ANSI 5010 is the newest standard adopted to transmit medical information securely and with as much detail as possible.

Reading this information was never truly meant for human eyes to process, but for quick information it is good to know the basics and you can generally pick out what you are looking for and what you are looking at.

Here is an example claim with two transactions (1 transaction containing an NDC) for one payer/carrier for one patient sent in ANSI 5010 837P format :

(Below the example I will break down what this information is and how it relates to the claim)

((Also note that this information is purely fictional and is pulled from Medisoft's Tutorial Data, any relationship or similarities to actual persons are completely coincidental and unintended))

ISA*00*          *00*          *ZZ*SENDERIDISA06*ZZ*RECEIVERIDISA08*120219*0910*|*00501*000000001*1*P*:

GS*HC*SENDERCODE*RECEIVERCODE*20120219*0910*1*X*005010X222A1

ST*837*0001*005010X222A1

BHT*0019*00*11AAAA*20120219*0910*CH

NM1*41*2*PRACTICE NAME*****46*SENDERID

PER*IC*FIRST LAST*TE*8003334747

NM1*40*2*CCB MEDICAID*****46*RECEIVERID

HL*1*1*20*1

NM1*85*2*HAPPY VALLEY MEDICAL CLINIC*****XX*1234567891

N3*5222 E. BASELINE RD.

N4*GILBERT*AZ*85234

REF*EI*123456789

NM1*87*2

N3*1944 N. KLUGE DR.*SUITE 8381

N4*GILBERT*AZ*85234

HL*1*1*22*1

SBR*P*18*25BB******CH

NM1*IL*1*YOUNGBLOOD*MICHAEL*C***MI*USAA236678

N3*73982 N. 28TH AVE.

N4*PHOENIX*AZ*85044

DMG*D8*19620705*M

NM1*PR*2*U.S. TRICARE*****PI

CLM*17*5007.5***11:B:1*Y*A*Y*Y**OA:EM

DTP*439*D8*20100101

HI*BK:8472*BF:73730*BF:3469

NM1*82*1*HINCKLE*WALLACE****XX*9876543210

PRV*PE*PXC*PROVITAXON

LX*1

SV1*HC:99000:::::HANDLING FEE*8*UN*1***1:2:3

DTP*472*D8*20120219

REF*6R*100

LX*1

SV1*HC:J0490:::::BENADRYL HCL, UP TO 50 MG.*4999.5*UN*1***1:2:3

DTP*472*D8*20120219

REF*6R*99

LIN**N4*12345678901

CTP****50*UN

SE*9999*0001

GE*9999*1

IEA*9999*000000001

FILE HEADER INFORMATION-
This information is normally defined at the clearing house or carrier direct where you are sending the claim file.  Checking for an EDI Companion guide would detail what information needs to be sent here; normally the entire file will be rejected if this information is incorrect.  (In Revenue Manager this information is defined under Configure->Receivers->Header Information &Transaction Set drop-downs)

 

Submitter Name & Contact Information

This information will be dependent on the clearing house or carrier direct's requirements; but will normally be the userID or Submitter Number, the contact information is required to be sent, but I have yet to meet someone that has been contacted via this information.  (In Revenue Manger this information is defined under Configure->Receivers->Header Information)

 

Receiver Name

This information will be the clearing house or carrier direct where you are sending the claim file.  This information will be in the EDI Companion guide normally. (In Revenue Manger this information is defined under Configure->Receivers->Header Information)

 

Billing Provider's Name & Contact Information

This information will be defined and pulled from Medisoft's Practice information if the rendering provider is set to file claim as group.  Otherwise the individual provider's information would replace the information seen here.  This would relate to the information in Box 33 on a HCFA Paper claim.

 

Billing Provider's Pay-To Address Information

This information will be defined and pulled from Medisoft's Practice Information's Pay-To tab.  Because of new requirements with ANSI 5010, a physical address must be sent for the Billing Provider in loop 2010AA and then an additional address can be added such as a PO Box or another separate payment address can in loop 2010AB, if you would prefer not to have payments sent to the Billing Provider's physical address.  Normally the payment address must be on file with both the carriers and the clearing house where you are sending the claim.

 

Patient and Contact Information

This information will be pulled from the patient's information in Medisoft.  This loop will repeat until all the patients and their claims and transactions have been processed.

 

Claim's Carrier/Payer

This will be the claim's current payer. (ex if the claim has Medicare as primary insurance and BCBS for secondary insurance; if this was the primary claim, this would show Medicare's information, otherwise for secondary claims this would show BCBS' information.)

 

Beginning of Claim

This is the beginning of the claim for this patient.  Claims will have a transaction limit of 6, so after 6 transactions have been processed a new claim loop of 2300 will repeat if there are more pending transactions for this patient.

 

Rendering Provider's Information

This information will be pulled from the Assigned Provider of the claim. (Note: this does not mean the transaction line's assigned provider necessarily; this will depend on how you "Create Claims" in Medisoft; Assigned Provider radio will pull from the Assigned Provider of that Case, where Attending Provider will group and create claims based on the Assigned Provider at the Transaction line.)  This loop will be omitted if the Billing Provider is the Rendering Provider (ex. Provider is filing claim as Individual).  (Note: This NPI would relate to box 24j on a Paper HCFA claim.)

 

First Transaction on Claim

This is the first transaction's information broken down.

 

Second Transaction on Claim

The transaction loop will repeat until all the transaction lines on the claim have been processed.

 

NDC Information for Second Transaction on Claim

Additional information, such as the NDC information, will sometimes be added between the transaction entries and will apply to the transaction directly above it.

 

File Footer Information

Once all the transactions, claims, and patients have been processed, this information will be added to signify the end of the claim file.