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| Option | Setting |
|---|---|
| Component element separator* | Enter the component element separator character in the Setting column to the right of this option. The component element separator is a character used to separate multiple components that are associated to make up an element within a segment. Typically, the component element separator is a colon (:). This option is required. |
| Element separator* | Enter the element separator character in the Setting column to the right of this option. The element separator is a character used to separate the elements that make up a segment. Typically, the element separator is an asterisk (*). This option is required. |
| Segment terminator* | Enter the segment terminator character in the Setting column to the right of this option. The segment terminator is a character used to separate each segment in a control segment. Typically, the segment terminator is a tilde (~). This option is required. |
*Consult the Trading Partner Agreement/Companion Guide for instructions on filling out this option.
| Option | Setting |
|---|---|
| Claims per submission limit* | Enter the claims per submission limit in the Setting column to the right of this option. The claims per submission limit is the maximum number of claims that can be submitted in an entire 837 electronic file. This option is required. Typically, the claims per submission limit are defined by the clearinghouse and/or direct payer. The default setting is 0. |
| CLM segment limit per transaction set* | Enter the CLM segment limit per transaction set in the setting field to the right of this option. The CLM segment limit per transaction set is the maximum number of claim/encounter (CLM) transactions that can be sent in a ST/SE Transaction Set. This option is required. Typically, the CLM segment limit per transaction set cannot exceed 5000. However, the CLM segment limit per transaction set is defined by the clearinghouse and/or direct payer. The default setting is 5000. |
| Number of transactions sets per file* | Enter the number of transactions sets per file in the Setting column to the right of this option. The number of transactions sets per file is the maximum number of payers who can be included in one file, which is the ISA/IEA Envelope. This option is required. Typically, the number of transactions sets per file is defined by the clearinghouse and/or direct payer. The default setting is 0. |
| Number of functional groups per file* | Enter the number of functional groups per file in the setting field to the right of this option. The number of functional groups per file is the maximum number of claim types (HCFA, UB, and ADA) that can be included in one electronic file. This option is required and should always be set to 1, because only one claim form type (HCFA, UB, or ADA) can be selected on the 837 Electronic File Creation window when the 837 electronic file is created. The default setting is 0. |
*Consult the Trading Partner Agreement/Companion Guide for instructions on filling out this option.
| Option | Setting |
|---|---|
| Use Addenda A1 version | Select this option to set the 837 electronic send file to use updated Institutional (004010X096A1) and Professional (004010X098A1) addenda-compliant specifications from the implementation guides, published in October 2002. If this option is unchecked, the original Institutional (004010X096) and Professional (004010X098) specifications from the implementation guides, published in May 2000 are used. |
| Convert all data to upper case* | Activate this option to convert all the data in the 837 electronic file to upper case. The default, when this option is not activated, is for the data to display as it is in the application. This option is not required. |
| Default file name (see below)* | Enter the default file name in the Setting column to the right of this option. This option is not required. The default file name needs to be descriptive to distinguish electronic claim files for this submitter profile from other electronic files for other submitter profiles. When electronic claims are processed for this submitter profile, the default file name entered here automatically appends to the file path in the Send Filename field on the 837 Electronic File Creation window. In addition to the default file name, dates and counters can be added to the to the file name. Refer to the field definition that follows for an explanation of valid date formats and the symbol used to include a counter. For example, if you enter the following text for the default file name (NYMedicareYYYYDDMM##), then the default file name would be NYMedicare2003160303. The system checks for invalid file name characters. Invalid file name characters are: \ / : * ? " < > | |
| Date values entered in one of the following formats will automatically be replaced with the appropriate date values: YYYYMMDD, YYYYDDMM, MMDDYYYY, DDMMYYYY, MMDDYY, DDMMYY, YYMMDD, YYDDMMA counter can be inserted with the # symbol. | This field is informational only and refers to the previous field definition Default file name (see above). When one of the valid date formats is used, a dash (-) can be used as a separator between the day, month, and year (YYYY-DD-MM). When the counter symbol (#) is included as part of the default file name, it will increment by 1 each time an electronic claim file for this submitter profile is created. The counter resets each day, unless a value greater than zero is entered in the field below, The default file name is maximum counter. Once the counter reaches the maximum counter value, the counter will reset. In addition, if multiple counter symbols are used, they will act as placeholder values for the counter and will convert to leading zeros. |
| Default file name max counter (Blank or zero value resets counter each day)* | Enter the default file name maximum counter in the Setting column to the right of this option. The default file name, maximum counter, is a value greater than zero, which controls when the counter set in the default file name resets. For example, if the default file name maximum counter is set at 50, then the counter in the default file name will reset after 50 electronic claim files are created for this submitter profile. This option is not required. |
*Consult the Trading Partner Agreement/Companion Guide for instructions on filling out this option.
