compantion_guide
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Table of Contents
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 | ||
| 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 | T = Test, 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*12001*X*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 | O | 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~
compantion_guide.1756907163.txt.gz · Last modified: by brad.sharp