1️⃣ Transaction & File Control Information (8)

Sender ID
Receiver ID
Transmission Time
Control Number
Sender Code
Receiver Code
GS Date
GS Time

2️⃣ Submitter & Receiver Information (4)

Submitter Name
Submitter ID
Receiver Name
Receiver ID

3️⃣ Billing & Facility Provider Information (10)

Billing Provider Name
Billing Provider NPI
Billing Provider Tax ID
Billing Provider Street
Billing Provider City
Billing Provider State
Billing Provider ZIP
Facility Name
Facility NPI
Facility Address (Street, City, State, ZIP)

4️⃣ Patient & Subscriber Information (11)

Patient Last Name
Patient First Name
Patient DOB
Patient Gender
Patient Member ID
Patient Street
Patient City
Patient State
Patient ZIP
Admission Date
Discharge Date

5️⃣ Admission & Claim Information (7)

Admission Type Code
Admission Source Code
Claim Number
Total Claim Amount
Facility Type Code
Claim Frequency Code
Diagnosis Codes (Principal + Additional)

6️⃣ Procedure & Service Line Information (6)

Procedure Code (ICD-10-PCS)
Revenue Code
Charge Amount
Units of Service
Service Date
Condition Codes

7️⃣ Payer Information (5)

Payer Name
Payer ID
Payer Street
Payer City
Payer ZIP

8️⃣ Provider Roles (8)

Attending Provider Name
Attending Provider NPI
Operating Provider Name
Operating Provider NPI
Referring Provider Name
Referring Provider NPI
Supervising Provider Name
Supervising Provider NPI

9️⃣ EDI File Control Segments (4)

SE01 (Number of Included Segments)
SE02 (Transaction Set Control Number)
GE Control Number
IEA Control Number


📊 Total Number of Input Fields for 837I → ✅ 63 Fields
This count includes all fields required to generate a valid 837I (Institutional Claims) EDI file. 🎯

