Envelope Structure of 837 Health Care Claim EDI Transaction
837 Health Care Claim transaction example below will be used to explain EDI enveloping. This particular EDI file contains two 837 claims transmitted on 01/01/2012.
837 Health Care Claim Envelope
ISA*00* *00* *12*8586755250 *01*807685339 *120101*0742*^*00501*000001899*0*P*:
GS*HC*8586755250*807685339*20120101*0742*685*X*005010X222A1
ST*837*3701*005010X222A1
BHT*0019*00*004545*20120101*135420*CH
NM1*41*2*AGILE BILLING SOLUTIONS*****46*1981
PER*IC*ANN GILLIS*TE*8185601000
NM1*40*2*ANTHEM BLUE CROSS*****46*47198
HL*1**20*1
PRV*BI*PXC*207Q00000X
NM1*85*1*WATSON*JOHN*H***XX*1134125736
N3* 15255 INNOVATION DR
N4*SAN DIEGO*CA*921283400
REF*EI*123456789
HL*2*1*22*0
SBR*P*18*******CI
NM1*IL*1*MOUSE*MICKEY****MI*123456789A
N4*ANAHEIM*CA*928021234
NM1*PR*2*ANTHEM BLUE CROSS*****PI*47198
N4*OXNARD*CA*930311234
CLM*ABC7001*145.5***11:B:1*Y*A*Y*Y
HI*BK:7215
LX*1
SV1*HC:98940*145.5*UN*1***1
DTP*472*D8*20120101
SE*23*3701
ST*837*3702*005010X222A1
BHT*0019*00*004545*20120101*135420*CH
NM1*41*2*AGILE BILLING SOLUTIONS*****46*1981
PER*IC*ANN GILLIS*TE*8185601000
NM1*40*2*ANTHEM BLUE CROSS*****46*47198
HL*1**20*1
NM1*85*1*CHECKOV*ANTON*P***XX*1134125737
N3* 15255 INNOVATION DR
N4*SAN DIEGO*CA*921283400
REF*EI*123456789
HL*2*1*22*0
SBR*P*18*******CI
NM1*IL*1*MOUSE*MICKEY****MI*123456789A
N4*ANAHEIM*CA*928021234
NM1*PR*2*ANTHEM BLUE CROSS*****PI*47198
N4*OXNARD*CA*930311234
CLM*ABC7002*827***22:B:1*Y*A*Y*Y
HI*BK:36616
LX*1
SV1*HC:00142:QK:QS:P1*827*MJ*61***1
DTP*472*D8*20050112
SE*22*3702
GE*2*685
IEA*1*000001899
The following example illustrates how you can have multiple group envelopes per ISA-IEA envelope. In this example there are three 837 Health Care Claim transactions in the first group and two 999 Implementation Acknowledgement transactions in the second group. Only a few example segments of the 837 Health Care Claim have been included for illustration purposes.
ISA*00* *00* *12*8586755250 *01*807685339 *120101*0742*^*00501*000001899*0*P*:
GS*HC*8586755250*807685339*20120101*0742*685*X*005010X222A1
ST*837*3701*005010X222A1
BHT*0019*00*004545*20120101*135420*CH
CLM*ABC7001*145.5***11:B:1*Y*A*Y*Y
SE*4*3701
ST*837*3702*005010X222A1
BHT*0019*00*004546*20120101*135420*CH
CLM*ABC7002*827***22:B:1*Y*A*Y*Y
SE*4*3702
GE*2*685
GS*FA*8586755250*807685339*20120101*0742*686*X*005010X231
ST*999*120108*005010X231
AK1*HP*2145001*005010X221A1
AK2*835*2341*005010X221A1
IK5*A
AK9*A*1*1*1
SE*6*120108
GE*1*686
IEA*2*000001899
Now you see why 837 Health Care Claim transactions are primarily handled by computers. Reading an 837 Health Care Claim EDI transaction begins by knowing that each line (properly referred to as a segment) starts with a code that tells you something about the information on that line, and each line has a matching pair item that marks the end of that level of information. A functional group header has a functional group trailer; an interchange control header has an interchange control trailer. On the image above, you will see what these letter codes mean and as we progress, you will learn more about each type of information. For now, just understand that each of these is a carefully agreed upon, completely standardized means of transmitting some portion of the information that is important to the particular transaction—in this case, 837 Health Care Claim transaction.
Within each segment, various kinds of information appear, each separated by an asterisk or other identifier. In discussing 837 Health Care ClaimEDI information, we refer to a particular line by its letter/number name and then to the specific position within that line. So, “ISA 1 through 4” is the ISA segment, element positions 1 through 4. Each position is a data element separated a delimiter (e.g. asterisk.).