X12 837I Institutional Claim

1. Envelopes and structure

   Interchange, functional group, transaction set envelopes and the HL billing/subscriber/patient hierarchy.

2. Claim loop 2300 institutional

   CLM, CL1 admission type, source and patient status, DTP statement dates and HI code qualifiers.

3. Institutional code sets

   Type of bill, revenue codes, condition, occurrence and value codes, and admission type and source.

4. Diagnosis and procedure reporting

   Principal, admitting, other diagnoses and ICD-10-PCS procedures with present-on-admission indicators.

5. Service lines 2400

   SV2 revenue code with HCPCS, units, charges, and drug identification with LIN and CTP.

6. DRG and payment grouping

   How diagnoses and procedures drive MS-DRG assignment on inpatient claims.

7. Completing institutional claims

   UB-04 data set and 837I mapping rules in the Medicare Claims Processing Manual.

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