Institutional vs professional
Outcome
You can tell at a glance whether a service should bill as 837P (professional) or 837I (institutional), you understand which fields each form needs, and you know how the platform decides for you.
The decision
The platform's PayerProgramConfig.institutionalBillingPeriod tells the
build engine when to file I vs P:
| Setting | Effect |
|---|---|
null | Always P. |
WEEKLY / MONTHLY / SPAN | Always I, with the bill cycle as configured. |
Most outpatient programs are P. Most residential / inpatient and many
day programs are I. Your tenant admin owns this configuration.
What the two forms carry differently
| Field | 837P | 837I |
|---|---|---|
| Form | CMS-1500 | UB-04 |
| Bill type | n/a | 4-digit CLM05-1 (e.g. 0117, 0866). |
| Revenue codes | n/a | One per line — SV2* 0911, 1002, etc. |
| Procedure code | SV1* HCPCS / CPT | Optional SV2* HCPCS / CPT. |
| DRG | n/a | HI*DR segment. |
| Length of stay | n/a | Implicit (admit + discharge dates) or OCC-74. |
| Occurrence codes | n/a | HI*OCC*nn segments. |
| Value codes | n/a | HI*VAL*nn segments. |
| Patient liability | 2300 AMT*F5 | 2300 AMT*F5 |
| Place of service | 2300 CLM05-1 | n/a (bill type covers it). |
On the claim detail — the Institutional tab
For 837I claims, /claims/:id shows an Institutional tab:
| Sub-section | Field |
|---|---|
| Stay | Admit date, discharge date, admit type, admit source. |
| Diagnosis | Principal + admitting diagnosis (HI*ABK, HI*ABJ). |
| DRG | Code (HI*DR*). |
| Occurrence | Codes + dates (e.g. 74 LOA, 42 discharge, 46 discharge). |
| Value | Codes + amounts (e.g. 80 covered days, 81 non-covered). |
| Condition | Codes (e.g. 02 employment-related). |
Most fields auto-populate from the program setting + DOS. You can override in-app where the policy allows; many tenants gate these to a supervisor scope.
How the build engine decides
If a partner only handles one filing type, the routing rules pick the correct partner per program (see Tenant Manual → Trading Partners).
Mixing P and I — don't
The selection rules from 2.2 — Charges worklist prevent it: the Build claim button greys out for a mix, and the tooltip says Different filing types. If the EMR is sending charges that look mixed for one stay, the program config or the mapping is likely wrong; tag and route.
Validation
| Check | Expected |
|---|---|
| 837I bills carry revenue codes on every line | Yes. |
HI*DR writes when DRG is on the claim | Yes. |
OCC-74 writes when LOA dates are populated | Yes. |
VAL-80/81 writes for covered/non-covered days on stay claims | Yes. |
| Routing picks an I-capable partner for 837I | Yes; verify on Submission tab. |
Troubleshooting
| Symptom | Cause | Fix |
|---|---|---|
| 837I missing revenue codes | Procedure → revenue code mapping not seeded | Tenant admin → code-set; refresh and rebuild. |
| 837P built when 837I expected | Program config doesn't have institutionalBillingPeriod | Tenant admin → program config; rebuild. |
277CA rejects with "Bill type required" | 837P routed to UB-04-only payer | Update routing; rebuild as 837I. |
| Institutional tab missing on a claim that should have it | Filing type is P (config issue) | Same as above. |
Where to next
- 3.7 — Group billing & per-diem — the per-diem stay-billing flow.
- 4.1 — ERA inbox — institutional 835s carry the same six-tab flow with extra adjustments at the bill-type level.