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837I — Institutional Claims
The 837I (Institutional) transaction is used by hospitals, skilled nursing facilities, and other institutional providers to submit claims for inpatient and outpatient services. It handles the complex billing requirements of facility-based care.
Purpose
The 837I transmits:
- Claims for institutional services (hospital stays, emergency room visits, outpatient procedures)
- Facility-specific information (admission dates, discharge status, type of bill)
- Revenue codes and service charges
- Occurrence codes, value codes, and condition codes
- Supporting clinical data (diagnosis codes, procedure codes)
It flows from facility → clearinghouse → payer during the claims submission process.
Key Differences from 837P
| Aspect | 837P (Professional) | 837I (Institutional) |
|---|---|---|
| Providers | Physicians, labs, ambulatory | Hospitals, SNFs, facilities |
| Service Lines | SV1 segment (CPT/HCPCS) | SV2 segment (Revenue codes) |
| Place of Service | CLM05 facility code | Type of Bill (CLM05) |
| Procedures | CPT codes on service lines | ICD-10-PCS in HI segment |
| Additional Data | Minimal | Occurrence/Value/Condition codes |
| Admission Info | N/A | CL1 segment with admit type/source |
Loop Structure
Loop 1000A — Submitter Name
Loop 1000B — Receiver Name
Loop 2000A — Billing Provider (HL*20)
Loop 2010AA — Billing Provider Name
Loop 2010AB — Pay-To Address (if different)
Loop 2010AC — Pay-To Plan Name (if different)
Loop 2000B — Subscriber (HL*22)
Loop 2010BA — Subscriber Name
Loop 2010BB — Payer Name
Loop 2000C — Patient (HL*23, if different from subscriber)
Loop 2010CA — Patient Name
Loop 2300 — Claim Information
Loop 2310A — Attending Provider
Loop 2310B — Operating Physician
Loop 2310C — Other Operating Physician
Loop 2310D — Rendering Provider
Loop 2310E — Service Facility
Loop 2310F — Referring Provider
Loop 2320 — Other Subscriber Info (COB)
Loop 2400 — Service Lines
Loop 2420A-D — Line-level providersKey Segments
CLM — Claim Information
The foundation of every institutional claim:
CLM*CLAIM001*25000***14:A:1*Y*A*Y*Y~| Element | Position | Description | Example |
|---|---|---|---|
| Claim ID | 01 | Submitter's claim identifier | CLAIM001 |
| Total Charge | 02 | Total billed amount | 25000 |
| Facility Code | 05 | Type of Bill (05-1 = 14 = Hospital Inpatient) | 14:A:1 |
| Provider Signature | 06 | Signature on file indicator | Y |
| Assignment | 07 | Accept assignment code | A |
| Benefits Assignment | 08 | Benefits assigned indicator | Y |
| Release of Info | 09 | Information release signed | Y |
Type of Bill (CLM05)
The first two digits indicate facility type and billing classification:
| First Digit | Facility Type |
|---|---|
| 1 | Hospital |
| 2 | Skilled Nursing Facility |
| 3 | Home Health |
| 4 | Religious Nonmedical (Hospital) |
| 5 | Religious Nonmedical (Extended Care) |
| 6 | Intermediate Care |
| 7 | Clinic or Hospital-Based Renal Dialysis |
| 8 | Special Facility |
| Second Digit | Bill Classification |
|---|---|
| 1 | Inpatient (Part A) |
| 2 | Inpatient (Part B) |
| 3 | Outpatient |
| 4 | Other |
| 8 | Swing Bed |
CL1 — Institutional Claim Code
Unique to 837I, contains admission information:
CL1*1*1*01~| Element | Position | Description | Example |
|---|---|---|---|
| Admit Type | 01 | 1=Emergency, 2=Urgent, 3=Elective, 4=Newborn, 5=Trauma | 1 |
| Admit Source | 02 | 1=Physician Referral, 2=Clinic, 4=Transfer, 5=ER, etc. | 1 |
| Patient Status | 03 | Discharge status (01=Home, 02=SNF, 20=Expired, etc.) | 01 |
