HIPAA: ANSI 4010 Supplemental Guide

ANSI 4010 SUPPLEMENTAL GUIDE

FOR THE- INBOUND 837

Please Note: This supplemental guide to the ANSI ASC X12N 837 4010 Implementation is being provided to offer additional information to the provider community. As additional areas of concern are identified, this supplemental guide will be expanded.

HIPAA Support: To obtain help with HIPAA, assistance will be provided by calling 1-412-544-3593 or e-mail the HIPAA coordinator at: hipaa.coordinator@veritusmedicare.com.

Interchange Control Header for the 837: The following guidance is offered for the completion of the ISA Fields.

ANSI field	Field Description	Highmark Medicare Services Required Entry
ISA01	Author Info Qualifier	Enter 00 (zero zero)
ISA02	Author Information	Enter Spaces
ISA03	Security Info Qual	Enter 00 (zero zero)
ISA04	Security Information	Enter Spaces
ISA05	Interchange ID Qual	Enter ZZ
ISA06	Interchange Sender ID	Enter the ID number given to you by Highmark Medicare Services. If you are a new submitter, contact us by e-mail.
ISA07	Interchange ID Qual	Enter ZZ
ISA08	Interchange Receiver ID	Enter 00363 (Left Justified)
ISA09	Interchange Date	Enter the send date at YYMMDD (Year Month Date)
ISA10	Interchange Time	Enter as HHMM format (Hours Minutes)
ISA11	Inter Ctrl Stand Ident	Enter U
ISA12	Inter Ctrl Version Number	Enter 00401
ISA13	Inter Ctrl Number	Do Not enter spaces
ISA14	Ack Requested	Enter 0 (zero)
ISA15	Usage Indicator	T=Test; P= Production
ISA16	Component Element Separator	Enter a Colon

The segment terminator is tilde ~

NOTE: All fields should be left justified

The following guidance is offered for the completion of the GS Segments:

ANSI field	Field Description	Highmark Medicare Services Required Entry
GS01	Functional ID Code	Enter HC
GS02	Applications Send's Code	E-mail the HIPAA Coordinator for this data element
GS03	Applications Rec's Code	Enter 00363
GS04	Date	Enter in CCYYMMDD format per the IG
GS05	Time	Highmark Medicare Services will accept HHMM as a minimum
GS06	Group Control Number	Assigned by provider
GS07	Responsible Agency Code	Enter X
GS08	Ver/Release ID Code	Enter 004010X096

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