Quick Reference Guide - Working With The 837 Transaction
Workingwiththe837Transaction
837 Transactions and Code SetsElectronic Transactions not only make good business sense; they are also required by law.This Quick Reference Guide is part of a package of training materials to help you successfullymeet the requirements for HIPAA electronic 837 transactions and code sets. A companionQuick Reference Guide deals with the 835 transactions and code sets.OTHER ELECTRONIC TRANSACTIONS YOU MIGHT USE .1PREPARING TO TEST THE 837.2Process and Positions Affected by the 837 and 835 Electronic Transactions . 2Old and New Electronic Formats. 2RPMS Software Requirements: Patches available from OIT as of July 2005. 2Six Preparation Steps . 3Understanding Implementation Guide Terms. 4TESTING THE 837 .5Set Up RPMS: Input Provider Taxonomy Codes . 5Individual or Group Taxonomy Codes . 53 Levels. 5Use the following steps to add the provider taxonomy into VA Fileman/New Person File:. 6Non-Individual Taxonomies . 7Use the following steps to add the provider taxonomy into VA Fileman/Location File. 7Set Up RPMS: Set Up Location Files. 8Use the following steps to populate the facility street address in 3P Table Maintenance:. 9Set Up RPMS: Set Up Insurer File . 10Use the following steps to set up the insurer file in VA Fileman Add/Edit Insurer (EDIN) File: . 10Common Data Errors That Cause an 837 Claim to Be Rejected. 111. Special Characters or Punctuation in any field within the file. 112. Leading or Trailing Spaces . 113. Missing or Incomplete Names- Error Segments NM103, NM104, NM105. 124. Missing or Incomplete Dates- Error Segments DTP02 or HI101. 125. Missing Provider ID, UPIN, or License numbers- Error Segment . 136. Missing Provider Taxonomy . 147. Missing Patient Relationship Codes- Error Segments SBR02 or PAT01. 158. Missing Dates of Birth/Gender Codes- Error Segment . 159. Missing AO Control Number- Error Segment. 1610. Incorrect Claim Totals- Error Segment. 1611. Missing or Incorrect Diagnosis Codes- Error Segment . 16Ready to Begin Testing Claims?. 17Revised: August 2005Page i
837 Transactions and Code SetsTest Mode . 17Production Mode. 191. Change the “T” to “P” in the Insurer file. 192. Change mode of export for the Visit Type to default 837 HIPAA format from the Insurer Filewithin Table Maintenance. 20READING 837 ERROR REPORTS AND MAKING CORRECTIONS .21837 Data Layout Example . 21Billing Scenario . 21Scenario Presented in 837 Format . 22Line-by-Line Explanation of 837 Format . 22To convert an 837 file to line-by-line: . 25Match 837 and 997. 26Example of How to Find the Error . 26To identify the error in a 997 and to determine how to fix it: . 27Locate Claim Number; Correct Errors in RPMS; Recreate and Resubmit Batch(es) . 28INDEX .29Revised: August 2005Page ii
837 Transactions and Code SetsOther Electronic Transactions You Might UseHealthcare Claims Status / ResponseStandard Transaction Form: X12-276/277 Health Care Claim Status Request andResponseCoordination of BenefitsStandard Transaction Form: X12-837 Health Care ClaimReferral Certification and AuthorizationStandard Transaction Form: X12-278 Health Care Services Review - Request forReview and ResponseEnrollment and Disenrollment in a HealthPlanStandard Transaction Form: X12-834Premium PaymentsStandard Transaction Form: X12-820837 and 835 ReferencesTrailblazers Medicare Part A: 837 Testing andProductionProcedures (sent to all Area Offices)Trailblazers Medicare Part B: 837 Testing andProductionProcedures (sent to all Area Offices)HIPAA 835 Testing and Production Procedures (sent toall Area Offices)See also Electronic Transactions It’s Easier ThanYou Think newsletters and PowerPoint presentations ligibility for a Health Plan / ResponseStandard Transaction Form: X12-270/271Other TransactionsStandard Transaction Form: x12-275 –Claims Attachment – final rule has not beenpublishedRevised: August 2005Page 1
