Payment integrity
Source document
Centene · payment integrity
Source document
The claim as it was received
Availity clearinghouse · EDI 837P · received 19 Mar 2026 10:35 · 837P_20260319_045583.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 *260319*1035*^*00501*224770140*0*P*:~
Interchange header — submitter, receiver, control number
GS*HC*AVAILITY*CENTENE*20260319*1035*420193*X*005010X222A1~
Functional group — health care claim, 837P version
ST*837*4880*005010X222A1~
Transaction set header
BHT*0019*00*704950*20260319*1035*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*802415112~
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*BARROS*TOMAS****MI*MBR-55810322~
Subscriber — member id MBR-55810322
N3*100 MAIN STREET~
Subscriber address
N4*HOUSTON*TX*77002~
Subscriber city / state / ZIP
NM1*PR*2*CENTENE*****PI*68069~
Payer
CLM*CLM-0000011*10.56***11:B:1*Y*A*Y*I~
Claim — total charge $10.56, place of service 11 (office)
HI*ABK:E119~
Diagnoses — ABK principal, ABF secondary, decimals removed
LX*1~
Service line 1
SV1*HC:80053*10.56*UN*1***1~
80053 — charged $10.56, 1 unit
DTP*472*D8*20260316~
Date of service 16 Mar 2026
SE*22*4880~
Transaction set trailer — segment count from ST to SE
GE*1*420193~
Functional group trailer
IEA*1*224770140~
Interchange trailer