This blog post describes the mapping specifications and the conversion between HIPAA 837 professional and CMS 1500 in PDF format.
This was another one of the 300+ pre-defined HIPAA maps that we have developed in the past. The user can integrate this map into their system with no further work. You can test the map by going to Redix HIPAA Compliance and Conversion Demo.
A blank CMS 1500 form looks like the following. 
Mapping Specification
The CMS 1500 form is using the box id to identify the meaning of each field. For example, a patient name is in box 2 and the patient address is in 5. The patient name in a HIPAA 837 professional is defined in 2010BA. Below is a table to describe the box id in the CMS 1500 form and its corresponding element in HIPAA 837 professional.
| CMS 1500 Form Box ID | HIPAA 837 Professional Corresponding Field(s) |
|---|---|
| 1 | Checkbox Xwalked from 2000B SBR09 |
| 1a | 2010BA NM109 |
| 2 | 2010BA NM103-05 overwritten by 2010CA NM103-5 if exists |
| 3 | 2010BA DMG02, 03 overwritten by 2010CA DMG02, 03 if exists |
| 4 | 2010BA NM103-05 |
| 5 | 2010BA N3xx, N4xx overwritten by 2010CA N3xx, N4xx if exists |
| 6 | Checkbox Xwalked from 2000B SBR02 | 2000C PAT01 |
| 7 | 2010BA N3xx, N4xx |
| 8 | (Internally Used) |
| 9 | 23230A NM103-05 |
| 9a | 2320 SBR03 |
| 9b | (Internally Used) |
| 9c | (Internally Used) |
| 9d | 2320 SBR04 |
| 10a | Checkbox Xwalked from 2300 CLM11:01 | :02 | :03="EM" |
| 10b | Checkbox Xwalked from 2300 CLM11:01 | :02 | :03="AA" |
| 10c | Checkbox Xwalked from 2300 CLM11:01 | :02 | :03="OA" |
| 10 (state) | if 2300 CLM11:01 | :02 | :03="AA" then CLM11:04 |
| 11 | 2000B SBR03 |
| 11a | 2010BA DMG02, 03 |
| 11b | 2000x REF02 (REF01="Y4") |
| 11c | 2000B SBR04 |
| 11d | Checkbox Xwalked from 2310 Existence |
| 12 | Signature Field (Not Mapped) |
| 13 | Signature Field (Not Mapped) |
| 14 | 2300 DTP01, 03 (DTP01="431" | "438") |
| 15 | 2300 DTP01, 03 (DTP01="454" |"304" | "453" | "439" | "455" | "471" | "090" | "091" | "444") |
| 16 | 2300 DTP03 (DTP01="360" & "361") concatenated |
| 17 | 2310A, D NM101, 03-05 |
| 17a | 2310A REF01-02 |
| 17b | 2310A, D NM109 |
| 18 | 2300 DTP03 (DTP01="435" & "096") concatenated |
| 19 | (reserved for proprietary usage) |
| 20 | 2300 AMT02 (AMT01="NE"), Checkbox Xwalked from existence of 2310C |
| 21 | "9" if HI01:01("BK") exists, else "0" |
| 21A | 2300 HI01:02 (HI01:01="BK" | = "ABK") |
| 21B | 2300 HI02:02 (HI01:02="BK" | = "ABK") |
| 21C | 2300 HI03:02 (HI01:03="BK" | = "ABK") |
| 21D | 2300 HI04:02 (HI01:04="BK" | = "ABK") |
| 21E | 2300 HI05:02 (HI01:05="BK" | = "ABK") |
| 21F | 2300 HI06:02 (HI01:06="BK" | = "ABK") |
| 21G | 2300 HI07:02 (HI01:07="BK" | = "ABK") |
| 21H | 2300 HI08:02 (HI01:08="BK" | = "ABK") |
| 21I | 2300 HI09:02 (HI01:09="BK" | = "ABK") |
| 21K | 2300 HI10:02 (HI01:10="BK" | = "ABK") |
| 21L | 2300 HI11:02 (HI01:11="BK" | = "ABK") |
| 22 | 2300 CLM05:03 when is "7" | "8", REF02 (REF01="F8") |
| 23 | 2300 REF02 (REF01="G1") |
| 24A | 2400 DTP03 (DTP01="472") |