837 Transactions and Code SetsPreparing to Test the 837Process and Positions Affected by the 837 and 835 Electronic TransactionsOld and New Electronic of Benefits)835Used to submit claims tosecondary payers.replacesNSFformsRPMS Software Requirements: Patches available from OIT as of July 2005837-Third Party Billing and835-Accounts ReceivableGeneric Interface Software (GIS)837-Third Party BillingInstitutional, Professional and Dental ClaimRequests837-Third Party BillingProvider/Location Taxonomy837-Third Party Billing997 Functional Acknowledgement and CompReport835-Accounts ReceivableClaim Replay, (Remittance Advice)835-Accounts ReceivableStandard Adjustment/Reason CodesRevised: August 2005GIS v3.01, p2 & p5 (Optional)3rd Party Billing, v2.5, p7AUT Patch v98.1, Patch 16Manually Adding Provider Taxonomy provides instructions to addprovider and location taxonomy codes. As a backup, third party RPMSsoftware (3P) uses crosswalk to find taxonomy number.Macro has been developed to convert error report format into list ofsegment lines for easier interpretation.Accounts Receivable, v1.7, p5Accounts Receivable, v1.7, p5Page 2
837 Transactions and Code SetsSix Preparation StepsBefore beginning to test the electronic transactions process:1. Obtain (from OIT) and install the required software patches.a. GIS v3.01, p2 & p5 (Optional)b. 3rd Party Billing, v2.5, p7c. 3rd Party Billing, AUT Patch v98.1, Patch 162. Obtain 837 ASC X12N Implementation Guides and Addenda.a. Three Implementation Guides and their Addendai. 837: HIPAA Claim: Dentalii. 837: HIPAA Claim: Institutionaliii. 837: HIPAA Claim: Professionalb. Either download Guides/Addenda at http://www.wpc-edi.com/ and click on Products/Publications/ PDF Download (Free)c. Or order Guides/Addenda (book, CD, or combined Implementation Guide andAddendum) online or call 1-800-972-4334.Don’t Cut Corners!The Implementation Guides and Addenda arecritical tools. You need to have hard copies ofthem. Keep them where you use them. TheGuides are long (as much as 768 pages).Download the Guides and Addenda at a slowtime and print them double-sided.3.4.5.6.Establish contact with your payers.Get to know person you will be working with.IMPORTANT: Request payer’s Companion Guide and review it in depth. Ask OIT to review it.Complete and submit Trading Partner Agreement.RememberDon’t submit the Trading Partner Agreement until youare ready to begin testing. The insurer will stipulatethe effective date and you must begin testing withinsix months of that date.For more information, see Preparing to Test the 837 Newsletter and PowerPoint presentation evised: August 2005Page 3
837 Transactions and Code SetsUnderstanding Implementation Guide TermsImplementation Guide Terms1. Headera. Header: start segment fortransaction set2. Data Elementa. Smallest named item inASC X12 standardb. Corresponds to data fieldc. Mandatory or situational3. Data Segmenta. Related data elementsb. Sequence of data elementsspecified by ASC X12Nstandardc. Corresponds to record4. Control Segmenta. Same structure as segmentb. Usesi. To transfer controlinformation (e.g., start,stop) rather thanapplication informationii. To group data elements5. Delimitera. Character used to separatetwo data elements or toend a data segmentb. An integral part of data6. Loopa. Group of related segmentsb. Loops specified byImplementation Guide7. Transaction Set (whole thing)a. Contains data segmentsb. Corresponds to groupingof data recordsc. Sequence of data segmentsspecified by ASC X12Nstandard8. Trailera. Trailer: end segment fortransaction setRevised: August 2005Location in 837 Transaction SetISA*00**00* *ZZ*903314521 87*004010X096A1NM1*41*2*UNSPECIFIED SERVICE UNIT*****46PER*IC*BUSINEESS OFFICE*TENM1*40*28NM XNM1*85*2*UNSPECIFIED SERVICE UNIT*****24*903314521N3*123 ABC UE ADMINISTRATION*****24*850105601N3*PO BOX 10N3*100 VALLEY RDN4*ZIA*NM*33333DMG*D8*19880501*FNM1*PR*2*NM e 4