| Option | Setting |
|---|---|
| Create one ISA segment per payer | Activate this option to create a new ISA segment for each payer. |
| Authorization info qualifier ID [ISA01]* | Select one of the pre-loaded options in the drop-down list in the Setting column to the right of this option. This option is required. The option that follows is dependent on the selection made here. |
| Authorization info [ISA02]* | Enter the authorization information in the Setting column to the right of this option. This option is dependent on the selection in the previous option. If Additional data identification was selected, then this option automatically becomes required. |
| Security info qualifier ID [ISA03]* | Select one of the pre-loaded options in the drop-down list in the Setting column to the right of this option. This option is required. The option that follows is dependent on the selection made here. |
| Security info [ISA04]* | Enter the security information in the Setting column to the right of this option. This option is dependent on the selection in the previous option. If Password was selected, then this option automatically becomes required. |
| Interchange ID qualifier [ISA05]* | Enter the interchange ID qualifier in the Setting column to the right of this option. This option is required and is provided to you by the clearinghouse and/or direct payer. |
| Interchange sender ID [ISA06]* | Enter the interchange sender ID in the Setting column to the right of this option. This option is required and is provided to you by the clearinghouse and/or direct payer. |
| Interchange ID qualifier [ISA07]* | Enter the interchange ID qualifier in the Setting column to the right of this option. This option is required and is provided to you by the clearinghouse and/or direct payer. |
| Interchange receiver ID: Use elec trans ID from payer master OR [below] | Activate this option to draw information from the Payer master file to fill the ISA08 Interchange receiver ID field. |
| Interchange receiver ID [ONLY if line ABOVE is unchecked] [ISA08]* | Enter the interchange receiver ID in the Setting column to the right of this option. This option is required and is provided to you by the clearinghouse and/or direct payer. |
| Increment Interchange Counter [ISA13] | Activate this option to increment the ISA13 segment by the number of claims submitted in your 837 electronic file. This process occurs after the 837 electronic file generation and the claim request status are updated to Archive. If this option is not activated, the ISA13 segment is set to 000000001 every time the file is generated. This option has been added to the Submitter Profile Listing report as ISA13 Counter Ind. |
| Interchange Counter Value [ISA13] | Enter a value to set as the initial value for the ISA13 counter. |
| Request acknowledgment [ISA14]* | Activate this option to send a TA1 Request acknowledgment in the file (file element ISA14) and a response is transmitted back to the submitter. This option is not required. |
*Consult the Trading Partner Agreement/Companion Guide for instructions on filling out this option.
| Option | Setting |
|---|---|
| Application sender code [GS02]* | Enter your application sender code in the setting field to the right of this option. The Application sender code is a required option and is provided to you by the clearinghouse and/or direct payer. |
| Application receivers code: Use elec trans ID from payer master OR (below) | Activate this option by selecting the setting field to the right of the option. When this option is activated, the application draws information from the Payer master file to fill the GS03 Application receiver code field. |
| Application receivers code [ONLY if line ABOVE unchecked] [GS03]* | Enter the application receiver code in the Setting column to the right of this option. The application receiver code is a required option and is provided to you by the clearinghouse and/or direct payer. |
| Break claim file based on submitter ID (GS02) | Select the applicable options:
|
| Suppress leading zeroes in Group Control Number (GS06) | Activate this option to suppress the leading zeroes in the Groups Control Number that prints on the claim. |
| Option | Setting |
|---|---|
| Transaction set purpose code (BHT02) must equal ‘00’ (Original)* | Activate this option to populate the BHT02 element position in the 837 file with 00. BHT02 defines the transmission status of the batch being transmitted in the 837 ST/SE segment. A ‘00’ setting indicates that the batch is an Original. This option is not required. |
| Transaction set purpose code (BHT06) must equal ‘CH’ (Chargeable)* | Activate this option to populate the BHT02 element position in the 837 file with CH. BHT02 defines the transmission status of the batch being transmitted in the 837 ST/SE segment. A CH setting indicates that the batch is a Reissue. This option is not required. |
*Consult the Trading Partner Agreement/Companion Guide for instructions on filling out this option.
| Option | Setting |
|---|---|
| First name [NM104]* | Enter the first name in the Setting column to the right of this option. This option is dependent on the option selected in the Person or non-person option below. If Person is selected, then this option automatically becomes required. |
| Last name/Organization name [NM103]* | Enter the last name or organization name in the Setting column to the right. This option is required. If Person is selected in the Person or non-person option below, then enter the person’s last name. If Organization is selected, then enter the name of the organization. |
| Middle name [NM105]* | Enter the middle name of the person in the Setting column to the right of this option, if Person is selected in the Person or non-person option below. This option is not required. |
| Person or non-person [NM102]* | Select one of the pre-loaded options in the drop-down list in the Setting column to the right of this option. This option is required. The First name and Last name/Organization name options above are dependent on the selection made here. |
| Primary ID number: Use elec trans ID from payer master OR (below) | Activate this option to draw information from the Payer master file to fill the 1000A loop NM109 Primary ID number field. |
| Primary ID number [ONLY if line ABOVE is unchecked] [NM109]* | Enter the primary ID number in the Setting column to the right of this option. The primary ID number is provided to you by the clearinghouse and/or direct payer. This option is required. |
| Reject claim if frequency is not '1' (Original), '6' (Corrected), '7' (Replacement) or '8' (Void)* | Activate this option to reject the 837 electronic file if the frequency is not a 1, 6, 7, or 8. This option is not required. |
| Option | Setting |
|---|---|
| Contact email [PER04/06/08]* | Enter the contact email in the Setting column to the right of this option. This option is not required. |
| Contact fax [PER04/06/08] (No Dashes)* | Enter the contact fax number, with no dashes, in the Setting column to the right of this option. This option is not required. |
| Contact name [PER02]* | Enter the contact name in the Setting column to the right of this option. This option is required. |
| Contact phone [PER04/06/08] (No Dashes)* | Enter the contact phone number, with no dashes, in the Setting column to the right of this option. This option is not required. |
| Contact phone ext [PER06/08]* | Enter the contact phone extension in the Setting column to the right of this option. This option is not required. |
| Option | Setting |
|---|---|
| Suppress service facility loop for place(s) of service | Select the applicable option to suppress the 2310D claim-level Service Facility loop if the place of service is home or office. Valid options include:
|
| Option | Setting |
|---|---|
| Default ID for Other Payers without eTrans IDs or NEIC numbers (NM109)* | Activate this option to insert the default NM109 value into the NM1 segment of the Other Payers for other payers that do not have eTrans IDs/NEIC numbers. |