SPARCS-837 PC Application
Data Element Look-Up Reference
Revised: April 21, 2010
Data Element Names
Screen/Data Element Location
Accommodations Days
Claim Information (Revenue Tab) IP
Add/Update: enter Quantity then
Add/Update.
Accommodations Rate
Claim Information (Revenue Tab)
Add/Update: enter Rate then
Add/Update.
IP
Accommodations Total Charges
Claim Information (Revenue Tab)
Add/Update: enter Total Charges
in Amount then Add/Update.
IP
Accommodations Total Non-Covered Charges
Claim Information (Revenue Tab) IP
Add/Update: enter Total NonCovered Charges in Non-Covered
then Add/Update.
ADMISSION DATE/START OF CARE
Claim Information (General Tab):
Admit/Start Date use arrow to
select MMDDYYYY then Save.
AS, ED, IP
Admission Hour/Emergency Visit Hour
Claim Information (General Tab):
Admit/Start Date Hour use
arrow to select time then Save.
AS, ED, IP
Admitting Diagnosis Code
Claim Information (Diagnoses
Tab) Add/Update: Diagnosis
Type use arrow to select “Admit”
then enter Diagnosis Code then
Add/Update.
IP
AMI (Acute Myocardial Infarction) - Diastolic Blood Pressure on
Arrival
Claim Information (AMI Elements
Tab): enter 3-digit for Diastolic
then Save.
ED, IP
AMI (Acute Myocardial Infarction) - Heart Rate on Arrival
Claim Information (AMI Elements
Tab): enter 3-digit for Heart
Rate on Arrival then Save.
ED, IP
AMI (Acute Myocardial Infarction) - Systolic Blood Pressure on
Arrival
Claim Information (AMI Elements
Tab): enter 3-digit for Systolic
then Save.
ED, IP
ATTENDING/EMERGENCY DEPT PHYSICIAN 1 STATE
LICENSE NUMBER
Claim Information (General Tab):
Attending Physician License
Type use arrow to select and
enter License Number then
Save.
ED, IP
Condition Information - Homeless Patients
Claim Information (Condition
Codes Tab) Add/Update: enter
“17” in Condition Code for
Homeless Patients then
Add/Update.
AS, ED, IP
Page 1 of 8
Required For
SPARCS-837 PC Application
Data Element Look-Up Reference
Revised: April 21, 2010
Data Element Names
Screen/Data Element Location
Required For
Condition Information - Non-US Resident Patients
Claims (Condition Codes Tab)
Add/Update: enter “25” in
Condition Code for Non-US
Resident Patient’s then
Add/Update.
AS, ED, IP
Condition Information - Special Program (DIS)
Claim Information (Condition
Codes Tab) Add/Update: enter
“A5” for Condition Code (DIS)
then Add/Update.
IP
Condition Information - Special Program (FP)
Claim Information (Condition
Codes Tab) Add/Update: enter
“A4” for Condition Code (FP)
then Add/Update.
IP
Condition Information - Special Program (PHC)
Claim Information (Condition
Codes Tab) Add/Update: enter
“A2” for Condition Code (PHC)
then Add/Update.
IP
Condition Information - Special Program (SFP)
Claim Information (Condition
Codes Tab) Add/Update: enter
“A3” for Condition Code (SFP)
then Add/Update.
IP
Covered Days
Claim Information (General Tab):
enter number of days in Covered
Days then Save.
IP
Discharge Hour
Claim Information (General Tab): AS, ED, IP
Through Date Hour use arrow to
select time then Save.
Exempt Unit Indicator
Claim Information (General Tab):
Exempt Unit use arrow to select
then Save.
IP
Expected Principal Reimbursement
Claim Information (General Tab):
Expected Payer: Primary use
arrow to select then Save.
AS, ED, IP
Expected Reimbursement Other 1
Claim Information (General Tab):
Expected Payer: Other 1 use
arrow to select then Save.
IP
Expected Reimbursement Other 2
Claim Information (General Tab):
Expected Payer: Other 2 use
arrow to select then Save.
IP
External Cause-of-Injury Code
Claim Information (Diagnoses
AS, ED, IP
Tab) Add/Update: Diagnosis
Type use arrow to select “E-Code”
and enter Diagnosis Code then
Add/Update.
