Not Required

For Medicare purposes, we don't require you to complete data elements shown in Table 4. But other payers may require them.

Not Required

Table 4: Data Elements Medicare Doesn’t Require

CMS-1450 Form Locator (FL) & Description	837I Loop / Segment
FL 2 - Billing Provider's Designated Pay-to Name, Address, and Secondary Identification	Loop 2010AB
FL 13 - Admission Hour	Loop 2300 / DTP segment
FL 16 - Discharge Hour	Loop 2300 / DTP segment
FL 38 - Responsible Party Name and Address	Not used in 837I
FL 55 A, B, and C - Estimated Amount Due From Patient	Loop 2300 / AMT segment
FL 81 - Code-Code – QUAL/CODE/VALUE	Loop 2300

We'll now review the claim information relevant to providers.