ANSI 837 - Florida Blue - BCBSF

Florida Blue 837 P Companion Guide 2012Enveloping Information – 837 Professional Claim SubmissionIMPORTANT NOTE: If you submit your transactions through Availity, please refer to the Availity EDIguide at www.Availity.com. This section is specifically intended for trading partners who exchangetransactions directly with Florida Blue.Req #E1Loop ID - Segment Description &Element NameInterchange Control HeaderAuthorization Information QualifierTR3DataElementISA01TR3 Page(s)Appendix C(C.4)Plan RequirementFlorida Blue requires 00 in this field.E2Interchange Control HeaderAuthorization InformationISA02Appendix C(C.4)Florida Blue requires 10 spaces in this field.E3Interchange Control HeaderSecurity Information QualifierISA03Appendix C(C.4)Florida Blue requires 00 in this field.E4Interchange Control HeaderSecurity InformationISA04Appendix C(C.4)Florida Blue requires 10 spaces in this field.E5Interchange Control HeaderInterchange ID QualifierISA05Appendix C(C.4)Florida Blue requires 01 in this field.E6Interchange Control HeaderInterchange Sender IDISA06Appendix C(C.4)Florida Blue requires submission of yourindividually assigned Florida Blue sender mailboxnumber in this field.E7Interchange Control HeaderInterchange ID QualifierISA07Appendix C(C.5)Florida Blue requires ZZ in this field.E8Interchange Control HeaderInterchange Receiver IDISA08Appendix C(C.5)Florida Blue will only accept the submission ofFlorida Blue Tax ID number 592015694 in this field.E9Interchange Control HeaderAcknowledgement RequestedISA14Appendix C(C.6)The TA1 will not be provided without a code valueof 1 in the field.121 Availity, LLC Is a multi-payer joint venture company. For more information or to register, visit Availity’s website atwww.availity.com.900-3398-1112005010X222A1Florida Blue December 2012