837 Health Care Claim: Institutional - Louisiana Medicaid

06/30/2014 Health Care Claim: Institutional - 837ISAInterchange Control HeaderPos: Max: 1Not Defined - MandatoryLoop: N/A Elements: 16User Option (Usage): RequiredElement Summary:RefISA01IdI01Element NameAuthorization Information QualifierLA Medicaid: Use 00 for this elementISA02 I02 Authorization InformationLA Medicaid: Must be spacesISA03 I03 Security Information QualifierLA Medicaid: Use 00 for this elementISA04 I04 Security InformationLA Medicaid: Must be spacesISA05 I05 Interchange ID QualifierLA Medicaid: Use the value ZZ for this element.ReqMTypeIDMin/Max2/2M AN 10/10M ID 2/2M AN 10/10M ID 2/2ISA06 I06 Interchange Sender ID M AN 15/15LA Medicaid: Use the 7 digit Molina assigned submitter ID (i.e.450XXXX) followed by spacesISA07 I05 Interchange ID Qualifier M ID 2/2ISA08I07LA Medicaid: Use the value ZZ for this element.Interchange Receiver ID M AN 15/15LA Medicaid: Use the value LA-DHH-MEDICAID for thiselementISA09 I08 Interchange DateLA Medicaid: The date format is YYMMDDM DT 6/6ISA10 I09 Interchange TimeM TM 4/4LA Medicaid: The time format is HHMMISA11 I10 Repetition SeparatorM 1/1LA Medicaid: Use the value ^ for this element – ASCII x5EISA12 I11 Interchange Control Version NumberM ID 5/5LA Medicaid: Use the value 00501 for this elementISA13 I12 Interchange Control NumberM N0 9/9LA Medicaid: Must be a positive unsigned number and identicalto the interchange trailer IEA02. Must be unique for everytransmission submitted.ISA14 I13 Acknowledgment RequestedM ID 1/1LA Medicaid: Use the value 0 or 1 for this elementISA15 I14 Usage IndicatorM ID 1/1LA Medicaid: T= Test DataP=Production DataISA16 I15 Component Element Separator M 1/1LA Medicaid: Must be a colon : -ASCII x3A2