Listed below are the data elements on the HIPAA X12N 837 institutional and professional health care claim forms that are required, but were not previously required on the electronic Part A (UB92) formats and Medicare Part B (National Standard Format):

Part A 837:

• X12 837i transaction overhead information (ST, BHT, Transmission Type REF, HLs, and SE segments, along with numerous qualifiers)
• Submitter Identifier (837 overhead info)
• Receiver Name
• Receiver Identifier
• Billing Provider Tax Identification Number or Social Security Number
  (Note: One of the following is required
  • Attending Physician Tax Identification Number or Social Security Number
  • Operating Physician Tax Identification Number or Social Security Number
  • Other Provider Tax Identification Number or Social Security Number)
• Payer Identifier
• Explanation of Benefits Indicator
• Provider or Supplier Signature Indicator

Part B 837:

• Receiver name and ID
• Submitter Name
• Submitter Phone Number
• Billing Provider Tax Identification Number or Social Security Number
• Pay-To Provider Tax Identification Number or Social Security Number
• Rendering Provider Tax Identification Number or Social Security Number
• Admission Date for inpatient medical visits