see our [EDI document types reference](/edi-document-types), the [997 functional acknowledgment guide](/guides/edi/997-functional-acknowledgment) and the [834 enrollment guide](/guides/edi/834-benefit-enrollment-and-maintenance) for the plan side.
## Reading 837 Files With OrderSync's Free Inspector
When a claim file is rejected, the fastest way in is to read it loop by loop. Paste any X12 file into the [free EDI inspector](/edi-inspector) to see the envelope, the billing provider, subscriber, claim and service line loops broken out segment by segment, with control-number and segment-count problems flagged. It runs in your browser and needs no signup. Use sample files, or files with patient data removed, when you are trying it out. The [EDI to JSON converter](/edi-to-json) and [EDI translator](/edi-translator) work on the same files.
## Frequently Asked Questions
### What is an 837 file?
An 837 file is the X12 Health Care Claim transaction. Providers, billing services and clearinghouses use it to send claims and encounters to health plans. Under HIPAA it comes in three variants: 837P professional, 837I institutional and 837D dental, each with its own 5010 implementation guide.
### What is the difference between 837P and 837I?
The 837P carries professional claims from physicians and other practitioners, with SV1 service lines and a place of service in CLM05. The 837I carries facility claims from hospitals and other institutions, with SV2 revenue-code lines, a type of bill in CLM05 and institutional detail such as statement dates and CL1 codes.
### What are the main loops in an 837?
Loop 2000A is the billing provider, 2000B the subscriber and payer, 2000C the patient when different from the subscriber, 2300 the claim and 2400 the service lines. 1000A and 1000B before them identify the submitter and receiver.
### How do I validate an 837 file?
Check it in layers: X12 syntax and envelopes, the implementation guide's required segments and values, balancing (line charges must add up to CLM02), situational rules, code sets, variant rules and the payer's companion guide. A parser covers the first layers; clearinghouse and payer edits cover the rest. The 999 and 277CA report what failed.
### What is CLM01 in an 837?
CLM01 is the patient control number, the provider's own ID for the claim. The payer returns it in CLP01 on the 835 remittance and in claim status responses, so it should be unique for every claim.
### What does CLM05 mean?
CLM05 is a composite. In 837P and 837D it holds the place of service code, the qualifier B and the claim frequency code. In 837I it holds the facility type code, the qualifier A and the frequency code, which together make the type of bill. Frequency 1 is an original claim, 7 a replacement and 8 a void.
### What acknowledgments come back for an 837?
A 999 reports whether the file passed X12 and implementation guide validation. A 277CA reports which claims were accepted into adjudication or rejected. Later, 277 claim status responses answer 276 inquiries, and the 835 reports payment.
### How is an 837 matched to an 835?
CLM01 on the 837 equals CLP01 on the 835. Line item control numbers in REF*6R match at line level, and the payer's claim control number in CLP07 is what you send back in REF*F8 on a replacement or void claim.