Are you Billing Long Term care Submission on Texas Medicaid, Don't forget to add Budget Number values at 2300 Loop/NTE02 Segment of the 837 Professional, 837 Institutional, and 837 Dental Claims.
In the following example carriage return line feeds are inserted in place of ~ character for improved readability purposes.
ISA*00* *00* *ZZ*SenderID *01*ReceiverID *190831*1251*^*00501*269000000*1*P*:
GS*HC*SenderID*ReceiverID*20190831*1251*269*X*005010X222A1
ST*837*0001*005010X222A1
BHT*0019*00*0001*20190831*1251*CH
NM1*41*2*XXX XX XXXX*****46*SenderID
PER*IC*XXXX XXXX*TE*1111111111*FX*1111111111
NM1*40*2*ReceiverID*****46*ReceiverID
HL*1**20*1
PRV*BI*PXC*200000000X
NM1*85*2*ORGANIZATION NAME*****XX*1111111111
N3*100 MAIN STREET
N4*TOWN*TX*123456789
REF*EI*111111111
HL*2*1*22*0
SBR*P*18*******MC
NM1*IL*1*LASTNAME*FIRSTNAME*T***MI*111111111
N3*XXX XXXX ST.
N4*TOWN*TX*77520
DMG*D8*19720427*M
NM1*PR*2*Payer*****PI*ReceiverID
CLM*1424*772.88***12:B:1*Y*A*Y*Y
REF*9F*12429619
REF*G1*1234567890
NTE*ADD* 1
HI*ABK:I10
NM1*DN*1*XXXXXX*XXXX****XX*1111111111
LX*1
SV1*HC:S5125*772.88*UN*57.25*12**1
DTP*472*RD8*20190816-20190827
REF*6R*1159
SE*29*0001
GE*1*269
IEA*1*269000000