| 24B | 2400 SV105 | 2300 CLM05:01 |
| 24C | 2300 CLM05:03 |
| 24D | 2400 SV101:02-:06 concatenated |
| 24E | 2400 SV107:01-:04 concatenated |
| 24F | 2400 SV102 |
| 24G | 2400 SV104 |
| 24H | "Y" if 2400 SV111 | SV112 are present |
| 24I | (Not mapped, currently assuming NPI is used in 'J') |
| 24J | NM109 (NM108="XX") (2010A is used, overwritten by 2310B if present, ultimately overwritten by 2420A if exists) |
| 25 | 2010AA REF02 (REF01="EI" | "24") | NM109 (NM108<>"XX") | 2010AB NM109 (NM108<>"XX") |
| 26 | 2300 CLM01 |
| 27 | Checkbox Xwalked from CLM07 |
| 28 | 2300 CLM02 |
| 29 | DNE |
| 30 | (Internally Used) |
| 31 | Signature Field (Not Mapped) |
| 32 | 2310C NM103, N3xx, N4xx (If 2310 DNE then same contents from Box 33 are used) |
| 32a | 2310C NM109 (If 2310 DNE then same contents from Box 33a are used) |
| 32b | (Not mapped, currently assuming NPI is used in 'A') |
| 33 | 2010AA NM103, N3xx, N4xx, PER04,06,08 (qual = "TE") |
| 33a | 2010AA NM109 (NM108="XX") |
| 32b | (Not mapped, currently assuming NPI is used in 'A') |
Some of the notes about this conversion:
- Validates the input file. Only the file 837 is validated, the file will be converted.
- Generates PDF file for each claim.
Example
Below is an 837 professional example:
ISA*00* *00* *ZZ*123456789012345*ZZ*123456789012345*030101*1253*^*00501*987654321*1*T*: GS*HC*123456789012345*123456789012345*19991231*0802*123456789*X*005010X222A1 ST*837*2021*005010X222A1 BHT*0019*00*0123*20051015*1023*CH NM1*41*2*PREMIER BILLING SERVICE*****46*TGJ23 PER*IC*JERRY*TE*3055552222 NM1*40*2*XYZ REPRICER*****46*66783JJT HL*1**20*1 NM1*85*1*KILDARE*BEN****XX*1234567893 N3*1234 SEAWAY ST N4*MIAMI*FL*33111 REF*EI*123456789 PER*IC*CONNIE*TE*3055551234 NM1*87*2 N3*2345 OCEAN BLVD N4*MIAMI*FL*33111 HL*2*1*22*1 SBR*P********CI NM1*IL*1*SMITH*JANE****MI*111223333 DMG*D8*19430501*F NM1*PR*2*KEY INSURANCE COMPANY*****PI*999996666 N3*3333OCEAN ST N4*SOUTH MIAMI*FL*33000 REF*G2*PBS3334 HL*3*2*23*0 PAT*19 NM1*QC*1*SMITH*TED N3*236 N MAIN ST N4*MIAMI*FL*33413 DMG*D8*19730501*M CLM*26407789*79.04***11:B:1*Y*A*Y*I*P HI*BK:4779*BF:2724*BF:2780*BF:53081 NM1*82*1*KILDARE*BEN****XX*1234567893 PRV*PE*PXC*204C00000X REF*G2*KA6663 NM1*77*2*KILDARE ASSOCIATES*****XX*1234567893 N3*2345 OCEAN BLVD N4*MIAMI*FL*33111 SBR*S*01*******CI OI***Y*P**Y NM1*IL*1*SMITH*JACK****MI*T55TY666 N3*236 N MAIN ST N4*MIAMI*FL*33111 NM1*PR*2*KEY INSURANCE COMPANY*****PI*999996666 LX*1 SV1*HC:99213*43*UN*1***1:2:3:4 DTP*472*D8*20051003 LX*2 SV1*HC:90782*15*UN*1***1:2 DTP*472*D8*20051003 LX*3 SV1*HC:J3301*21.04*UN*1***1:2 DTP*472*D8*20051003 SE*52*2021 GE*1*123456789 IEA*1*987654321
The generated PDF file is as follows.
About Us
Redix International, Inc. is an enterprise software company. Redix develops software and provides services to help organizations convert their proprietary or organization-specific data to standardized data. Among the standardized formats supported are X12, EDIFACT, XML, NSF, UB92, HIPAA, HL7, CDA, Blue-Ribbon, FHIR, NCPDP, and PDF.
