X12 EDI Examples for Referring Provider in EDI 837 Claim

 

X12 EDI Examples

EDI 837 Professional. Version 005010X222A1

Example 1: Outpatient Visit
Example 2: Claim level Attachment (PWK) Example. 
Example 3: Claim with Referring Provider example.  
Example 4: Claim with Pay to Address example.   
Example 5: Claim for Ambulance service. 
Example 6: Claim with Prior Authorization Number. 
Example 7: Claim with Payer Claim Number. 
Example 8: Billing Provider Secondary identification. 
Example 9: Facility with Secondary identification.                     
Example 10: Billing Laboratory Claims Electronically
Example 11: Payer with secondary identification
Example 12: Billing Provider Complete information
Example 13: Patient is a different person than the Subscriber
Example 14:  K3 File Information                                                      
Example 15 : Claim Note NTE Segment
Example 16 : Billing for Physician Administered Drugs and NDC Reporting

EDI 837 Dental . Version 005010X224A2

Example 1: Orthodontic-treatment-plan
Example 2: One Claim with 12 Procedure Codes
               
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Attach supporting document with initial Claim

X12 EDI Examples