Payment integrity
Source document
Centene · payment integrity
Source document
The claim as it was received
Availity clearinghouse · EDI 837P · received 28 Mar 2026 13:46 · 837P_20260328_592055.edi
Generated from the claim record on request — no file is stored. The
storage path above is the hook for real blob storage; once wired it is
what would be handed to the agent's document_uri input.
837P transaction, as received
ISA*00* *00* *ZZ*AVAILITY *ZZ*CENTENE *260328*1346*^*00501*500520143*0*P*:~
Interchange header — submitter, receiver, control number
GS*HC*AVAILITY*CENTENE*20260328*1346*320090*X*005010X222A1~
Functional group — health care claim, 837P version
ST*837*1596*005010X222A1~
Transaction set header
BHT*0019*00*603525*20260328*1346*CH~
Beginning of hierarchical transaction — CH = chargeable
NM1*41*2*AVAILITY LLC*****46*AV01~
Submitter
NM1*40*2*CENTENE*****46*68069~
Receiver
HL*1**20*1~
Billing provider hierarchical level
NM1*85*1*SMITH*JANE****XX*1234567890~
Billing provider — NPI 1234567890
N3*1 MEDICAL PLAZA~
Billing provider address
N4*HOUSTON*TX*77002~
Billing provider city / state / ZIP
REF*EI*007516007~
Employer identification number
PRV*BI*PXC*207R00000X~
Taxonomy — Internal Medicine
HL*2*1*22*0~
Subscriber hierarchical level
SBR*P*18*******CI~
Subscriber — primary, self, commercial insurance
NM1*IL*1*WHITFIELD*JORDAN****MI*MBR-12345~
Subscriber — member id MBR-12345
N3*100 MAIN STREET~
Subscriber address
N4*HOUSTON*TX*77002~
Subscriber city / state / ZIP
NM1*PR*2*CENTENE*****PI*68069~
Payer
CLM*CLM-0000001*4280.00***11:B:1*Y*A*Y*I~
Claim — total charge $4,280.00, place of service 11 (office)
HI*ABK:Z0000~
Diagnoses — ABK principal, ABF secondary, decimals removed
LX*1~
Service line 1
SV1*HC:99215*4280.00*UN*1***1~
99215 — charged $4,280.00, 1 unit
DTP*472*D8*20260325~
Date of service 25 Mar 2026
SE*22*1596~
Transaction set trailer — segment count from ST to SE
GE*1*320090~
Functional group trailer
IEA*1*500520143~
Interchange trailer