837 Transactions and Code SetsTesting the 837Set Up RPMS: Input Provider Taxonomy CodesMost current code list at http://www.wpc-edi.com/codes/taxonomy. Go to drop-down menu onright under Provider Taxonomy Codes. Read through the topics, in particular “How do I use theOn-Line list?”Individual or Group Taxonomy Codes3 Levels One-time procedure using VA Fileman/New Person file and User Management options inKernel Menu. Set up codes for all billable providers, including secondary providers (e.g., RN’s,Pharmacists). Start by inputting most common providers. System is case sensitive.TipProviders may have more than one Taxonomy code associated tothem. When determining what code or codes to associate with aprovider, review the requirements of the trading partner withwhich the code(s) are being used.Revised: August 2005Page 5
837 Transactions and Code SetsSet Up RPMS: Input Provider Taxonomy Codes, continuedUse the following steps to add the provider taxonomy into VA Fileman/New Person File:1. Access VA FileMan.2. Choose ENTER OR EDIT FILE ENTRIES and press return .3. The system will prompt for the following: “INPUT TO WHAT FILE:” Type NEWPERSON and press return .4. The system will prompt for “EDIT WHICH FIELD: ALL//”. Type PERSON CLASS andpress return .5. Thy system will prompt for “EDIT WHICH PERSON CLASS SUB-FIELD: ALL//”. Press return .6. The system will then prompt for “THEN EDIT FIELD:”. Press return at this prompt.Select VA FileMan Option: ENTER or Edit File EntriesINPUT TO WHAT FILE: NEW PERSON// NEW PERSON(646 entries)EDIT WHICH FIELD: ALL// PERSON CLASS(multiple)EDIT WHICH PERSON CLASS SUB-FIELD: ALL//THEN EDIT FIELD:7. The system will then prompt for the name of the provider. Enter the provider name using theformat of Last name, First name. Press return .Select NEW PERSON NAME: CURESME,THOMAS8. The system will then prompt for the user to enter the Person Class. The user will need toenter the appropriate taxonomy code for their provider.Select NEW PERSON NAME:KILDARE,RACHEL VSelect Person Class: emergency1EMERGENCY Emergency Medical Service ProvidersEmergency Medical Technician, Paramedic2EMERGENCY Emergency Medical Service ProvidersEmergency Medical Technician, Intermediate3EMERGENCY Emergency Medical Service ProvidersEmergency Medical Technician, Basic4EMERGENCY Nursing Service ProvidersRegistered NurseEmergency5EMERGENCY PhysiciansAllopathic/Osteopathic, Physiciani i9. The system will prompt for an effective date. Enter the date the provider’s credentialsbecame effective. Press return .Revised: August 2005Page 6
837 Transactions and Code Sets10. The system will prompt for an expiration date. Leave this field blank unless the credentialsexpired for that provider. Press return .11. Once the information has been entered, press return and the information will be stored.The user has the option to enter another provider taxonomy.Non-Individual Taxonomies One-time procedure using VA Fileman/ Location file.Enter location name and classification of facility.To determine facility classification, you may choose to use RPMS Provider TaxonomyCrosswalk. For standard I/T/U Location Taxonomy codes, scroll