File Sequence and Serial Number
Generated
Page 2 of 8
AS, ED, IP
SPARCS-837 PC Application
Data Element Look-Up Reference
Revised: April 21, 2010
Data Element Names
Screen/Data Element Location
Required For
Inpatient Ancillary Revenue Code
Claim Information (Revenue Tab)
Add/Update: enter Revenue
Code then Add/Update.
IP
Inpatient Ancillary Total Charges
Claim Information (Revenue Tab)
Add/Update: enter Total Charges
in Amount then Add/Update.
IP
Inpatient Ancillary Total Non-Covered Charges
Claim Information (Revenue Tab) IP
Add/Update: enter Total NonCovered Charges in Non-Covered
then Add/Update.
MEDICAL RECORD NUMBER
Claim Information (General Tab):
enter Medical Record Num then
Save.
AS, ED, IP
Method of Anesthesia Used
Claim Information (General Tab):
Anesthesia use arrow to select
then Save.
AS, IP
MOTHER'S MEDICAL RECORD NUMBER FOR NEWBORN
CHILD
Claim Information (General Tab):
enter Mother’s MRN then Save.
IP
New York State Patient Status or Disposition
Claim Information (General Tab)
Add/Update: Patient Status use
arrow to select then Save.
AS, ED, IP
Non-Covered Days
Claim Information (General Tab):
enter number of days in Noncovered Days then Save.
IP
Occurrence Information - ACCIDENT RELATED Codes and
DATES
Claim Information (Occurrence
Dates Tab) Add/Update: enter
Occurrence Code and
Occurrence Date use arrow to
select MMDDYYYY then
Add/Update.
AS, ED, IP
OCCURRENCE SPAN INFORMATION - ALC AND LOA DATES
Claim Information (Occurrence
Spans Tab) Add/Update: enter
Occurrence Span Code, From
Date use arrow to select
MMDDYYYY and Through Date
use arrow to select MMDDYYYY
then Add/Update.
IP
OPERATING/EMERGENCY DEPARTMENT PHYSICIAN 2
STATE LICENSE NUMBER
Claim Information (General Tab):
Operating Physician License
Type use arrow to select and
enter License Number then
Save.
AS, ED, IP
Page 3 of 8
SPARCS-837 PC Application
Data Element Look-Up Reference
Revised: April 21, 2010
Data Element Names
Screen/Data Element Location
Required For
Other Diagnosis Code 1-14
Claim Information (Diagnoses
Tab) Add/Update: Diagnosis
Type use arrow to select “Other”
and enter Diagnosis Code then
Add/Update.
AS, ED, IP
OTHER/EMERGENCY DEPARTMENT PHYSICIAN 3 STATE
LICENSE NUMBER
Claim Information (General Tab):
Other Physician License Type
use arrow to select and enter
License Number then Save.
ED, IP
Other Procedure Code 1-14
Claim Information (Procedures
Tab) Add/Update: Procedure
Type use arrow to select “Other”
then enter Procedure Code then
Add/Update.
IP
OTHER PROCEDURE DATE 1-14
Claim Information (Procedures
Tab) Add/Update: Procedure
Date use arrow to select
MMDDYYY then Add/Update.
IP
Outpatient Ancillary Revenue Code
Claim Information (Revenue Tab)
Add/Update: enter Revenue
Code then Add/Update.
AS, ED
Outpatient Ancillary Total Charges
Claim Information (Revenue Tab)
Add/Update: enter Total Charges
in Amount then Add/Update.
AS, ED
Outpatient Ancillary Total Non-Covered Charges
Claim Information (Revenue Tab) AS, ED
Add/Update: enter Total NonCovered Charges in Non-Covered
then Add/Update.
PATIENT BIRTH DATE
Claim Information (From Tool Bar AS, ED, IP
II select Patient/Subscriber Icon
then Update Icon): Date of Birth
use arrow to select MMDDYYYY
then Save.
Patient City
Claim Information (From Tool Bar
II select Patient/Subscriber Icon
then Update Icon): enter City
then Save.
AS, ED, IP
PATIENT CONTROL NUMBER
Claim Information (General Tab):
enter Patient Control Num then
Save.
