Claim Sample Data in HIPAA Format
Note: Your claim file must follow this layout to be successfully recognized by our system. Please note the "A1" segment of the top most rectangle and the "A2" segment of the second red rectangle from the top. The "A1" is the request sent to the payer and the "A2" is the response you get from the payer. The "A1" and "A2" compose of one successful transaction from the Pharmacy POS to the Payer's Adjudication and back. Each transaction must be separated by a "BLANK LINE" as seen on the sample data.