Payment integrity
Source document
Centene · payment integrity
Source document
The claim as it was received
Availity clearinghouse · EDI 837P · received 26 Mar 2026 12:27 · 837P_20260326_041179.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 *260326*1227*^*00501*215351309*0*P*:~
Interchange header — submitter, receiver, control number
GS*HC*AVAILITY*CENTENE*20260326*1227*558321*X*005010X222A1~
Functional group — health care claim, 837P version
ST*837*2209*005010X222A1~
Transaction set header
BHT*0019*00*256911*20260326*1227*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*RIO GRANDE DIAGNOSTIC IMAGING*****XX*1288556172~
Billing provider — NPI 1288556172
N3*1 MEDICAL PLAZA~
Billing provider address
N4*HOUSTON*TX*77002~
Billing provider city / state / ZIP
REF*EI*680102531~
Employer identification number
PRV*BI*PXC*207R00000X~
Taxonomy — Diagnostic Radiology
HL*2*1*22*0~
Subscriber hierarchical level
SBR*P*18*******CI~
Subscriber — primary, self, commercial insurance
NM1*IL*1*OKONKWO*PRIYA****MI*MBR-41220863~
Subscriber — member id MBR-41220863
N3*100 MAIN STREET~
Subscriber address
N4*HOUSTON*TX*77002~
Subscriber city / state / ZIP
NM1*PR*2*CENTENE*****PI*68069~
Payer
CLM*CLM-0000023*191.72***11:B:1*Y*A*Y*I~
Claim — total charge $191.72, place of service 11 (office)
HI*ABK:M5450~
Diagnoses — ABK principal, ABF secondary, decimals removed
LX*1~
Service line 1
SV1*HC:72148*191.72*UN*1***1~
72148 — charged $191.72, 1 unit
DTP*472*D8*20260323~
Date of service 23 Mar 2026
SE*22*2209~
Transaction set trailer — segment count from ST to SE
GE*1*558321~
Functional group trailer
IEA*1*215351309~
Interchange trailer