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HIPAA ANSI X12N 837
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Negative values submitted in the following fields will not be processed and will result in the claim being rejected: Total Charge amount (2300 Loop CLM02), Patient Amount Paid (2300 Loop,AMT02), Patient Weight (2300 and 2400 Loop CR102) Transport distance (2300 and 2400 Loop,CR106) Payer Paid Amount (2320 Loop, AMT02), Allowed Amount (2320 Loop, AMT02), Line Item Charge Amount (2400 Loop, SV102). Service Unit Count(2400 Loop, SV104), Total Purchased Service Amount (2300 Loop, AMT02), and Purchased Service Charge Amount(2400 Loop, PS102)
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HIPAA ANSI X12N 837
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The only valid values for CLM05-3 (Claim Frequency Type Code) are '1' (ORIGINAL) and '7' (REPLACEMENT). Claims with a value of '7' will be processed as original claims and may result in duplicate claim rejection. The claims processing system does not process electronic replacements.
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HIPAA ANSI X12N 837
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The maximum number of characters to be submitted in the dollar amount field is seven characters. Claims in excess of 99,999.99 will be rejected
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HIPAA ANSI X12N 837
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Claims that contain percentage amounts submitted with values in excess of 99.99 will be rejected.
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HIPAA ANSI X12N 837
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Claims that contain percentage amounts submitted with more than two positions to the left or the right of the decimal will be rejected.
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HIPAA ANSI X12N 837
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Data submitted in the CLM20 (Delay Reason Code) will not be used for processing.
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HIPAA ANSI X12N 837
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You must submit incoming 837 claim data using the basic character set as defined in Appendix A of the 837 Professional Implementation Guide. In addition to the basic character set, you may choose to submit lower case characters and the '@' symbol from the extended character set . Any other characters submitted from the extended character set will cause the interchange (transmission) to be rejected at the carrier translator.
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HIPAA ANSI X12N 837
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The subscriber hierarchical level (HL segment) must be in order from one, by one(+1) and must be numeric.
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HIPAA ANSI X12N 837
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Currency code (CUR02) must equal 'USA'.
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HIPAA ANSI X12N 837
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Transaction Set Purpose Code (BHT02) must equal '00' (ORIGINAL).
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HIPAA ANSI X12N 837
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Claim or Encounter Indicator (BHT06) must equal 'CH' (CHARGEABLE).
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HIPAA ANSI X12N 837
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Total submitted charges (CLM02) must equal the sum of the line item charges amounts (SV102).
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HIPAA ANSI X12N 837
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Service unit counts (units or minutes) cannot exceed 999.9 (SV104)
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HIPAA ANSI X12N 837
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Any data submitted in the PWK (Paperwork) segment may not be considered for processing.
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