837P Sample File with WHAIC-Defined Fields: Complete Guide and Download
In the healthcare billing and data submission landscape, especially within the state of Wisconsin, understanding the 837P file format and its WHAIC-specific extensions is essential. Whether you are a medical billing professional, software developer, or healthcare administrator, having access to a sample 837P file with WHAIC-defined fields can help streamline your compliance and reporting process.
This guide explains what the 837P file is, how WHAIC defines additional data requirements, and provides a direct download link to an official sample file to help you get started.
What is an 837P File?
The term 837P refers to the 837 Professional Health Care Claim file, which is part of the HIPAA (Health Insurance Portability and Accountability Act) EDI transaction set. It is used by healthcare providers to electronically submit professional claims for reimbursement. These are typically services performed by individual healthcare practitioners such as physicians, therapists, and chiropractors.
Key Characteristics of an 837P File:
| Feature | Description |
|---|---|
| Format | Electronic Data Interchange (EDI), specifically ANSI X12N 837 version 5010 |
| Purpose | Used for submitting healthcare claims electronically to payers (insurance companies, Medicaid, Medicare) |
| Submitters | Physicians, private practice providers, outpatient clinics, and other licensed professionals |
| Compliance | Must adhere to HIPAA EDI standards mandated by federal law |
An 837P file includes detailed information about the patient, provider, services rendered, diagnosis codes, and charges associated with a medical claim.
Who is WHAIC and Why Are Their Fields Important?
WHAIC stands for the Wisconsin Hospital Association Information Center. It is the data collection and analytics division of the Wisconsin Hospital Association (WHA). WHAIC is responsible for collecting and managing comprehensive healthcare data across Wisconsin to support public health planning, quality measurement, and policy development.
WHAIC requires healthcare providers and organizations in Wisconsin to submit standardized data files. In the case of professional claims, they mandate the inclusion of certain custom-defined fields that go beyond the basic HIPAA requirements.
WHAIC-Defined Fields
These are additional data elements or specific formatting rules added to the standard 837P file structure. They often include:
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Wisconsin-specific encounter indicators
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Payer-specific identification requirements
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Unique reference codes and internal identifiers
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Data used for statistical and regulatory reporting
Purpose of the WHAIC 837P Sample File
The 837P Sample File with WHAIC-defined fields serves as a reference or template to help developers, billing staff, and healthcare IT teams understand how to structure their claims data correctly for submission to WHAIC.
This file:
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Illustrates a valid 837P structure
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Highlights fields that are specific to WHAIC requirements
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Ensures submitters can meet technical submission standards without trial-and-error
It is especially useful during the development or testing phase of EDI systems, or when onboarding new data reporting staff.
Download the Sample File
WHAIC has made the 837P sample file publicly available as a PDF document. It contains a formatted EDI sample with annotations pointing out WHAIC-specific requirements.
Direct Download Link (from WHAIC official site):
Download the 837P Sample File with WHAIC-defined fields (PDF)
This file is best viewed with a fixed-width font editor or an EDI file viewer to understand the segment-based layout.
Key EDI Segments in the 837P File
Below is a table outlining some of the primary EDI segments found in a standard 837P file, including notes on their relevance to WHAIC:
| Segment | Description | WHAIC Use |
|---|---|---|
| ISA | Interchange Control Header – sets up the overall envelope for the EDI file | Required |
| GS | Functional Group Header – defines type of transaction (in this case, healthcare claims) | Required |
| ST | Transaction Set Header – starts the specific 837P transaction | Required |
| BHT | Beginning of Hierarchical Transaction – indicates purpose and timing | Required |
| NM1 | Name Segment – includes patient, provider, payer identification | Required and validated by WHAIC |
| CLM | Claim Information – contains service details, charges, claim control numbers | WHAIC may require certain control numbers or encounter indicators |
| HI | Health Care Diagnosis Code – ICD codes related to the services provided | Required and audited by WHAIC |
| REF | Reference Identification – used for payer ID, encounter indicators, unique identifiers | Frequently customized by WHAIC |
| K3 | File-level Notes – sometimes used to include state-specific indicators | WHAIC often uses this segment for regulatory data |
| NTE | Notes/Special Instructions – free-text notes, often required for specific reporting | Sometimes used in WHAIC file formats |
How is This File Used?
This sample file is used by:
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Medical Billing Teams
To understand how to populate and format data correctly in claims. -
Software Developers and Vendors
To develop EDI interfaces that comply with WHAIC data submission rules. -
Healthcare IT Departments
To verify that submitted files meet formatting and structural standards before going live. -
Quality and Compliance Teams
To cross-check internal data against WHAIC submission requirements. -
Clearinghouses and Data Aggregators
To test system interoperability with WHAIC’s submission environment.
Other 837 Variants
The 837 transaction set comes in three primary formats. Here’s how they differ:
| File Type | Description | Use Case |
|---|---|---|
| 837P | Professional Claims | Used by physicians, therapists, chiropractors |
| 837I | Institutional Claims | Used by hospitals, nursing facilities, inpatient services |
| 837D | Dental Claims | Used by dental providers |
WHAIC also accepts 837I for institutional data reporting. The same principles apply, but the data elements and structure vary slightly.
Tools for Viewing and Validating 837 Files
Working with EDI files like 837P can be challenging without the right tools. Here are some useful resources:
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EDI Notepad – A free tool for viewing and editing EDI files
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EDIValidator – Web-based validation of X12 837 files
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Bots Open Source Translator – A Python-based EDI translator that supports 837P
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WHAIC Data Submission Portal – WHAIC’s official platform for uploading and testing files
It is recommended that submitters test their 837 files using a WHAIC test environment before final submission.
WHAIC Submission Guidelines and Technical Manual
For a complete understanding of submission rules, data validation, and formatting, WHAIC provides a detailed technical guide:
Download WHAIC 837 Technical Submission Manual (PDF)
This manual includes:
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Layout expectations
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Acceptable code sets
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Segment-by-segment breakdowns
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WHAIC-specific rules and validation checks
Conclusion
Understanding and using the 837P Sample File with WHAIC-defined fields is critical for any healthcare provider, software vendor, or EDI specialist working within Wisconsin’s healthcare system. This file serves as a practical example of how to build compliant claims submissions that meet both national HIPAA and state-specific WHAIC requirements.
By studying the file structure, using the right tools, and referring to WHAIC’s official documentation, you can ensure that your data submissions are complete, accurate, and in full compliance with regulatory standards.
If you’re just getting started, downloading the sample file and reviewing the technical manual are the best first steps toward successful WHAIC data submission.