AS, ED, IP
Patient County Code
Claim Information (From Tool Bar
II select Patient/Subscriber Icon
then Update Icon): County use
arrow to select then Save.
AS, ED, IP
Page 4 of 8
SPARCS-837 PC Application
Data Element Look-Up Reference
Revised: April 21, 2010
Data Element Names
Screen/Data Element Location
Required For
Patient Ethnicity
Claim Information (From Tool Bar
II select Patient/Subscriber Icon
then Update Icon): Ethnicity use
arrow to select then Save.
AS, ED, IP
Patient Postal Service Zip Code and EXTENSION CODE
Claim Information (From Tool Bar
II select Patient/Subscriber Icon
then Update Icon): enter 5-digit
or 9-digit Zip Code then Save.
AS, ED, IP
Patient Race
Claim Information (From Tool Bar
II select Patient/Subscriber Icon
then Update Icon): Race use
arrow to select then Save.
AS, ED, IP
Patient Reason For Visit Code
Claim Information (Diagnoses
Tab) Add/Update: Diagnosis
Type use arrow to select “Reason
for Visit” and enter Diagnosis
Code then Add/Update.
AS, ED
PATIENT RESIDENCE ADDRESS - ADDRESS LINE 1
Claim Information (From Tool Bar
II select Patient/Subscriber Icon
then Update Icon): Address 1
enter street address then Save.
AS, ED, IP
PATIENT RESIDENCE ADDRESS - ADDRESS LINE 2
Claim Information (From Tool Bar
II select Patient/Subscriber Icon
then Update Icon): Address 2
enter apt# or leave blank then
Save.
AS, ED, IP
Patient Sex
Claim Information (From Tool Bar
II select Patient/Subscriber Icon
then Update Icon): Sex use
arrow to select then Save.
AS, ED, IP
Patient State
Claim Information (From Tool Bar
II select Patient/Subscriber Icon
then Update Icon): State use
arrow to select then Save.
AS, ED, IP
Payer Identification Number
Claim Information (From Tool Bar
II Subscriber Icon then Update
Icon): enter 5-digit Payer ID
then Save; or
AS, ED, IP
Claim Information (Secondary
Payers Tab) Add/Update: enter 5digit Payer ID then select
Add/Update.
Page 5 of 8
SPARCS-837 PC Application
Data Element Look-Up Reference
Revised: April 21, 2010
Data Element Names
Screen/Data Element Location
Required For
Place-of-Injury Code
Claim Information (Diagnoses
Tab) Add/Update: Diagnosis
Type use arrow to select “Ecode”, and enter Diagnosis Code
then Add/Update.
AS, ED, IP
Point of Origin / Source of Admission
Claim Information (General Tab):
Origin use arrow to select Source
of Admission then Save.
IP
POLICY NUMBER
Claim Information (From Tool Bar IP
II Subscriber Icon then Update
Icon): enter Policy Number then
Save; or
Claim Information (Secondary
Payers Tab) Add/Update: enter
Policy Number then select
Add/Update.
Present on Admission Indicator
Claim Information (Diagnoses
IP
Tab) Add/Update: Present on
Admission use arrow to select
appropriate POA then Add/Update.
Principal/Primary Diagnosis Code
Claim Information (Diagnoses
Tab) Add/Update: Diagnosis
Type use arrow to select
“Principal” and enter Diagnoses
Code then Add/Update.
AS, ED, IP
Principal Procedure Code
Claim Information (Procedures
Tab) Add/Update: Procedure
Type use arrow to select
“Principal” then enter Procedure
Code then Add/Update.
IP
PRINCIPAL PROCEDURE DATE
Claim Information (Procedures
Tab) Add/Update: Procedure
Date use arrow to select
“MMDDYYYY” then Add/Update.
IP
Procedure Code - CPT-4 / HCPCS & Modifier 1 and 2
Claim Information (Revenue Tab)
Add/Update: Procedure Code
enter CPT-4/HCPCS and Modifier
1 & Modifier 2 then Add/Update.
AS, ED
Procedure Time/Operating Room Time
Claim Information (General Tab): AS
Procedure Time: use arrow to
select Hours H and Mins MM then
Save.
