Understanding Loop 2300 in EDI Claims: A Comprehensive Guide

 Loop 2300 is assigned to ‘Provider Specific Information’. In detail, it is one of the loop qualifiers used in EDI (Electronic Data Interchange) files, which are key for billing and claims processing in health care. This article offers an in-depth study of Loop 2300. You will get to know the specifics on this subject. You will also find some illustrative examples that will be useful in your better understanding of the topic. No matter whether you are already familiar with this matter or if it is a new skill you are interested in, we will help you to master Loop 2300 easily.

Demystifying Loop 2300: Claim Information

 Loop 2300 captured core personal healthcare claim data in a logical order that could structure and transmit the critical information necessary for billing and payment: Reference, Loop 2300 stores the billing and payment information for a specific provider.

Segment CLM - Claim

 The CLM segment is the main support of all the remaining clauses in Loop 2300 – it provides essential information about the claim made in the claim-related segment (CRS). A quick overview of the elements that make up the CLM segment:

 • This unique identifier enables matching with ERA (Electronic Remittance Advice) for easier reconciliation 01.

 - Claim Amount (Element 02):

 This is the amount of money associated with the claim, and presumably a rather important element of acquiring reimbursement.

 - Location of Service (Element 05-1):

 Specifies the place at which the healthcare service was rendered, including traditional locations such as office and hospital settings, as well as more novel ones such as telehealth or assisted living facilities.

 - Provider Signature Indicator (Element 06):

Denotes whether the provider has signed the claim, thereby affecting the adjudication process.

 - Release of Information Code (ELEMENT 09):

 Addresses how patient information is released or shared.

Segment DTP - Date

 ‘DTP segment’ is segment D’s responsibility; here are the dates connected to the claim:1905: A vessel with underwater pipes is introduced into the water1909: The ship leverages the underwater tubes to ‘pick up steam’ and alert the surrounding area of impending harm1910-1912: More ships equipped with the same technology continually circle the submerged pipes around New York Harbor to prevent further contamination in the harbourOne can divide the items in the ‘DT segment’ and ‘DP segment’ further.

 - Date Qualifier (Element 01): 

Identifies the meaning of the date, whether it is the initial diagnosis date, a hospital admission or discharge, all of which play a different role in the billing world.

 - Unit of measure: 

‘Standardises the expression of quantity by changing its unit from the one used in the source system (e.g., grams) to the target system (pounds, ounces, etc)’ ­- **Format (Element 02):** ‘Standardises “dates” so that every date in every system appears in the same format; this assists in the interoperability and transfer of systems’ ­

Segment PWK - Workers Comp and Auto

 In instances such as supplemental information for workers’ compensation or auto insurance claims, the PWK segment facilitates information exchange. Let’s take a look at the important constituents within the PWK segment:

 - Supplemental Information Code (Element 01):

 This code identifies the nature of the supplemental information provided (eg, within patient notes, treatment plan, progress report, functional goal, etc).

 - Transmission Element (Element 02):

 Specifies delivery method for supplemental material, from electronic submission to snail-mail and fax.

Segment REF - Identifier

 The REF segment allows you to reference identifiers for the claim, which helps you identify and track it more precisely. Here is how the REF segment breaks down:

 - Identifier Code Qualifier (Element 01):

 A code that specifies the type of identifier being referred to, whether an authorisation number, control number, referral number … etc. 

 – Specific identifier (02):

 This element contains the specific identifier corresponding to the qualifier, which can be used as part of digital audit trails for accountability.

Segment AMT - Amount

 The AMT section deals with the monetary value of the claim, providing information about payments or financial issues. Here’s what the AMT section often contains:

 - Qualifier Code (Element 01):

 standardised code identifying the type of monetary amount (eg, patient payments or insurance reimbursements).

  - Financial Amount (Element 02): 

A number that quantifies the financial value of the qualifier specified. This makes it possible to reconcile figures when needed.

 Segment NTE - Note

The NTE segment allows for any additional notes or comments pertaining to the claim, offering ancillary context to stakeholders. Here is a working map of the NTE segment components:

 - FDE (Element 01):

 Indicates the purpose of the note, whether it’s an annotation, clarification or reference to external document.

 Here’s the text of that note: note Text (Element 02): This is the main content of the note, providing pertinent information or instructions to enhance clarity and readability. 

Segment HI - Diagnosis Codes

 The HI segment contains codes related to the diagnosis that was documented in the claim. Medical conditions are accurately coded and categorised based on codes received in the HI segment. Here is a list of entries in the HI segment:

 - Diagnosis Code Qualifier (Sub-Element 1):

 Provides insight into whether a diagnosis was the primary diagnosis for the clinic/encounter or a secondary diagnosis, helping payers and providers prioritise and categorise medical conditions.

 - Diagnosis Code (Sub-Element 2):

 Indicating the exact Diagnosis Code that the qualifier corresponds to, and which must be documented by the attending healthcare provider for medical bureaucratic requirements. 

Visualizing Loop 2300: A Schematic Representation

 In order to better illustrate the structure and parts of Loop 2300, let’s transform its schematic diagram: 

Visualizing Loop 2300

you can read more :Understanding EDI 837 Files: A Comprehensive Guide 


 In other words, all the information that EDI needs to know in order to bill and reimburse charges is encapsulated in Loop 2300. Understanding the components and structure of Loop 2300 is essential for healthcare professionals processing claims to ensure that all the information is correct and the transaction completed.