EDI Loop → Box Number Reference
Ritten sends JSON to Stedi; Stedi converts to EDI for payers. Rejection messages reference EDI loops. Use this table to translate loop references to the corresponding claim form box.
Loop / Segment | CMS-1500 Box | UB-04 Box | Meaning |
Loop 2000A PRV PRV03 | Box 33 (billing provider) | — | Billing provider taxonomy code |
Loop 2010AA NM1*85 | Box 33 | Box 56 | Billing provider name/NPI |
Loop 2010AA REF*EI | Box 25 | Box 5 | Federal Tax ID (EIN) |
Loop 2010AB NM1*87 | Box 32 | Box 76 | Service facility location |
Loop 2010BA NM1*IL | Box 1a | Box 60 | Insured's ID / Member ID |
Loop 2010BB NM1*PR | Box 1 / Box 11 | Box 50 | Payer name/insurance info |
Loop 2300 CLM | Box 21 + Box 24 | Box 4+ | Claim-level data |
Loop 2300 DTP*435 | Box 14 | — | Onset of current illness date |
Loop 2300 REF*G1 | Box 23 | Box 63 | Prior authorization number |
Loop 2300 REF*9F | Box 19 | Box 80 | NTE/remarks field |
Loop 2310B NM1*82 | Box 24J | Box 82 | Rendering provider NPI |
Loop 2310C NM1*77 | Box 32 | — | Service facility (professional) |
Loop 2320 COB | Box 11 area | Box 50–65 | COB/secondary payer info |
Loop 2400 SV1 | Box 24 A–G | — | Professional service line |
Loop 2400 SV2 | — | Box 42–49 | Institutional service line |
Loop 2400 DTP*472 | Box 24A | Box 45 | Service date(s) |
Loop 2400 SV1*02 | Box 24B | Box 42 | Place of service / revenue code |
Loop 2400 REF*6R | Box 24J shaded | — | Rendering provider secondary ID |
UB-04 Specific Notes
Box 39–41 (Value Codes): Set in billing rule "Value Codes and Amounts." Only exists on UB-04 (837I) — not CMS-1500.
Box 64 (Payer Claim Control Number): Required for replacement/void claims (Frequency codes 7, 8, G, I, X, Y).
Key Rule: Rendering Provider Removal
If rendering provider = billing provider (or facility provider = billing provider), Stedi removes the rendering provider from the EDI per X12 standard. This is correct behavior, not a bug.