SV2 — Institutional Service Line
Each revenue line on the claim:
SV2*0450*HC:99283*350*UN*1~| Element | Position | Description | Example |
|---|---|---|---|
| Revenue Code | 01 | 4-digit revenue code | 0450 (Emergency Room) |
| Procedure Code | 02 | Composite: qualifier:code:modifiers | HC:99283 |
| Charge Amount | 03 | Line item charge | 350 |
| Unit Type | 04 | UN=Units, DA=Days | UN |
| Quantity | 05 | Number of units | 1 |
Common Revenue Codes
| Code | Description |
|---|---|
| 0100-0109 | Room & Board - All Inclusive |
| 0110-0119 | Room & Board - Private |
| 0120-0129 | Room & Board - Semi-Private |
| 0250-0259 | Pharmacy |
| 0300-0309 | Laboratory |
| 0320-0329 | Radiology - Diagnostic |
| 0450-0459 | Emergency Room |
| 0720-0729 | Labor Room/Delivery |
HI — Diagnosis and Procedure Codes
ICD-10-CM diagnosis codes:
HI*ABK:J189*ABF:E119*ABF:I10~| Qualifier | Meaning |
|---|---|
| ABK | Principal Diagnosis (ICD-10-CM) |
| ABF | Other Diagnosis (ICD-10-CM) |
| ABJ | Admitting Diagnosis |
| BK | Principal Procedure (ICD-10-PCS) |
| BF | Other Procedure (ICD-10-PCS) |
HI — Occurrence and Value Codes
Occurrence codes (events with dates):
HI*BH:A1:D8:20240110~| Qualifier | Meaning |
|---|---|
| BH | Occurrence Code |
| BE | Occurrence Span Code |
| BG | Value Code |
Common occurrence codes:
- 01 — Accident/Medical Coverage Effective Date
- 11 — Onset of Symptoms
- 17 — Date of Onset of Current Illness
- A1 — Birthdate - Insured A
PWK — Claim Supplemental Information
Attachment information:
PWK*OZ*EL***AC*ATTACH123~| Element | Position | Description |
|---|---|---|
| Report Type | 01 | OZ=Support Data, CT=Certification |
| Transmission | 02 | EL=Electronic, BM=By Mail, FX=By Fax |
| Attachment Control | 06 | Attachment tracking number |
EDI Paisan Features
Viewing
- Claim tree navigation — Expand/collapse by provider, subscriber, patient, claim
- Revenue code display — Human-readable descriptions for revenue codes
- Type of Bill decoding — Instant breakdown of facility type, bill classification, frequency
- Segment inspector — Click any segment to see element descriptions
- Admission/discharge timeline — Visual representation of patient stay
- Search — Find claims by ID, patient name, diagnosis, revenue code, or procedure
Splitting (Pro)
| Split Mode | What It Does |
|---|---|
| By Claim | One file per CLM segment with proper envelopes |
| By Subscriber | All claims for one subscriber in a file |
| By Rendering Provider | Group by the rendering provider (NM1*82) |
| By Transaction | One file per ST...SE envelope |
| In Half | Divide claims evenly into two files |
| Into N Parts | Divide claims evenly into N files |
Each split file includes:
- Correct ISA/IEA envelope with new control numbers
- Correct GS/GE envelope with new control numbers
- Proper ST/SE with accurate segment counts
- All required header segments (BHT, submitter, receiver, billing provider)
- Subscriber/patient hierarchy for each claim
Anonymization (Pro)
Masks PHI while preserving file structure:
| Data Type | Masking Method |
|---|---|
| Names | First character preserved: "SMITH" → "S****" |
| Addresses | First character preserved |
| DOB | Year only: "19850315" → "1985XXXX" |
| Member IDs | Consistent replacement (same ID = same mask) |
| SSN | Full mask: "*********" |
| Phone Numbers | Preserve area code: "555-123-4567" → "555-XXX-XXXX" |
| ZIP Codes | HIPAA Safe Harbor: preserve first 3 digits |
| MRN (Medical Record) | Consistent replacement |
Anonymization only affects patient/subscriber data, not provider or facility information.
