Billing File Generator

Company Name:	Loop 1000A, 2010AA
Company Type:	Home Care Agency Day Care Facility
Address 1:	Loop 2010AA
Address 2:	Loop 2010AA
City:	Loop 2010AA
State:	Loop 2010AA
Zip:	Loop 2010AA
Submitter Id:	Loop 1000A
Employer Id:	Loop 2010AA
NPI:	Loop 2010AA
Provider Taxonomy Code:	Loop 2000A
Contact Name:	Loop 1000A
Phone Number:	Loop 1000A

These values will change depending on a clearing house you are using. Follow the implementation guide provided by your clearing house.

Clearing House Receiver Name:	Loop 1000B
Clearing House Receiver Number:	Loop 1000B
ISA1:	Default value is "00"
ISA2:	Blank by default
ISA7:	Default value is "ZZ"

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