837 is the Standard format for transmitting health care
claims electronically. The 837P is the standard format used by
health care professionals to transmit health care claims electronically. Here P stands for Professional version of the 837 electronic
format.
Interchange: An Interchange is the lowest unit
of data exchanged between providers or their representatives and Health
Insurance payer organizations or their representatives. It consists of one or
more Functional Groups. It is like an envelope for the Functional Groups that starts with ISA segment know as Interchange
Control Header segment and ends with IEA
segment known as Interchange Control
Trailer segment.
Sample
ISA:
ISA*00* *00* *ZZ*99999999999 *ZZ*888888888888
*111219*1340*^*00501*000001377*0*T*:~
Sample IEA:
IEA*1*000001377~
ISA13(Interchange
Control Number) and IEA02(Interchange Control Number) must match.
Segment:
Each
line of EDI 837 is known as a segment. Segments consist of logically related
data elements in a defined sequence. A segment contains a segment identifier,
one or more data elements each preceded by an element separator, and a segment
terminator.
Data Element:
A
data element is equivalent to a field in a X12 format. Data elements have a
name, a data element number, a brief description, a data type, and a minimum
and maximum length. The elements in a segment may be assigned the following
attributes: Mandatory, Optional, or
Conditional.
Delimiter:
A
delimiter is a character used to separate two data elements or sub-elements.
Delimiters are specified in the interchange header segment called ISA. Usually
* (Asterisk) sign is used as the
Data element separator and :
(Colon) sign is used as the Sub-element separator.
Segment Terminator:
Segment
Terminator is a unique character appearing at the end of each segment to
indicate the end of the segment. A
segment terminator is specified in the interchange header segment. Usually ~
(Tilde) sign is used as the Segment Terminator
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