Common Options for the 4010 and 5010 Format

Note: Prior to setting up these options, you may want to consult the Trading Partner Agreement/Companion Guide for instructions to fill these options. Each option with an asterisk that may apply to a trading partner.

Option	Setting
Separators/Delimiters
Component element separator*	Displays the component element separator character in the Setting column. 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 (:).
Element separator*	Displays the element separator character in the Setting column. The element separator is a character used to separate the elements that make up a segment. Typically, the element separator is an asterisk (*).
Segment terminator*	Displays the segment terminator character in the Setting column. The segment terminator is a character used to separate each segment in a control segment. Typically, the segment terminator is a tilde (~).
Limits
Claims per submission limit*	Displays the claims per submission limit in the Setting column. The claims per submission limit is the maximum number of claims that can be submitted in an entire 837 electronic file. Typically, the claims per submission limit are defined by the clearinghouse and/or direct payer.
CLM segment limit per transaction set*	Displays the CLM segment limit per transaction set in the setting field. 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. Typically, the CLM segment limit per transaction set cannot exceed 5000. However, the CLM segment limit per transaction set is defined by the clearinghouse or direct payer.
Number of transactions sets per file*	Displays the number of transaction sets per file in the Setting column. 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. Typically, the number of transactions sets per file is defined by the clearinghouse or direct payer.
Number of functional groups per file*	Displays the number of functional groups per file in the setting field. 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 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.
File Options
Use Addenda A1 version*	Sets 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 cleared, the original Institutional (004010X096) and Professional (004010X098) specifications from the implementation guides, published in May 2000 are used.
Convert all data to upper case*	Converts 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.
Default file name (see below)*	Displays the default file name in the Setting column. 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 like \, /, :, *, ?, ", <, >, \|.
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. 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)*	Displays the default file name maximum counter in the Setting column. 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.
Interchange Control Header (Header Loop ISA Segments)
Create one ISA segment per payer*	Creates 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. The option that follows is dependent on the selection made here.
Authorization info (ISA02)*	Enter the authorization information in the Setting column. 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)*	Displays one of the pre-loaded options in the list in the Setting column. The option that follows is dependent on the selection made here.
Security info (ISA04)*	Enter the security information in the Setting column. 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)*	Displays the interchange ID qualifier in the Setting column. This is provided by the clearinghouse or direct payer.
Interchange sender ID (ISA06)*	Displays the interchange sender ID in the Setting column. This option is provided by the clearinghouse or direct payer.
Interchange ID qualifier (ISA07)*	Displays the interchange ID qualifier in the Setting column. This option is provided by the clearinghouse or direct payer.
Interchange receiver ID: Use elec trans ID from payer master OR (below)*	Draws information from the Payer master file to fill the ISA08 Interchange receiver ID field.
Interchange receiver ID (ONLY if line ABOVE is unchecked) (ISA08)*	Displays the interchange receiver ID in the Setting column. This option is provided by the clearinghouse or direct payer.
Increment Interchange Counter (ISA13)*	Increments 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)*	Displays the value to be set as the initial value for the ISA13 counter.
Request acknowledgment (ISA14)*	Sends a TA1 Request acknowledgment in the file (file element ISA14) and a response is transmitted back to the submitter.
Functional Group Header (Header Loop GS Segments)
Application sender code (GS02)*	Displays your application sender code in the setting field. The Application sender code is a required option and is provided to you by the clearinghouse or direct payer.
Application receivers code: Use elec trans ID from payer master OR (below)*	Draws information from the Payer master file to fill the GS03 Application receiver code field.
Application receivers code (ONLY if line ABOVE unchecked) (GS03)*	Displays the application receiver code in the Setting column. The application receiver code is a required option and is provided by the clearinghouse or direct payer.
Break claim file based on submitter ID (GS02)*	Select the applicable options: Use Standard Submitter Logic (default setting) Multiple Submitters Per File/Separate GS Headers Multiple Submitters Per File/One GS Header
Suppress leading zeroes in Group Control Number (GS06)*	Suppresses the leading zeroes in the Groups Control Number that prints on the claim.
Begin Hierarchical Transaction (Header Loop BHT Segments)
Transaction set purpose code (BHT02) must equal ‘00’ (Original)*	Populates 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.
Transaction set purpose code (BHT06) must equal ‘CH’ (Chargeable)*	Populates 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.
Submitter Details (1000A Loop NM1 Segments)
First name (NM104)*	Displays the first name in the Setting column. This option is dependent on the option selected in the person or non-person option. If person is selected, then this option automatically becomes mandatory.
Last name/Organization name (NM103)*	Displays the last name or organization name in the Setting. If person is selected in the person or non-person option, then enter the person’s last name. If Organization is selected, then enter the name of the organization.
Middle name (NM105)*	Displays the middle name of the person in the Setting column, if person is selected in the person or non-person option.
Person or non-person (NM102)*	Select one of the pre-loaded options in the list in the Setting column. The First name and Last name/Organization name options are dependent of 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)*	Displays the primary ID number in the Setting column. The primary ID number is provided to you by the clearinghouse or direct payer.
Reject claim if frequency is not '1' (Original), '6' (Corrected), '7' (Replacement) or '8' (Void)*	Rejects the 837 electronic file if the frequency is not a 1, 6, 7, or 8.
Submitter Details (1000A Loop NM1 Segments)
First name (NM104)*	Displays the first name in the Setting column. This option is dependent on the option selected in the person or non-person option. If person is selected, then this option automatically becomes mandatory.
Last name/Organization name (NM103)*	Displays the last name or organization name in the Setting. If person is selected in the person or non-person option, then enter the person’s last name. If Organization is selected, then enter the name of the organization.
Middle name (NM105)*	Displays the middle name of the person in the Setting column, if person is selected in the person or non-person option.
Person or non-person (NM102)*	Select one of the pre-loaded options in the list in the Setting column. This option is required. The First name and Last name/Organization name options are dependent on the selection made here.
Primary ID number: Use elec trans ID from payer master OR (below) *	Draws 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)*	Displays 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 or direct payer.
Reject claim if frequency is not '1' (Original), '6' (Corrected), '7' (Replacement) or '8' (Void)*	Rejects the 837 electronic file if the frequency is not a 1, 6, 7, or 8.
Contact Information (1000A Loop PER Segments)
Contact email (PER04/06/08)*	Displays the contact email in the Setting column.
Contact fax (PER04/06/08) (No Dashes)*	Displays the contact fax number, with no dashes, in the Setting column.
Contact name (PER02)*	Displays the contact name in the Setting column.
Contact phone (PER04/06/08) (No Dashes)*	Displays the contact phone number, with no dashes, in the Setting column.
Contact phone ext (PER06/08)*	Displays the contact phone extension in the Setting column.
Service Facility (2310D Loop Segments)
Suppress service facility loop for place(s) of service	Suppress the 2310D claim-level Service Facility loop if the place of service is home or office. Valid options include: <none> Home (12) only Office (11) only Home (12) or Office (11) Outpatient (22) only Home (12) or Office (11) or Outpatient (22) This option can be overridden by the Suppress Facility Loop (2310D) setting in the Electronic Claims sub-tab on the System tab of Payer master file.
Other Payer (2330B Loop Segments)
Default ID for Other Payers without eTrans IDs or NEIC numbers (NM109)*	Inserts the default NM109 value into the NM1 segment of the Other Payers for other payers that do not have eTrans IDs/NEIC numbers.

