837P — Professional Claims
The 837P (Professional) transaction is used to submit healthcare claims for professional services. In RCMbox, the outbound 837P mapping is a project-specific activity that converts a FHIR Claim into a ParsedX12 structure, which is then serialized by the build-x12 activity.
Typical structure
- 1000A — Submitter (billing entity with NPI)
- 1000B — Receiver (payer)
- 2000A / 2010AA — Billing provider (name, address, tax ID)
- 2000B / 2010BA — Subscriber (member ID, demographics)
- 2010BB — Payer (name, payer ID)
- 2300 — Claim details (PCN, total charge, place of service, frequency code)
- HI — Diagnosis codes
- 2400 — Service lines (CPT/HCPCS codes, modifiers, amounts, service dates)
Resubmissions
The mapping detects Claim.related[] references and adjusts the CLM05-3 frequency code: 1 for original, 7 for replacement, 8 for void. Replacement and void claims include a REF*F8 segment with the original payer claim control number.
Used in
- Claim Submission workflow