california division of workers compensation medical data training
Download
Skip this Video
Download Presentation
CALIFORNIA DIVISION OF WORKERS’ COMPENSATION MEDICAL DATA TRAINING

Loading in 2 Seconds...

play fullscreen
1 / 8

CALIFORNIA DIVISION OF WORKERS COMPENSATION MEDICAL DATA TRAINING - PowerPoint PPT Presentation


  • 114 Views
  • Uploaded on

CALIFORNIA DIVISION OF WORKERS’ COMPENSATION MEDICAL DATA TRAINING. WCIS Medical Data Collection. Workers’ Compensation Information System. WCIS . Division of Workers’ Compensation. www.dir.ca.gov. Workers’ Compensation Information System (WCIS) California EDI Implementation Guide for

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'CALIFORNIA DIVISION OF WORKERS COMPENSATION MEDICAL DATA TRAINING' - rane


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide2

Workers’ Compensation Information System

WCIS

Division of Workers’ Compensation

slide3

www.dir.ca.gov

Workers’ Compensation Information System (WCIS)

California EDI Implementation Guide

for

Medical Bill Payment Records

Version 1.0

December 2005

california implementation guide table of contents
California Implementation GuideTable of Contents
  • EDI service providers
  • Events that trigger required medical EDI reports
  • Required medical data elements
  • Data edits
  • System specifications
  • IAIABC information
  • Code lists and state license numbers
  • Medical EDI glossary and acronyms
  • Standard medical forms

Page 3

slide6

Step 1 Mandatory Segments (BSRC = 00)

BHT*0080*00*0123*19960618*0932~

NM1*10*2******FI*123456789~

N4***751230064~

NM1*40*2******FI*987654321~

N4***751230064~

DTP*582*RD8*19970201-19970228~

NM1*CA*2*PREMIEREINSURANCE COMPANY OF NORTH*****FI*111223333~

H

DTP*558*D8*19920101~

NM1*CC*1*DOE*SALLY*J***34*012345678~

REF*Y1*528779999~

CLM*A37YH556*500**MO*11:B*Y**********P***00~

DTP*050*D8*19970115~

DTP*666*D8*19970115~

REF*DD*13579~

REF*2I*TJ98UU321~

NM1*82*1*WELBY*MARCUS*C**SR*FI*123456789~

PRV*PE*S3*203BP0400Y~

N4***751230064~

REF*OB*PSY00001574~

LX*1~

slide7

Step 2 Hierarchical Segments (BSRC = 00)

BHT*0080*00*0123*19960618*0932~

NM1*10*2******FI*123456789~

N4***751230064~

NM1*40*2******FI*987654321~

N4***751230064~

HL*1**20*1~

DTP*582*RD8*19970201-19970228~

NM1*CA*2*PREMIEREINSURANCE COMPANY OF NORTH*****FI*111223333~

HL*2*1*EM*1~

MN1*36*2~

HL*3*2*CL~

DTP*558*D8*19920101~

NM1*CC*1*DOE*SALLY*J***34*012345678~

REF*Y1*528779999~

CLM*A37YH556*500**MO*11:B*Y**********P***00~

DTP*050*D8*19970115~

DTP*666*D8*19970115~

REF*DD*13579~

REF*2I*TJ98UU321~

NM1*82*1*WELBY*MARCUS*C**SR*FI*123456789~

PRV*PE*S3*203BP0400Y~

N4***751230064~

REF*OB*PSY00001574~

LX*1~

step 3 continued conditional data elements segments bsrc 00
Step 3 (continued)Conditional Data Elements/Segments (BSRC = 00)
  • Professional 837 Office visit with drugs dispensed
  • Institutional 837 Hospital/Surgical Scenario
  • Other Bill Types
    • Pharmaceutical utilizing a Professional 837
    • Pharmaceutical utilizing a NCPDP
    • Durable Medical Equipment
    • Dental utilizing a Professional 837
  • Various Generic Bill Adjustment Scenarios
    • Capitated treatment
    • Previous Provider Over payment
    • Provider Refund
ad