down to Non-Individual(Facility) Taxonomy Code A/documents/TAXONOMY crosswalk document.xlsSelect VA FileMan Option: ENTER or Edit File EntriesINPUT TO WHAT FILE:9999999.06LOCATION(3486 entries)EDIT WHICH FIELD: ALL// 1101 CLASS (multiple)EDIT WHICH CLASS SUB-FIELD: ALL// .07 CLASSTHEN EDIT CLASS SUB-FIELD:THEN EDIT FIELD:Select LOCATION NAME: INDIAN HEALTH HOSPITALALBUQUERQUE10NM IHS.OK? Yes// (Yes)Select BEGIN DATE: JAN 1,1960//CLASS: GENERAL ACUTE CARE HOSPITALHEADQUARTERS WEST202810Non-Individual Taxonomy CodeUse the following steps to add the provider taxonomy into VA Fileman/Location File.1. Access VA FileMan.2. Choose ENTER OR EDIT FILE ENTRIES and press return .3. The system will prompt for the following: “INPUT TO WHAT FILE:” Type LOCATIONand press return .4. The system will prompt for “EDIT WHICH FIELD: ALL//”. Type CLASS and press return .5. The system will prompt for “EDIT WHICH CLASS SUB-FIELD: ALL//”. Type CLASSand press return . This allows you to only edit the class field.6. The system will then prompt for “THEN EDIT CLASS SUB-FIELD:”. Just hit return atthis prompt.Revised: August 2005Page 7
837 Transactions and Code SetsSelect option: ENTER OR EDIT FILE ENTRIESINPUT TO WHAT FILE: LOCATION//EDIT WHICH FIELD: ALL// CLASS(multiple)EDIT WHICH CLASS SUB-FIELD: ALL// CLASSTHEN EDIT CLASS SUB-FIELD:THEN EDIT FIELD:ÅType 'CLASS' hereÅType 'CLASS' here7. The system will then prompt the user for “Select LOCATION NAME:”. Type theappropriate location name. If more than one location entry appears, the system will thendisplay all available locations from the Location File. Choose your location if a list appearsthen press return .8. The system will prompt “Select BEGIN DATE: date ”. A date should already beestablished. DO NOT MODIFY THIS ENTRY. Press return to go to the next prompt.9. The system will prompt for “CLASS”. You may use the Health Care Provider Taxonomymanual provided on the WPC website or type in double question marks (?) to get a listing ofthe location taxonomy codes. Type in the appropriate class code that best defines yourfacility. Once entered, press return .Select LOCATION NAME: MAJOR MED C808401.OK? Yes//(Yes)Select BEGIN DATE: JAN 1,1960//CLASS:AREANAMESERVICEUNIT 01NMPHSÅChoose your location here return ÅType in the classification of your facilitySet Up RPMS: Set Up Location Files Set up on one-time basis.Completed for each location to be billed. Gives the street address for the location.Revised: August 2005Page 8
837 Transactions and Code SetsUse the following steps to populate the facility street address in 3P Table Maintenance:1.2.3.4.Go to 3P Table Maintenance Site Parameters.Select TMTP.Select SITM.View Site Parameter field.5. View Facility to Receive Payments: Write down name. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THIRD PARTY BILLING SYSTEM - VER 2.5 Site Parameter Maintenance INDIAN HEALTH HOSPITAL - - - - - - - - - - - - - - - - - - - - - - - - - - - - - User: LUJAN,ADRIAN M9-NOV-2004 10:41 AMEMC File Preference.: HOST FILE//DEFAULT EMC PATH.: c:/rpms///Facility to Receive Payments.: ALBUQUERQUE ADMINISTRATION//6. Go to 3P Table Maintenance.7. Select LOTM (Location file menu).8. Select Edit Location File Maintenance.9. At the Select LOCATION to Edit, type in your facility location. Make sure that all addressfields are completed. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - THIRD PARTY BILLING SYSTEM - VER 2.6 Location File Maintenance UNSPECIFIED SERVICE UNIT - - - - - - - - - - - - - - - - - - - - - - - - - - - - - User: USER,DEMO18-FEB-2004 5:05 PMSelect LOCATION to Edit: UNSPECIFIED SERVICE UNITMAILING ADDRESS-STREET: 123 ABC ST//MAILING ADDRESS-CITY: OCEAN//MAILING ADDRESS-STATE: NEW MEXICO//MAILING ADDRESS-ZIP: 33333//PHONE:FEDERAL TAX NO.: 903314521//MEDICARE NO.: CAR000//STREET ADDR. 1: 123 ABC STSTREET ADDR. 2:CITY: OCEANSTATE: NEW MEXICOZIP: 33333}HEADQUARTERS WEST01NMInstitution File data: Enter Physical AddressPLACE OF SERVICE CODE: 22//BILL NUMBER SUFFIX: US//Revised: August 2005Page 9
