|A||Submitter/Receiver Loop||This section identifies Procentive as the submitter. It also identifies the receiver/clearinghouse.|
|B||Billing/Pay-to Loop||This section identifies your agency. It contains your agency's applicable billing and payment information, such as NPI, billing address, taxonomy and tax id.|
|C||Subscriber Loop||This section identifies the subscriber (your client). It contains the subscriber's insurance information, such as patient ID, address and date of birth.|
|D||Claim Loop||This section provides claim information on the service(s) provided. It begins with the claim identifier (the claim number) and includes information such as total charges submitted, diagnosis, rendering provider and the rendering provider's NPI. It will also list any secondary and tertiary insurance information that is in the client record (if this information has been entered into the Clients Module, Payer tab).|
|E||Service Line Loop||This section will list each service line associated with this claim. Here you can verify dates of service, codes and modifiers.|
NOTE: The Subscriber loop and claim loop will repeat for each client. Notice the gray shading to help you identify the breaks.
Lines, Loops and Segments
In the electronic world of claims, payers/clearinghouses will identify issues with your claims by line, loop and segment. These lines, loops and segments can be found on the X12 Summary.
How do I get to the X12 Summary?
Prior to sending a claim
- In the Confirm Invoices Window.
- Click on the data link
- The X12 Claim Data window will open
- Click on the X12 Summary radio button at top of window.
- The X12 Summary report will display.