Submit an X12 837P professional claim through a clearinghouse for reimbursement

Verified steps

1. Construct the 837P transaction set with required loop and segment hierarchy: ISA/GS envelope, ST*837, BPR (financial information), NM1 loops for submitter (Loop 1000A), receiver (Loop 1000B), billing provider (Loop 2000A), subscriber (Loop 2000B), and claim (Loop 2300).
2. Populate the CLM segment (claim information): CLM-01 (patient account number), CLM-02 (total charge), CLM-05 (place of service code, facility/non-facility), CLM-11 (provider acceptance of assignment).
3. Add LX/SV1 (service line) loops under Loop 2400 for each procedure: SV1-01 (procedure code composite with CPT/HCPCS code and modifiers), SV1-02 (line charge amount), SV1-03 (unit of measurement), SV1-04 (service unit count).
4. Include DTP segments for claim service dates (qualifier 472 for service date range) and NPI numbers in NM1 segments using qualifier XX.
5. Submit to the clearinghouse via their REST or SFTP API; receive a 999 functional acknowledgment confirming EDI structural acceptance; then wait for the 277CA (claim acknowledgment) to confirm payer acceptance.
6. Monitor for ERA (835 electronic remittance advice) for adjudication results: CAS segments contain adjustment reason codes and CO/PR/OA adjustment group codes indicating payer vs. patient responsibility.