ClaimRev Support Documentation

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====== 837 Companion Guide – Header and Submitter Information ======

The following sections explain how to populate the ISA, GS, and 1000A loops when sending 837 files to **ClaimRev**.

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===== ISA Segment (Interchange Control Header) =====

The ISA segment is the fixed-length envelope header that begins every 837 EDI transaction.

^ Element  ^ Name  ^ Req  ^ Length  ^ What to Use  |
| ISA01 | Authorization Info Qualifier | R | 2 | 00 (No authorization info) |
| ISA02 | Authorization Info | R | 10 | 0000000000 |
| ISA03 | Security Info Qualifier | R | 2 | 00 (No security info) |
| ISA04 | Security Info | R | 10 | 0000000000 |
| ISA05 | Interchange ID Qualifier (Sender) | R | 2 | ZZ |
| ISA06 | Interchange Sender ID | R | 15 | Account Number (space-filled) |
| ISA07 | Interchange ID Qualifier (Receiver) | R | 2 | ZZ |
| ISA08 | Interchange Receiver ID | R | 15 | CLAIMREV |
| ISA09 | Interchange Date | R | 6 | YYMMDD |
| ISA10 | Interchange Time | R | 4 | HHMM (24-hour) |
| ISA11 | Repetition Separator | R | 1 | <nowiki>^</nowiki> |
| ISA12 | Interchange Control Version | R | 5 | 00501 |
| ISA13 | Interchange Control Number | R | 9 | Unique, matches IEA02 |
| ISA14 | Acknowledgment Requested | R | 1 | 0 or 1 |
| ISA15 | Usage Indicator | R | 1 | P = Production |
| ISA16 | Component Element Separator | R | 1 | : |

**Example ISA (Production):**
ISA*00*00*ZZ*SUBMITTERID*ZZ*CLAIMREV*2509031200*^00501*00000000*10*P*:~


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===== GS Segment (Functional Group Header) =====

^ Element  ^ Name  ^ Req  ^ Length  ^ What to Use  |
| GS01 | Functional ID Code | R | 2 | HC |
| GS02 | Application Sender’s Code | R | 2–15 | Same as ISA06 |
| GS03 | Application Receiver’s Code | R | 2–15 | CLAIMREV |
| GS04 | Date | R | 8 | CCYYMMDD |
| GS05 | Time | R | 4–8 | HHMM or HHMMSS |
| GS06 | Group Control Number | R | 1–9 | Unique, matches GE02 |
| GS07 | Responsible Agency Code | R | 2 | X |
| GS08 | Version/Release/Industry Identifier | R | 1–12 | 005010X222A1 |

**Example GS (Production):**
GS*HC*SUBMITTERID*CLAIMREV*20250903*1200*1*X*005010X222A1~

==== 837 Transaction Versions ====

The version identifier in the GS segment (GS08) and the ST segment (ST03) determines the type of 837 claim being sent.  

^ Claim Type  ^ Common Name  ^ GS08 / ST03 Version  ^ Notes  |
| 837P | Professional | 005010X222A1 | Used for physician, outpatient, and supplier claims. |
| 837I | Institutional | 005010X223A2 | Used for hospital, facility, and institutional claims. |
| 837D | Dental | 005010X224A2 | Used for dental service claims. |

**Guidance:**  
- Choose the correct version based on the type of claim you are submitting.  
- The rest of the GS and ST segments follow the same pattern, only the version code changes.  
- ClaimRev accepts all three transaction types.  

**Example (Professional Claim):**
GS*HC*SUBMITTERID*CLAIMREV*20250903*12001*X*005010X222A1~
ST*837*0001*005010X222A1~
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===== Loop 1000A – Submitter Name =====

This loop identifies the entity (provider or billing service) submitting the claim.

==== NM1 – Submitter Name ====
^ Element  ^ Name  ^ Req  ^ What to Use  |
| NM101 | Entity Identifier Code | R | 41 (Submitter) |
| NM102 | Entity Type Qualifier | R | 2 (Non-Person Entity) |
| NM103 | Submitter Name | R | Submitter’s organization name |
| NM104–NM105 | Not Used | – | Leave blank |
| NM108 | Identification Code Qualifier | R | 46 |
| NM109 | Identification Code | R | Submitter ID (same as ISA06/GS02) |

**Example NM1:**
NM1*41*2*YOUR CLINIC*****46*SUBMITTERID~


==== PER – Submitter EDI Contact Information ====

**This segment is REQUIRED.** Providers must include at least one valid contact method.

^ Element  ^ Name  ^ Req  ^ What to Use  |
| PER01 | Contact Function Code | R | IC (Information Contact) |
| PER02 | Name | R | Contact Person’s Name |
| PER03 | Communication Number Qualifier | R | TE (Telephone) |
| PER04 | Communication Number | R | Phone number |
| PER05 | Communication Number Qualifier | O | EM (Email) |
| PER06 | Communication Number | O | Email address |

**Example PER:**
PER*IC*John Smith*TE*5551234567*EM*jsmith@yourclinic.com~