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Diamond ANSI 837 Version 3 Release 4 (aka 3041)
Professional Claims Data Specifications

Loop Position Segment ID Segment Name / Data Element Name Req. Des. Format Length Value Notes
N/A 005 ST Transaction Set Header
Example:
St*837*profclm 		M   2 "ST" Indicates the start of a transaction set and to assign a control number.
ST01 Transaction Set Identifier Code M ID 3 "837"
This is an ANSI 837 Health Care
Claim Transaction set 		Code uniquely identifying a Transaction Set. Diamond will only accept 837 as a valid entry.
ST02 Transaction Set Control Number M AN 4/9 User defined Alpha-numeric value (must match SEO2) Identifying control number that must be unique within the transaction Set flinctional group assigned by the originator for a transaction set
010 BGN Beginning Segment Example: BGN*00* 1*970125 M   3 "BGN" Indicates the beginning of a transaction set
BGN01 Transaction Set Purpose Code M ID 2 "00"
This is an original transmission 		Diamond processing does not change with specified purpose code.
BGN02 Reference Number M AN 1/30 User defined Alpha-numeric value For submitter purpose only.
BGN03 Date M DT 6 "YYMMDD" For submitter purpose only.
BGN04 Time C TM 4 "HHMM" Diamond processing does not change with specified purpose code.
BGN05 Time Code O  ID 2 Not used  
BGN06 Reference Number C ID ? User defined Alpha-numeric value Used to identify the PAYOR in Diamond's provider mapping function.
1000 020 NM1 Individual or Organizational Name
Example:
NM1*41*2*Health_Systems_Design 		M   3 "NMI" Contains submitter and receiver information.
NM101 Entity Identifier Code M ID 2 Assigned by Receiver To be determined by Receiver to identify submitter.
NM102 Entity Type Qualifier M ID 1 Assigned by Receiver
"1" (Person) "2" (Non-Person Entity) 		 
NM103 Name Last or Organization Name M AN 1/35 Submitter Last Name or Organization  
NM104 Name First C AN 1/25 Submitter First Name  
NM105 Name Middle C AN 1/25 Submitter Middle Name or Initial  
2000 005 PRV Provider Information
Example:
PRV*BI*G2*12345 		M   3 "PRV" Specifies the identifying characteristics of a provider
PRV01 Provider Code M ID 1/3 "PT" (Pay-To), "BI" (Billing), "PE" (Performing)  
PRV02 Reference Number Qualifier M ID 2 "IC" Medicare Provider Number
"ID" Medicaid Provider Number
"IG" Provider UPIN Number
"IH" CHAMPUS ID Number
"62" Provider Commercial Number
"HI" Health Industry ID Number
"NS" Provider Plan Network ID
"SY" Social Security Number
"T3" Federal Taxpayer's ID 		 
PRV03 Reference Number M AN 1/30 Provider's Diamond Vendor Number Updates Diamond field CAVENDOR$ (Vendor) if "PRVO1" = "PT", "BI" or "PE". Else the FFS Vendor # from the provider's contract will be used.
2010 015 NM1 Individual or Organizational Name
Example:
NM1*87*1*Jones*William 		M   3 "NM1" Contains provider information: Billing Provider Information, PayTo Provider
NMl01 Entity Identifier Code M ID 2 Assigned by Receiver To be determined by Receiver to identify submitter.
NM102 Entity Type Qualifier O  ID 1 Assigned by Receiver
"1" (Person)
"2" (Non-Person Entity) 		 
NM103 Name Last or Organization Name O  AN 1/35 Provider Last Name or Organization  
NM104 Name First O  AN 1/25 Provider First Name  
NMl05 Name Middle O  AN 1/25 Provider Middle Name or Initial  
2100 045 SBR Subscriber Information
Example:
SBR*P 		M   3 "SBR" Contains information about the subscriber of the current insurance carrier
SBR01 Payor Responsibility Sequence
Number Code 		M ID 1/10 "P" (Primary) Required, but no Diamond processing logic.
2110 055 NM1 Individual or Organizational Name
Example:
NMI*IL*l*Doe*Carolyn****Cl*555774444 		M   3 "NM1" Contains name and address for: Subscriber, Subscriber's Current Insurance Carrier, Subscriber's School or Employer
NM101 Entity Identifier Code M ID 2 "IL" (Insured or Subscriber)  
NM102 Entity Type Qualifier M ID I "I" (Person)  
NM103 Name Last or Organization Name 0 AN 1/35 Member Last Name  
NM104 Name First O AN 1/25 Member First Name  
NM105 Name Middle O AN 1/25 Member Middle Initial  
NM106 Name Prefix O AN 1/?    
NM107 NameSuffix O AN 1/?    
