Payment integrity
Source document
Centene · payment integrity
Source document
The claim as it was received
Availity clearinghouse · EDI 837P · received 22 Mar 2026 11:31 · 837P_20260322_476306.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 *260322*1131*^*00501*594212022*0*P*:~
Interchange header — submitter, receiver, control number
GS*HC*AVAILITY*CENTENE*20260322*1131*586099*X*005010X222A1~
Functional group — health care claim, 837P version
ST*837*0203*005010X222A1~
Transaction set header
BHT*0019*00*920343*20260322*1131*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*BAYOU ONCOLOGY ASSOCIATES*****XX*1427809359~
Billing provider — NPI 1427809359
N3*1 MEDICAL PLAZA~
Billing provider address
N4*HOUSTON*TX*77002~
Billing provider city / state / ZIP
REF*EI*362547668~
Employer identification number
PRV*BI*PXC*207R00000X~
Taxonomy — Medical Oncology
HL*2*1*22*0~
Subscriber hierarchical level
SBR*P*18*******CI~
Subscriber — primary, self, commercial insurance
NM1*IL*1*CASTELLANOS*ROWAN****MI*MBR-30772614~
Subscriber — member id MBR-30772614
N3*100 MAIN STREET~
Subscriber address
N4*HOUSTON*TX*77002~
Subscriber city / state / ZIP
NM1*PR*2*CENTENE*****PI*68069~
Payer
CLM*CLM-0000021*8069.76***11:B:1*Y*A*Y*I~
Claim — total charge $8,069.76, place of service 11 (office)
HI*ABK:C3490~
Diagnoses — ABK principal, ABF secondary, decimals removed
LX*1~
Service line 1
SV1*HC:J9299*8069.76*UN*240***1~
J9299 — charged $8,069.76, 240 units
DTP*472*D8*20260319~
Date of service 19 Mar 2026
SE*22*0203~
Transaction set trailer — segment count from ST to SE
GE*1*586099~
Functional group trailer
IEA*1*594212022~
Interchange trailer