|
ISA Field |
Description |
Value |
|
ISA01 |
Authorization Information Qualifier |
00 |
|
ISA02 |
Authorization Information (must be left blank) |
|
|
ISA03 |
Security Information Qualifier |
00 |
|
ISA04 |
Security Information (must be left blank) |
|
|
ISA05 |
Interchange ID Qualifier |
30 |
|
ISA06 |
Interchange Sender ID Enter Companys Federal Tax ID (9 digit number format XXXXXXXXX) |
|
|
ISA07 |
Interchange ID Qualifier |
30 |
|
ISA08 |
Interchange Receiver ID |
660537624 |
|
ISA09 |
Interchange Date (format YYMMDD) |
YYMMDD |
|
ISA10 |
Interchange Time (format HHMM) |
HHMM |
|
ISA11 |
Interchange Control Standards Identifier |
U |
|
ISA12 |
Interchange Control Version Number |
00401 |
|
ISA13 |
Interchange Control Number (9 digit number) |
|
|
ISA14 |
Acknowledgement Requested |
1 |
|
ISA15 |
Usage Indicator (P Prod, T Test) |
T |
|
ISA16 |
Component Element Separator : Composite Element Separator * Element Separator ~ Segment Terminator |
:*~ |
Note: ISA06 and ISA13 must be entered by the provider.
First Medical tax ID # 660537624