NM108 Identification Code Qualifier M ID 1/2 "Cl" (Insured or Subscriber) This must value must be "Cl"
NM109 Identification Code M AN 2/17 Diamond Subscriber Number Updates Diamond field: CASUBN0$ (Subscriber Number)
2200 090 PAT Patient Information
Example: PAT*01 		M   3 "PAT"  
PAT0l Individual Relationship Code M ID 2 "Ol" Spouce
"02" Son or Daughter
"03" Father or Mother
"13" Self
"19" Child
"27" Student
"34" Other Adult
 
2210 095 NM1 Individual or Organizational Name
Example: NM1*QC* 1*Doe*Jill 		M   3 "NM1" Contains Patient's Name
NM101 Entity Identifier Code M ID 2 "QC" (Patient)  
NM102 Entity Type Qualifier M ID 1 "I" (Person)  
NM103 Name Last or Organization Name M AN 1/35 Member Last Name  
NM104 Name First O AN 1/25 Member First Name  
NM105 Name Middle O  AN 1/25 Member Middle Initial  
115 DMG Demographic Information
Example: DMG*D8* 1965041 5*F 		M   3 "DMG"  
DMG01 Date Time Period Format Qualifier M ID 2/3 "D8"  
DMG02 Date Time Period M AN 1/35 Member DOB expressed in CCYYMMDD format The Date of Birth is used to determine the Diamond person number
DMG03 Gender Code O  ID 1/1 "M", "F" or "U"  
2300 130 CLM Health Claim Example: CLM*Pat_CtrI_NO*121***B*21 M   3 "CLM" Specifies basic data about a claim header
CLM01 Claim Submitter's Identifier M AN 1/38 Patient Control Number Updates Diamond field CAPATCTRL$ (Patient Control No) Also maps to CAUD2$
CLM02 Monetary Amount M R 1/15 Total Billed Amount Updates Diamond field CABILLED (Total Billed)
CLM03 Claim Filing Indicator Code     I Not Used  
CLM04 Non-Institutional Claim Type Code     I Not Used  
CLM05 Facility Code Qualifier O  ID 1 "B" (Place of Service)  
CLM06 Facility Code O ID 1/2 Place of Service Code Updates CAPLACE$
135 DTP Date or Time or Period
Example:
DTP* 150*D6*970125 		M   3 "DTP" Specify any/or all of a date or time
DTP01 Date/Time Qualifier M ID 3 "150" Service Period Start "444" First Visit
DTP02 Date Time Period Format Qualifier M ID 2 "D6" or "D8" Six or Eight Digit Date
DTP03 Date Time Period M AN 6/8 Date expressed as YYMMDD or CCYYMMDD Updates Diamond CAPRIMDATE$. (Primary Date) If no date is supplied in this segment, Diamond will use the date found in segment "DTPO3" from loop "2400" if "DTPOI" = "1 50".
135 DTP Date or Time or Period M   3 "DTP"  
DTP01 Date/Time Qualifier M ID 3 "151" Service Period End  
DTP02 Date Time Period Format Qualifier M ID 2/3 "D6" or "D8"  
DTP03 Date Time Period M AN 1/35 Date expressed as YYMMDD or CCYYMMDD Updates Diamond CATHRUDATE$ (Claim Thru Date)
180 REF Reference Numbers
Example REF*BB*22756 		M   3 "REF"  
REF01 Reference Number Qualifier M ID 2 "BB" Authorization Number
"8A" HMO Auth #
"8B" PPO Auth #
"8C" TPO Auth#
or "9F" Referriil Number 		 
REF02 Reference Number C AN 1/30 Authorization Number Updates Diamond field CAAUTH$ (Authorization No) If no number is specified Diamond will attempt to match the claim to an exisnng authorization
181 REF Reference Numbers
Example:
REF*ZZ*(Provider/Payor ID} 		M   3 REF Allows retention of clearing house supplied provider ID, if the PAYOR/PROVX function is used to convert those IDs into Diamond Provider IDs
REF01 Reference Number Qualifier M ID 2 "ZZ" Diamond defined Used if MAPUSERDEF1 parameter is set to "Y".
REF02 Reference Number C AN 1/30 Cleannghouse supplied. provider ID. Updates CAUD1$
235 CD2 Multi-Valued Characteristics
Example:
CD2*13*DX*650 		M   3 "CD2"  
CD201 Code Category M ID 2 "13" Principal Diagnosis  
CD202 Product/Service ID Qualifier M ID 2 "DX"  
CD203 Medical Code Value M AN 1/15 Valid ICD-9 Diagnosis Code Updates Diamond field CADXI$ (Diagnosis I)
235 CD2 Multi-Valued Characteristics M   3 "CD2"  
CD201 Code Category M ID 2 "02" (Diagnosis)  
CD202 Product/Service ID Qualifier M ID 2 "DX"  
CD203 Medical Code Value M AN 1/15 Valid ICD 9 Diagnosis Code Updates: Diamond field CADX2$ (Diagnosis 2)
CD204 Medical Code Value O AN 1/15 Valid 1CD 9 Diagnosis Code Updates Diamond field CADX 3$ (Diagnosis 3)
245 LS Loop Header
Example LS*2310 		M   2 "LS"  
LS01 Loop Identifier Code M   4 "2310" (Next Segment Begins Loop 2310)  
2310 255 PRV Provider Information
Example PRV*PE*G2* {Provider ID} 		M   3 "PRV" Contains information about the provider rendering the service(s) This provider name and address information will apply to all service lines of the claim unless overrideen by provider information at the service line level.
