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You are here: Home Interview Questions Healthcare Interview Questions What is EDI Transaction Loops and Segments?
 
 

What is EDI Transaction Loops and Segments?

What is Loop?

A segment or series of segments that form(s) one set of information within the detail area of a transaction set is defined as Loop.

What is Segment?

A grouping of one or more data elements that appears as a line of information within an individual EDI message. Segments consist of logically related data elements in a defined sequence. A data segment consists of a segment identifier, one or more data elements each preceded by an element separator, and a segment terminator.

Please find Example of 837 EDI Transaction Set Loops and Segments:

Interchange Control Header (ISA)

  • ISA - Interchange Control Header

Functional Group Header (GS)

  • GS - Functional Group Header

Transaction Set Header (ST) 

Beginning of Hierarchical Transaction (BHT)

  • BHT - Beginning of Hierarchical Transaction

Loop 0000E - Transaction Header

  • REF*87 - Transmission Type Identification

Loop 1000A - Submitter Name

  • NM1*41 - Submitter Name
  • PER*IC - Submitter EDI Contact Information

Loop 1000B - Receiver Name

  • NM1*40 - Receiver Name

Loop 2000A - Billing/Pay-to Provider

  • HL - Billing/Pay-to Provider Hierarchical Level
  • PRV*BI - Billing/Pay-to Provider Specialty Information

Loop 2000B - Subscriber Hierarchical Level

  • HL - Subscriber Hierarchical Level
  • PAT - Patient Information
  • SBR - Subscriber Information

Loop 2000C - Patient Hierarchical Level

  • HL - Patient Hierarchical Level

Loop 2010AA - Billing Provider Name

  • N3 - Billing Provider Address
  • N4 - Billing Provider City, State, ZIP Code
  • NM1*85 - Billing Provider Name
  • REF - Billing Provider Secondary Identification

Loop 2010AB - Pay-to Provider Name

  • N3 - Pay-to Provider Address
  • N4 - Pay-to Provider City, State, ZIP Code
  • NM1*87 - Pay-to Provider Name
  • REF - Pay-to-Provider Secondary Identification

Loop 2010BA - Subscriber Name

  • DMG - Subscriber Demographic Information
  • N3 - Subscriber Address
  • N4 - Subscriber City, State, ZIP Code
  • NM1*IL - Subscriber Name
  • REF*1W - Subscriber Secondary Identification
  • REF*SY - Subscriber Secondary Identification

Loop 2010BB - Payer Name

  • N3 - Payer Address
  • N4 - Payer City, State, ZIP Code
  • NM1*PR - Payer Name

Loop 2010CA - Patient Name

  • DMG - Patient Demographic Information
  • N3 - Patient Address
  • N4 - Patient City, State, ZIP Code
  • NM1*QC - Patient Name

Loop 2300 - Claim Information

  • AMT*F5 - Patient Amount Paid
  • CLM - Claim Information
  • CN1 - Contract Information
  • CR1 - Ambulance Transport Information
  • CRC*07 - Ambulance Certification
  • CRC*75 - Home Bound Indicator
  • CRC*ZZ - EPSDT Referral
  • DTP*304 - Date - Date Last Seen
  • DTP*431 - Date - Onset of Current Illness/Symptom
  • DTP*435 - Date - Admission
  • DTP*454 - Date - Initial Treatment
  • HI - Health Care Diagnosis Code
  • NTE*ADD - Claim Note
  • PWK - Claim Supplemental Information
  • REF*9F - Prior Authorization or Referral Number
  • REF*EW - Mammography Certification Number
  • REF*F8 - Original Reference Number (ICN/DCN)
  • REF*G1 - Prior Authorization or Referral Number
  • REF*LX - Investigational Device Exemption Number
  • REF*P4 - Demonstration Project Identifier
  • REF*X4 - Clinical Laboratory Improvement Amendment (CLIA) Number

Loop 2310A - Referring Provider Name

  • NM1*DN - Referring Provider Name
  • REF - Referring Provider Secondary Identification

Loop 2310B - Rendering Provider Name

  • NM1*82 - Rendering Provider Name
  • PRV*PE - Rendering Provider Specialty Information
  • REF - Rendering Provider Secondary Identification

Loop 2310D - Service Facility Location

  • N3 - Service Facility Location Address
  • N4 - Service Facility Location City, State, ZIP Code
  • NM1*FA or 77 - Service Facility Location
  • REF - Service Facility Location Secondary Identification

Loop 2310E - Supervising Provider Name

  • NM1*DQ - Supervising Provider Name
  • REF - Supervising Provider Secondary Identification

Loop 2320 - Other Subscriber Information

  • AMT*B6 - Coordination of Benefits (COB) Allowed Amount
  • AMT*D - Coordination of Benefits (COB) Payer Paid Amount
  • DMG - Subscriber Demographic Information
  • MOA - Medicare Outpatient Adjudication Information
  • OI - Other Insurance Coverage Information
  • SBR - Other Subscriber Information

Loop 2330A - Other Subscriber Name

  • NM1*IL - Other Subscriber Name

Loop 2330B - Other Payer Name

  • NM1*PR - Other Payer Name

Loop 2330F - Other Payer Purchased Service Provider

  • NM1*QB - Other Payer Purchased Service Provider
  • REF - Other Payer Purchased Service Provider Identification

Loop 2400 - Service Line

  • AMT*AAE - Approved Amount
  • CR5 - Home Oxygen Therapy Information
  • DTP*119 - Date - Oxygen Arterial Blood Gas Test
  • DTP*431 - DTP03 Onset of Current Symptoms or Illness
  • DTP*439 - DTP03 Date of Accident
  • DTP*461 - Date - Last Certification Date
  • DTP*463 - Date - Begin Therapy Date
  • DTP*472 - Date - Service Date
  • DTP*480 - Date - Oxygen Arterial Blood Gas Test
  • DTP*481 - Date - Oxygen Saturation Blood Gas Test
  • DTP*607 - Date - Certification Revision Date
  • LX - Service Line
  • NTE - Line Note
  • QTY - Anesthesia Modifying Units
  • REF*6R - Line Item Control Number
  • REF*9F or G1 - Prior Authorization or Referral Number
  • SV1 - Professional Service

Loop 2410 - Drug Identification

  • CTP - Drug Pricing
  • LIN - Drug Identification

Loop 2420E - Ordering Provider Name

  • NM1*DK - Ordering Provider Name
  • REF - Ordering Provider Secondary Identification

Loop 2430 - Line Adjudication Information

  • CAS - Line Adjustment
  • SVD - Line Adjudication Information

Loop 2440 - Form Identification Code

  • FRM - Assigned Identification

Transaction Set Trailer (SE)

Functional Group Trailer (GE)

  • GE - Functional Group Trailer

Interchange Control Trailer (IEA)

  • IEA - Interchange Control Trailer