ANSI 837 4010 Professional Implementation Instructions

The associated implementation guide (AMM837P.xls) contains specification for ISA and GS segments only. Otherwise please use the standard transaction guidelines. Below are additional requirements related to payer specific instructions and segments specific requirements.

 

TESTING


When submitting your test file, please send a small batch between 50 to 100 claims. Contact Majken Flores at (562) 766-2000 Ext. 249 for additional information.


SEGMENT SPECIFIC REQUIRMENTS

 

  • NM1 Provider Information (loops 2010AA – Billing Provider, 2010 AB – PayTo Provider, 2310B – Rendering Provider) always use NPI to identify provider.

  • REF Provider Secondary Identificationsegments are required If “code XX - NPI” is used in the NM108/09 in loops (2010AA – Billing Provider,2010AB – PayTo Provider,2310B – Rendering Provider), then either the Employer’s Identification Number or the Social Security Number of the provider must be carried in the REF of that loop. The number sent is the one which is used on the 1099.

  • NM1 Payer Name Use the following payer identification rules for NM103 (payer name) NM109 (Payer Identifier). Use appropriate address for each payer to assure proper routing.

 

Payer Name

Address

Payer ID

Access Medial Group

5000 Airport Plaza Drive # 150 Long Beach, CA 90815

AMG

 

 

  • NTE Note/Special Instruction required for all ANESTHESIA PROCEDURES Start and Stop time is required if the value in Loop 2400, SV101-2 (procedure code) is in range 00001 to 09999 excluding codes that contain alpha characters (like 0016T). Time should be reported in the following format: NTE*ADD*STARTTIME 820 STOPTIME 1517

  • NDC Code Please use Loop 2410, Segment LIN, Data Element 03 to report National Drug Codes.