Example of a HIPAA EDI Transaction

Here’s a simplified example of an 837 Health Care Claim (Professional) transaction:

ISA*00*          *00*          *ZZ*SUBMITTER ID  *ZZ*RECEIVER ID   *20240814*1253*^*00501*000000001*0*P*:~
GS*HC*SUBMITTER ID*RECEIVER ID*20240814*1253*1*X*005010X222A1~
ST*837*0001*005010X222A1~
BHT*0019*00*0123*20240814*1253*CH~
NM1*41*2*SUBMITTER NAME*****46*SUBMITTER ID~
NM1*40*2*RECEIVER NAME*****46*RECEIVER ID~
HL*1**20*1~
NM1*85*2*PROVIDER NAME*****XX*1234567890~
N3*PROVIDER ADDRESS~
N4*CITY*STATE*ZIP~
HL*2*1*22*0~
NM1*IL*1*PATIENT LAST NAME*PATIENT FIRST NAME****MI*MEMBER ID~
N3*PATIENT ADDRESS~
N4*CITY*STATE*ZIP~
CLM*CLAIM ID*100***11:B:1*Y*A*Y*Y~
REF*D9*AUTHORIZATION ID~
HI*BK:Z1234*ABK:G5678~
LX*1~
SV1*HC:99213*100*UN*1***1~
SE*23*0001~
GE*1*1~
IEA*1*000000001~

• ISA/IEA Segments: The Interchange Control Header and Trailer, which envelop the entire transaction.
• GS/GE Segments: The Functional Group Header and Trailer, which group related transactions.
• ST/SE Segments: The Transaction Set Header and Trailer, which define the boundaries of a single transaction.
• NM1 Segments: Contain information about the entities involved in the transaction, such as the provider, patient, and insurer.
• CLM Segment: Contains claim information, including claim ID, amount, and service details.
• SV1 Segment: Contains information about the service provided, including the procedure code and charge amount.