====== 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**. --- ===== 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 | ^ | | 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*:~ --- ===== 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~ --- ===== 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~