Option	Setting
Separators/Delimiters
Component element separator*	Displays the component element separator character in the Setting column. 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 (:).
Element separator*	Displays the element separator character in the Setting column. The element separator is a character used to separate the elements that make up a segment. Typically, the element separator is an asterisk (*).
Segment terminator*	Displays the segment terminator character in the Setting column. The segment terminator is a character used to separate each segment in a control segment. Typically, the segment terminator is a tilde (~).
Limits
Claims per submission limit*	Displays the claims per submission limit in the Setting column. The claims per submission limit is the maximum number of claims that can be submitted in an entire 837 electronic file. Typically, the claims per submission limit are defined by the clearinghouse and/or direct payer.
CLM segment limit per transaction set*	Displays the CLM segment limit per transaction set in the setting field. 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. Typically, the CLM segment limit per transaction set cannot exceed 5000. However, the CLM segment limit per transaction set is defined by the clearinghouse or direct payer.
Number of transactions sets per file*	Displays the number of transaction sets per file in the Setting column. 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. Typically, the number of transactions sets per file is defined by the clearinghouse or direct payer.
Number of functional groups per file*	Displays the number of functional groups per file in the setting field. 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 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.
File Options
Use Addenda A1 version*	Sets 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 cleared, the original Institutional (004010X096) and Professional (004010X098) specifications from the implementation guides, published in May 2000 are used.
Convert all data to upper case*	Converts 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.
Default file name (see below)*	Displays the default file name in the Setting column. 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 like \, /, :, *, ?, ", <, >, \|.
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. 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)*	Displays the default file name maximum counter in the Setting column. 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.
Interchange Control Header (Header Loop ISA Segments)
Create one ISA segment per payer*	Creates 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. The option that follows is dependent on the selection made here.
Authorization info (ISA02)*	Enter the authorization information in the Setting column. 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)*	Displays one of the pre-loaded options in the list in the Setting column. The option that follows is dependent on the selection made here.
Security info (ISA04)*	Enter the security information in the Setting column. 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)*	Displays the interchange ID qualifier in the Setting column. This is provided by the clearinghouse or direct payer.
Interchange sender ID (ISA06)*	Displays the interchange sender ID in the Setting column. This option is provided by the clearinghouse or direct payer.
Interchange ID qualifier (ISA07)*	Displays the interchange ID qualifier in the Setting column. This option is provided by the clearinghouse or direct payer.
Interchange receiver ID: Use elec trans ID from payer master OR (below)*	Draws information from the Payer master file to fill the ISA08 Interchange receiver ID field.
Interchange receiver ID (ONLY if line ABOVE is unchecked) (ISA08)*	Displays the interchange receiver ID in the Setting column. This option is provided by the clearinghouse or direct payer.
Increment Interchange Counter (ISA13)*	Increments 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)*	Displays the value to be set as the initial value for the ISA13 counter.
Request acknowledgment (ISA14)*	Sends a TA1 Request acknowledgment in the file (file element ISA14) and a response is transmitted back to the submitter.
Functional Group Header (Header Loop GS Segments)
Application sender code (GS02)*	Displays your application sender code in the setting field. The Application sender code is a required option and is provided to you by the clearinghouse or direct payer.
Application receivers code: Use elec trans ID from payer master OR (below)*	Draws information from the Payer master file to fill the GS03 Application receiver code field.
Application receivers code (ONLY if line ABOVE unchecked) (GS03)*	Displays the application receiver code in the Setting column. The application receiver code is a required option and is provided by the clearinghouse or direct payer.
