MN–ITS Help – 837D, 837I & 837P Subscriber Information

The table below describes the individual fields on the Subscriber Information screens. * The Field Name column identifies X12 loops and elements only for fields that display in the MN–ITS screens. Refer to the X12 HIPAA Companion Guides available through the WPC X12 Registry for additional instruction when submitting batch claims.

Select MN–ITS User Guides to obtain additional instruction for submitting claims for specific services using MN–ITS Direct Data Entry (DDE).

Field Name*
(X12 loop & element)

Valid Values

Character Length

Field Description

Subscriber ID
(Loop: 2010BA, NM109)

 

8
(numeric)

The 8-digit identifier for the subscriber (recipient) indicated on the MHCP member identification card

Birth Date
(Loop: 2010BA, DMG02)

MMDDCCYY

8

The birth date of the subscriber

The following fields auto-populate based on the information entered in the Subscriber ID and Birth Date fields

Subscriber First Name
(Loop: 2010BA, NM104)

 

1-35

The first name of the subscriber

Middle Initial
(Loop: 2010BA, NM105)

 

1

The middle initial of the subscriber

Last Name
(Loop: 2010BA,NM103)

 

1-60

The last name of the subscriber

Gender
(Loop: 2010BA, DMG03)

F – Female

M – Male

U - Unknown

1

The gender of the subscriber