PRV01 Provider Code M ID 1/3 "PE" Performing or "RF" Referring "Ar" Attending Diamond will only recognize these three codes
PRV02 Reference Number Qualifier M ID 2    
PRV03 Reference Number M AN 1/30 Provider's Diamond ID Updates Diamond field
CAPROVIDER$ if PRVO1 = "PE" CAREFPROV$ if PRVO1 = "RF" CAATTPROV$ ifPRVOI = "AT"
2300 280 LE Loop Trailer
Example LE*2310 		M   2 "LE"  
LE01 Loop Identifier Code M AN 4 "2310" (Loop 2310 is Complete)  
2400 285 LX Assigned Number
Example LX*0l 		M   2 "LX" Contains Service Line Information
LX01 Assigned Number M   1/6 Line Number  
295 SV1 Professional Service
Example:
SVI*CJ*99213*l05 		M   3 "SVI" Claim service detail for Health Care institiution
SV101 Composite Medical Procedure Identifier C        
SV10la Product/Service ID Qualifier M ID 2/2 "Cr" CPT Code
"MC" IICPCS Code
or "ND" National Drug Code 		 
SV101b Product/Service ID M AN 1/30   Updates CBPROCCODE$
SV101c Procedure Modifier O AN 2/2   Identifies special circumstances related to the performance of service
SV102 Monetary Amount O  R 1/15 Billed Amount Updates Diamond field CBBILLED (Billed Amount)
SV103 Unit or Basis for Measurement Code C ID 2 "UN" (Unit)
SV104 Quantity C R 1/15 Quantity Updates Diamond field CBQUANT (Quantity)
375 DTP Date or Time or Period M   3 "DTP"  
DTP0l Date/Time Qualifier M ID 3 "150" Service Period Start or "444" First Visit or Consultation
DTP02 Date Time Period Format Qualifier M ID 2/3 "D6" or "D8"  
DTP03 Date Time Period M AN 1/35 Service Date Updates Diamond field CBSERVDATE$ (Service Date)
375 DTP Date or Time or Period O    3 "DTP"  
DTP0l Date/Time Qualifier M ID 3 "I51" (Service Period End)  
DTP02 Date Time Period Format Qualifier M ID 2/3 "D6" or "D8"  
DTP03 Date Time Period M AN 1/35 Thru Date Updates Diamond field CBTHRUDATE$ (Thru Date). Uses CBSEVDATE$ (Service Date) if not found.
395 AMT Monetary Amount
Example: AMT*B6*l00 		O   3 "AMT"  
AMT01 Amount Qualifier Code M ID 1/2 "B6" Allowed or "F9" Usual and Customary  
AMT02 Monetary Amount M R 1/35 Allowed Amount Updates Diamond field CBALLOWED (Allowed) if pricing is set to "N"
395 AMT Monetary Amount O    3 "AMT"  
AMT01 Amount Qualifier Code M ID 1/2 A8 Noncovered Charge
AMT02 Monetary Amount M R 1/35 Allowed Amount Updates Diamond field CBNOTCOV not Covered) if Adjudication is set to "N"
395 AMT Monetary Amount O    3 "AMT"  
AMT01 Amount Qualifier Code M ID 1/2 "B9" Co-insurance or "C1" Co-Payment Amount  
AMT02 Monetary Amount M R 1/35 Copayment Amount Updates Diamond field CBCOPAY (Copayment Amount) if Adjudication is Set to "N"
395 AMT Monetary Amount O   3 "AMT"  
AMT01 Amount Qualifier Code M ID 1/2 "D2" Deductible Amount  
AMT02 Monetary Amouunt M R 1/35 Deductible Amouut Updates Diamond field CBDEDUCT (Deductible) if Adjudication is set to "N"
415 LS Loop Header
Example LS*2420
Loop identifier Code 		M
M 		  2
4 		"LS"
"2426" Next Segment Begins Loop 2420) 		 
2420 425 PRV Provider Information
Example:
PRV*PE*G*{Provider ID} 		M   3 "PRV" Contains information about the provider rendering the service detailed on the service line These segments override the information in the claim level segments (within loop 2310)
PRV01 Provider Code M ID 1/3 "PE" (Performing)  
PRV02 Reference Number Qualifier M ID 2    
PRV03 Reference Number M AN 1/30 Provider's Diamond ID Updates Diamond field CAPROVIDEk$ (Provider Number)
2400 450 LE Loop Trailer
Example:
LE*2420 		M   2 "LE"  
LE01 Loop Identifier Code M AN 4 "24.26" (Loop 2420 is Contplete)  
N/A 520 SE Transaction Set Trailer
Example:
SE*52*profclm 		M   2 "SE"  
SE01 Number of Included Segments M NO 1/10 Total # of Segments included in a transction set including ST and SE segments  
5E02 Transaction Set Control Number M AN 4/9 User defined control number established in the ST segment. Must match value in STO2

NOTE: Shaded segments are optional. Mandatory elements within a segment are required only if the segment is included.