Submit an X12 837I institutional claim for a hospital inpatient stay

Verified steps

1. Construct the ISA/GS interchange and group envelopes with your clearinghouse-assigned sender ID and the payer receiver ID; use transaction set ID 837 and implementation convention reference 005010X223A2 for institutional claims
2. Build the 2000A (billing provider) and 2000B (subscriber) HL loops; for institutional claims the 2000B loop carries the subscriber and the 2000C loop carries the patient if different from the subscriber
3. Populate the CLM segment with the total claim charge, facility type code, and claim frequency type code; for inpatient claims the facility type is typically 11 (hospital inpatient) combined with appropriate bill type
4. Add the 2300 claim information loop including diagnosis codes in the HI segment using ICD-10-CM codes for principal and secondary diagnoses, and the principal procedure code in the HI segment using ICD-10-PCS codes for inpatient procedures
5. Include date ranges for the admission and discharge in DTP segments, and add condition codes, occurrence codes, and value codes in the appropriate HI segments as required by the payer's companion guide
6. Add 2400 service line loops for each revenue code line, specifying the revenue code in SV2-1, line charges, and service dates; close all loops and envelope segments with correct segment counts and control numbers