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5010 837p
5010 837p Details
16
Health Care
Professional
11/08/2011
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Term
Loop ID-2000B
 Definition
The Subscriber loop.
Term
The Subscriber Loop
 Definition
Contains information about the person who holds the policy with Payer A.
Term
Loop ID-2320
 Definition
Contains information about Payer B and the subscriber who hold the policy with Payer B.
Term
Electronic Remittance Advice (RA) Transaction
 Definition
835
Term
The other Subscriber Information loop.
 Definition
Loop ID-2320
Term
Destination Payer's Information Loop
 Definition
Loop ID-2010BB
Term
Destination Payer-specific Claim Information Loop
 Definition
Loop ID-2300
Term
All Provider Identifier Information is in which loops?
 Definition
Loop ID-2310
Term
Loop ID-2320 usage?
 Definition
Occurs once for each payer responsible for the claim, except for the payer receiving the 837 transaction set (destination payer).
Term
2330 loop usage?
 Definition
Provider identifiers in this loop are specific to the corresponding non-destination payer.
Term
Loop ID-2320 contains:
 Definition
Claim level adjustments
Other subscriber demographics
Various amounts
Other payer information
Assignment of benefits indicator
patient signature indicator
Term
Other loop ID-2320 details
 Definition
Inside Loop ID-2320, Loop ID-2330 contains the information for the payer and the subscriber. As the claim moves from payer to payer, the destination payer's information in Loop ID-2000B and Loop ID-2010BB must be exchanged with the next payer's information from Loop ID-2320/2330.
Term
Loop ID-2430
 Definition
A situational loop that can occur up to 15 times for each service line. As each payer adjudicates the service lines, occurrences may be added to this loop to explain how the payer adjudicated the service line.
Term
Loop ID-2430 contains:
 Definition
ID of the payer who adjudicated the service line.
Amount paid for the service line.
procedure code upon which adjudication of the service line was based. This code may be different than the submitted procedure code. (This procedure code also can be used for unbundling or bundling service lines.)
Paid units of service.
Service line level adjustments.
Adjudication date.
Term
Coordination of Benefits -- Claim Level
Loops?
 Definition
Loop ID-2320
Term
Coordination of Benefits -- Service Line Level
Loops?
 Definition
Loop ID-2430
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