Break claim file based on submitter ID (GS02)*	Select the applicable options: Use Standard Submitter Logic (default setting) Multiple Submitters Per File/Separate GS Headers Multiple Submitters Per File/One GS Header
Suppress leading zeroes in Group Control Number (GS06)*	Suppresses the leading zeroes in the Groups Control Number that prints on the claim.
Begin Hierarchical Transaction (Header Loop BHT Segments)
Transaction set purpose code (BHT02) must equal ‘00’ (Original)*	Populates 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.
Transaction set purpose code (BHT06) must equal ‘CH’ (Chargeable)*	Populates 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.
Submitter Details (1000A Loop NM1 Segments)
First name (NM104)*	Displays the first name in the Setting column. This option is dependent on the option selected in the person or non-person option. If person is selected, then this option automatically becomes mandatory.
Last name/Organization name (NM103)*	Displays the last name or organization name in the Setting. If person is selected in the person or non-person option, then enter the person’s last name. If Organization is selected, then enter the name of the organization.
Middle name (NM105)*	Displays the middle name of the person in the Setting column, if person is selected in the person or non-person option.
Person or non-person (NM102)*	Select one of the pre-loaded options in the list in the Setting column. The First name and Last name/Organization name options are dependent of 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)*	Displays the primary ID number in the Setting column. The primary ID number is provided to you by the clearinghouse or direct payer.
Reject claim if frequency is not '1' (Original), '6' (Corrected), '7' (Replacement) or '8' (Void)*	Rejects the 837 electronic file if the frequency is not a 1, 6, 7, or 8.
Submitter Details (1000A Loop NM1 Segments)
First name (NM104)*	Displays the first name in the Setting column. This option is dependent on the option selected in the person or non-person option. If person is selected, then this option automatically becomes mandatory.
Last name/Organization name (NM103)*	Displays the last name or organization name in the Setting. If person is selected in the person or non-person option, then enter the person’s last name. If Organization is selected, then enter the name of the organization.
Middle name (NM105)*	Displays the middle name of the person in the Setting column, if person is selected in the person or non-person option.
Person or non-person (NM102)*	Select one of the pre-loaded options in the list in the Setting column. This option is required. The First name and Last name/Organization name options are dependent on the selection made here.
Primary ID number: Use elec trans ID from payer master OR (below) *	Draws 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)*	Displays 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 or direct payer.
Reject claim if frequency is not '1' (Original), '6' (Corrected), '7' (Replacement) or '8' (Void)*	Rejects the 837 electronic file if the frequency is not a 1, 6, 7, or 8.
Contact Information (1000A Loop PER Segments)
Contact email (PER04/06/08)*	Displays the contact email in the Setting column.
Contact fax (PER04/06/08) (No Dashes)*	Displays the contact fax number, with no dashes, in the Setting column.
Contact name (PER02)*	Displays the contact name in the Setting column.
Contact phone (PER04/06/08) (No Dashes)*	Displays the contact phone number, with no dashes, in the Setting column.
Contact phone ext (PER06/08)*	Displays the contact phone extension in the Setting column.
Service Facility (2310D Loop Segments)
Suppress service facility loop for place(s) of service	Suppress the 2310D claim-level Service Facility loop if the place of service is home or office. Valid options include: <none> Home (12) only Office (11) only Home (12) or Office (11) Outpatient (22) only Home (12) or Office (11) or Outpatient (22) This option can be overridden by the Suppress Facility Loop (2310D) setting in the Electronic Claims sub-tab on the System tab of Payer master file.
Other Payer (2330B Loop Segments)
Default ID for Other Payers without eTrans IDs or NEIC numbers (NM109)*	Inserts the default NM109 value into the NM1 segment of the Other Payers for other payers that do not have eTrans IDs/NEIC numbers.

Common Options for the 4010 and 5010 Format

Recommendations

Common Options for the 5010 Format

Exception Options for the 4010 and 5010 Formats

Exception Options for the 5010 Format

Common Options for the 4010 and 5010 Format

Common Options for the 4010 Format

Common Options for the 4010 Format

Common Options for the 4010 and 5010 Format

Common Options for the 5010 Format

Exception Options for the 4010 and 5010 Formats

Exception Options for the 5010 Format

Common Options for the 4010 and 5010 Format

Common Options for the 4010 Format

Common Options for the 4010 Format