Processing Date
Generated (Date of Export)
AS, ED, IP
Provider Identification Number
Select Facility from list (Update
Icon): enter Provider ID (NPI)
then Update.
AS, ED, IP
Page 6 of 8
SPARCS-837 PC Application
Data Element Look-Up Reference
Revised: April 21, 2010
Data Element Names
Screen/Data Element Location
Required For
Source of Admission / Point of Origin
Claim Information (General Tab):
Origin use arrow to select Source
of Admission then Save.
IP
Source of Payment Code/Claim Filing Indicator Code
Claim Information (From Tool Bar
II Subscriber Icon then Update
Icon): Payer Source use arrow
to select then Save; or
AS, ED, IP
Claim Information (Secondary
Payers Tab) Add/Update: Payer
Source use arrow to select then
Add/Update.
Source of Payment Typology I
Claim Information (General Tab):
Source of Payment: Typology:
I use arrow to select then Save.
AS, ED, IP
Source of Payment Typology II
Claim Information (General Tab):
Source of Payment: Typology:
II use arrow to select then Save.
AS, ED, IP
Source of Payment Typology III
Claim Information (General Tab):
Source of Payment: Typology:
III use arrow to select then Save.
AS, ED, IP
SPARCS Collector Code
From Tool Bar I Menu select
Options (Update Submitter
Settings): enter 3-digit Collector
Number then Update.
AS, ED, IP
SPARCS Identification Number
Select Facility from list (Add
Icon): enter 5-digit SPARCS
Facility ID (PFI) then Add.
AS, ED, IP
STATEMENT COVERS PERIOD - FROM DATE
Claim Information (General Tab):
Admit/Start Date use arrow to
select MMDDYY then Save.
AS, ED, IP
STATEMENT COVERS PERIOD - THRU DATE
Claim Information (General Tab):
Through Date use arrow to
select MMDDYY then Save.
AS, ED, IP
Submitter Name
From Tool Bar I Menu select
Options (Update Submitter
Settings): enter Submitter
Name then Update.
AS, ED, IP
Test/Production Indicator
Export (Submission Type)
AS, ED, IP
Total Charges
Claim Information (General Tab):
enter Total Charges amount or
press calculate button then Save.
AS, ED, IP
Type of Admission
Claim Information (General Tab):
Claim Type use arrow to select
then Save.
IP
Page 7 of 8
SPARCS-837 PC Application
Data Element Look-Up Reference
Revised: April 21, 2010
Data Element Names
Screen/Data Element Location
Required For
Type of Bill
Claim Information (General Tab): AS, ED, IP
Bill Type use arrow to select then
Save.
UB Accommodation Code
Claim Information (Revenue Tab)
Add/Update: enter UB
Accommodation Code in Revenue
Code then Add/Update.
IP
UNIQUE PERSONAL IDENTIFIER
Claim Information (From Tool Bar
II select Patient/Subscriber Icon
then Update Icon): enter Unique
Personal Identifier then Save.
AS, ED, IP
Value Information - Accident Hour
Claim Information (Value Codes
Tab) Add/Update: enter “45” in
Value Code for Hour and 2-digit
hour in Value Amount then
Add/Update.
AS, ED
Value Information - Blood Furnished Code and Amount
Claim Information (Value Codes
Tab) Add/Update: enter “37” in
Value Code for Blood and
number of pints furnished in
Value Amount then Add/Update.
IP
Value Information - NEONATE BIRTH WEIGHT
Claim Information (Value Codes
Tab) Add/Update: enter “54” in
Value Code for Birth Weight and
weight in Value Amount then
Add/Update.
IP
Value Information - Surplus, Catastrophic, or Recurring Monthly
Income Code and Amount
Claim Information (Value Codes
IP
Tab) Add/Update: enter “21” for
Catastrophic, “22” for Surplus, or
“23” for Recurring Monthly Income
in Value Code and Value
Amount then Add/Update.
Value Information - Workers' Compensation/No Fault Indicator
Claim Information (Value Codes
Tab) Add/Update: enter Value
Code ”15” for Worker’s Comp or
“14” for No Fault and Value
Amount then Add/Update.
IP
NOTE: Bolded and UPPER CASE are IDENTIFYING DATA ELEMENTS [see "Data Protection Review
Board (DPRB)].
Page 8 of 8