Payment integrity
Source document
Centene · payment integrity
Source document
The claim as it was received
Availity clearinghouse · EDI 837P · received 14 Mar 2026 11:16 · 837P_20260314_602993.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 *260314*1116*^*00501*603230890*0*P*:~
Interchange header — submitter, receiver, control number
GS*HC*AVAILITY*CENTENE*20260314*1116*812864*X*005010X222A1~
Functional group — health care claim, 837P version
ST*837*1835*005010X222A1~
Transaction set header
BHT*0019*00*419821*20260314*1116*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*2*CYPRESS FAMILY CARE ASSOCIATES*****XX*1223887640~
Billing provider — NPI 1223887640
N3*1 MEDICAL PLAZA~
Billing provider address
N4*HOUSTON*TX*77002~
Billing provider city / state / ZIP
REF*EI*006692445~
Employer identification number
PRV*BI*PXC*207Q00000X~
Taxonomy — Family Medicine
HL*2*1*22*0~
Subscriber hierarchical level
SBR*P*18*******CI~
Subscriber — primary, self, commercial insurance
NM1*IL*1*RUIZ*ALMA****MI*MBR-30558129~
Subscriber — member id MBR-30558129
N3*100 MAIN STREET~
Subscriber address
N4*HOUSTON*TX*77002~
Subscriber city / state / ZIP
NM1*PR*2*CENTENE*****PI*68069~
Payer
CLM*CLM-0000004*135.42***11:B:1*Y*A*Y*I~
Claim — total charge $135.42, place of service 11 (office)
HI*ABK:M1711~
Diagnoses — ABK principal, ABF secondary, decimals removed
LX*1~
Service line 1
SV1*HC:20610*135.42*UN*2***1~
20610 — charged $135.42, 2 units
DTP*472*D8*20260311~
Date of service 11 Mar 2026
SE*22*1835~
Transaction set trailer — segment count from ST to SE
GE*1*812864~
Functional group trailer
IEA*1*603230890~
Interchange trailer