How to Submit Ambulance Claims in Non-ANSI Formats (CSV, Print Image or Tab Delimited)

If you're submitting ambulance claims and your software does not support the ANSI 837 file format, follow the steps below to correctly enter Pick-Up and Drop-Off location information.

Please note: If you are using Office Ally’s Online Entry or Practice Mate system to submit ambulance claims, you should enter location data directly into the designated Ambulance fields, do not use the steps below, they are only meant for non-837 claim files uploaded from other systems.

Steps to Submit Ambulance Claims Using Non-837 Upload:

1. Input the Ambulance Pick-up Location in Box 32 of the claim.
   
   • This information will be transmitted to the payer in Loop 2310E of the ANSI 5010 format.
2. Input the Ambulance Drop-off Location in Box 19 or in any Line Note field using the exact format below to be recognized and placed into Loop 2310F by the system.
   
   • AMBD;NAME;ADDRESS1;ADDRESS2;CITY;STATE;ZIP
   • All fields must be separated by a semicolon (;). If you do not have information for a field, still include the semicolon to maintain the correct structure.
   • Field Definitions:
     
     • AMBD – Required. Identifies following information as Ambulance Drop-off Location data.
     • NAME – Optional. Name of the drop-off location.
     • ADDRESS1 – Required. Street address of the drop-off location.
     • ADDRESS2 – Optional. Additional address info such as Suite or Apt #.
     • CITY – Required. Drop-off City.
     • STATE – Required. Drop-off State Code.
     • ZIP – Required. Drop-off zip code.
3. Upload claim file to Service Center or via SFTP for processing.

Examples of Correct Drop-Off Location Format:

1. All fields included:
   
   • AMBD;VANCOUVER GENERAL HOSPITAL;12345 TEST STREET;SUITE2;VANCOUVER;WA;99999
2. No Facility Name or Address 2 (e.g., Drop-off is patient’s home)
   
   • AMBD;;321 HOME STREET;;VANCOUVER;WA;99999