837 Transactions and Code SetsSet Up RPMS: Set Up Insurer File Set up on one-time basis.Completed for each location to be billed. Gives the street address for the location.Use the following steps to set up the insurer file in VA Fileman Add/Edit Insurer (EDIN) File:Select DESIRED ACTION: Enter 1 to
Standard Transaction Form: X12-837 - Health Care Claim . Referral Certification and Authorization . Standard Transaction Form: X12-278 - Health Care Services Review - Request for Review and Response . Enrollment and Disenrollment in a Health Plan . Standard Transaction Form: X12-834 . Premium Payments . Standard Transaction Form: X12-820
OC How-To Quick Reference Guide. FEMA-NIMS@fema.dhs.gov . National Engagement for Draft Emergency Operations Center (EOC) How-To Quick Reference Guide . Attached for your review is a working draft of the National Incident Management System (NIMS) EOC How-To Quick Reference Guide. The purpose of this guide is to introduce the
QUICK REFERENCE CATALOG 2008 QR QUICK REFERENCE SERVICE PARTS CATALOG 14.95 USD. T A B L E O F C O N T E N T S QUICK REFERENCE CATALOG TABLE OF CONTENTS SECTION 01 - SWITCHES . Set/resume 01969997 Multi-function gauge 01656487 High idle. QUICK REFERENCE CATALOG Switches 1-1
LOGIQ e GE Healthcare. 2 LOGIQ e Quick Card The Quick Card is a quick reference to operation. Please refer to Basic User Manual for detailed information. Control Panel 1 15 14 6 7 13 12 5 11 4 10 3 9 2 8. LOGIQ e Quick Card 3 The Quick Card is a quick reference to operation. Please refer to Basic User Manual for detailed information.
LOGIQ e Quick Card 10 11 LOGIQ e Quick Card The Quick Card is a quick reference and not does not replace the User Manual. Please refer to the Basic User Manual for complete safety and operation information. The Quick Card is a quick reference and not does not replace the User Manual. Please refer to the Basic User Manual for complete safety
MVP Health Care Cigna Quick Reference Guide 3-12 Author: MVP Health Care Subject: MVP Health Care Cigna Quick Reference Guide 3-12 Keywords: MVP Health Care, Cigna, Quick Reference, Guide, Provider, 2012 Created Date: 11/30/2016 12:37:34 PM
1ST GRADE 2019 QUICK REFERENCE GUIDE 5 INTRODUCTION This Quick Reference Guide for The North Carolina Standard Course of Study is a resource for teachers as they plan instruction to implement the North Carolina Standard Course of Study across multiple content areas . There are nine Quick Reference Guides available – one for each of the grade levels from kindergarten through 8th grade .
6TH GRADE 2019 QUICK REFERENCE GUIDE 5 INTRODUCTION This Quick Reference Guide for The North Carolina Standard Course of Study is a resource for teachers as they plan instruction to implement the North Carolina Standard Course of Study across multiple content areas . There are nine Quick Reference Guides available – one for each of the grade levels from kindergarten through 8th grade .
4TH GRADE 2019 QUICK REFERENCE GUIDE 5 INTRODUCTION This Quick Reference Guide for The North Carolina Standard Course of Study is a resource for teachers as they plan instruction to implement the North Carolina Standard Course of Study across multiple content areas . There are nine Quick Reference Guides available – one for each of the grade leve