Common Issues
Missing Required Segments
EDI Paisan validates and warns about:
- Missing CLM segment in claim loop
- Missing CL1 segment (required for inpatient)
- Missing subscriber/patient NM1 segments
- Missing payer NM1 segment
- Missing HI (diagnosis) segment
- Missing admission dates (DTP*435) for inpatient claims
Type of Bill Validation
When the Type of Bill doesn't match claim content:
- Inpatient Type of Bill (xx1) should have admission dates
- Outpatient Type of Bill (xx3) should not have CL1 patient status
- EDI Paisan displays warnings in the validation panel
Revenue Code Requirements
Each revenue code line should have:
- A valid 4-digit revenue code
- A charge amount (may be zero for informational lines)
- Unit quantity when applicable
Control Number Mismatches
When splitting, EDI Paisan automatically:
- Generates new ISA13/IEA02 control numbers
- Generates new GS06/GE02 control numbers
- Updates ST02/SE02 transaction control numbers
- Recalculates SE01 segment counts
Example 837I Structure
ISA*00* *00* *ZZ*SENDER *ZZ*RECEIVER *240115*1200*^*00501*000000001*0*P*:~
GS*HC*SENDER*RECEIVER*20240115*1200*1*X*005010X223A2~
ST*837*0001*005010X223A2~
BHT*0019*00*BATCH001*20240115*1200*CH~
NM1*41*2*GENERAL HOSPITAL BILLING*****46*123456789~
PER*IC*JANE DOE*TE*5551234567~
NM1*40*2*BLUE CROSS*****46*987654321~
HL*1**20*1~
NM1*85*2*GENERAL HOSPITAL*****XX*1234567890~
N3*500 MEDICAL CENTER DRIVE~
N4*ANYTOWN*NY*12345~
REF*EI*111111111~
HL*2*1*22*0~
SBR*P*18*GROUP001******CI~
NM1*IL*1*JONES*ROBERT****MI*MEM789012~
N3*100 OAK STREET~
N4*SOMEWHERE*NY*12346~
DMG*D8*19650520*M~
NM1*PR*2*BLUE CROSS*****PI*BCBS~
CLM*HOSP001*15750***14:A:1*Y*A*Y*Y~
DTP*434*RD8*20240105-20240108~
DTP*435*D8*20240105~
DTP*096*TM*1430~
CL1*1*1*01~
HI*ABK:J189*ABF:E119*ABF:I10~
HI*BF:0BJ08ZZ~
NM1*71*1*SMITH*JOHN*A***XX*9876543210~
PRV*AT*PXC*207R00000X~
LX*1~
SV2*0121*HC:99223*2500*UN*1~
DTP*472*RD8*20240105-20240108~
LX*2~
SV2*0250**750*UN*3~
DTP*472*RD8*20240105-20240108~
LX*3~
SV2*0300*HC:80053*350*UN*2~
DTP*472*D8*20240106~
LX*4~
SV2*0320*HC:71046*450*UN*1~
DTP*472*D8*20240105~
LX*5~
SV2*0730**1200*UN*1~
DTP*472*D8*20240107~
SE*35*0001~
GE*1*1~
IEA*1*000000001~This example shows:
- Hospital inpatient claim (Type of Bill 14:A:1)
- 4-day stay (Jan 5-8, 2024)
- Emergency admission (CL1*1) with physician referral
- Principal diagnosis: Pneumonia (J189)
- Surgical procedure: Bronchoscopy (0BJ08ZZ)
- Revenue codes for room, pharmacy, lab, radiology, and surgery
Related Documentation
- 999 Troubleshooting — Diagnose and fix rejected claims
- 837P Professional Claims — Comparison for professional claims
- Claim Splitting Guide — Step-by-step splitting instructions
- PHI Anonymization — Detailed anonymization options
- Segment Reference — All segment types