Dummy’s Guide to the ANSI 837. And Now That I’ve Seen The IG. By: Cynthia Korman. 09/25/2003. Professional Claims - The 837P. For use by: Physicians (Hospital and Office-based services) Behavioral Health clinicians Ambulance Claims Some Home Health And more...
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And Now That I’ve Seen The IG...
By: Cynthia Korman
For use by:
If you’d file a paper HCFA 1500 or electronic NSF file, chances are you’ll file an 837P, not an 837I. Payer Companion Documents should tell you if that’s not true
For use by:
If you’d file a paper UB92 or earlier version of the 837I, chances are you’ll file an 837I, not an 837P. Payer Companion Documents should tell you if that’s not true
A “claim” is something that relates to one patient. It’s not a file of episodes of care for multiple patients: that would be a claim file
If you are or will be responsible for reading X12 files, for debugging purposes or denials management purposes or for any other purposes, you must understand how HLs work.
HL Segments are what properly connect groups of information in X12 files.
HL * 4 * 3 * 23 * 0
Code telling HL Type
Child HL? 1=Yes 0=No
Pointer to Parent HL
The bill from a Pediatrician’s Office or a hospital’s mater- nity floor can easily look like this when it gets to X12 format...
Tracks a claim from creation through payment - new for many provider information systems, look for itSome call itPatient Account Number, but be careful with that.
Maximum length 20 characters
IG Data Element Descriptions, and IG Appendix C tell you the code sets, or where to find them. Some externals available at www.wpc-edi.com (free)
. . . AND
the Date of Death is available to the Provider Billing System
Claim Data Requirements from the English Perspective
We’re all in Glass Houses
Don’t lose sight of the forest because of the trees
Don’t forget that we all need administrative simplification in healthcare - this is how we’ll get there
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