[The Toninator]

Hippa, anybody familiar with 837 professional?

 

[SkaredShtles]

I guess I'm not.

-S.S.-

 

[berkshire_rider]

Hippa, anybody familiar with 837 professional?

Yes. I look at X12 files every day.

 

[The Toninator]

Yes. I look at X12 files every day.

WOOHOO

So i'm trying to figure out if i can tell a submitter to send COB information in their submittions. i'm not looking to get all formal with the data i just need it.
so i need 3 peices of informtion adjust code, copay and paid date.

is there going to be 2 cas segements under the svd per lx? 1 for the pt co and then another for the adj code?
ie
lx
sv1
dtp
ref
svd
cas*ptcopay
CAS*adj code
dtp?

OR do i have to create 2 seperate SVD segements and reference the ref under the lx in some way?

 

[SkaredShtles]

WOOHOO

So i'm trying to figure out if i can tell a submitter to send COB information in their submittions. i'm not looking to get all formal with the data i just need it.
so i need 3 peices of informtion adjust code, copay and paid date.

is there going to be 2 cas segements under the svd per lx? 1 for the pt co and then another for the adj code?
ie
lx
sv1
dtp
ref
svd
cas*ptcopay
CAS*adj code
dtp?

OR do i have to create 2 seperate SVD segements and reference the ref under the lx in some way?

I can't tell you how glad I am that I don't have ^^ that job. Whoa.

-S.S.-

 

[The Toninator]

I can't tell you how glad I am that I don't have ^^ that job. Whoa.

-S.S.-

i guess he is too

 

[SkaredShtles]

i guess he is too

You scared him right off!

-S.S.-

 

[berkshire_rider]

i guess he is too

It takes a little more than that to scare me off. I have a new job now where I have to be fairly productive. I can't stay logged into RM all day, like my last IT job. I can only surf for an hour at lunch, unless it's business related. Otherwise, no posting until I get home after work. Bastards. :eviltongu

I'll try to help out, but we don't currently take COB claims electronically. (A future headache ) I'm guessing you will need a 2nd segment. On page 558 of the prof. IG, it looks like you can use Loop 2430 to reflect the co-pay: CAS*OA*copay code*copay amount~

Let me know how this turns out.

 

[The Toninator]

It takes a little more than that to scare me off. I have a new job now where I have to be fairly productive. I can't stay logged into RM all day, like my last IT job. I can only surf for an hour at lunch, unless it's business related. Otherwise, no posting until I get home after work. Bastards. :eviltongu

I'll try to help out, but we don't currently take COB claims electronically. (A future headache ) I'm guessing you will need a 2nd segment. On page 558 of the prof. IG, it looks like you can use Loop 2430 to reflect the co-pay: CAS*OA*copay code*copay amount~

Let me know how this turns out.

cas*PR*3*15~ pr=patient responsibility 3=copay adj code 15=$

copy's the easy part but i also need the Adjust code for the service line item. i have a call in to someone in the know. we'll see. i dummied both cas in there and to me it looks good, i think i'm right
are you a payor, provider or vendor?

 

[berkshire_rider]

Payor. I'm an EDI coordinator at an HMO.

Do you have a test enviornment you can run files through and see if the claim(s) will ajudicate?

 

[Barbaton]

i knew every field had it's own language but jaysus. no wonder every doctor i know has been discouraging about becoming a doctor.

 

[S.n.a.k.e.]

Krikey!!

I do retail EDI, 4010-VICS, and I have seen the spec documents, now I know who uses all that crap that I never do.....

HIPPA is a fun 'standard' to try to adhere. Due diligence is teh shiznitz....


Looks like fun..

Marc

 

[The Toninator]

Payor. I'm an EDI coordinator at an HMO.

Do you have a test enviornment you can run files through and see if the claim(s) will ajudicate?

Right on i think i'm the same my title kind of changes from time to time.
And ooo i could ask a bunch of questions...

Anyhoo to answer your question 'Yes and No.'

No. In my current production environment I cannot handle the extra fields because our conversion software is not formatted to capture that data. I have to send a request to our Software vendor to capture the fields, takes forever, and then even though I have the data I’m not sure our current claims processing software could handle the data.

Yes. My test environment does actually capture (some) of the data and pass into our databases BUT the software I’m testing for the data conversion also does not capture these fields and pass it to the CPS. But I’m trying to make sure that I have the correct description of the fields and there usage correct. I’ve dummied up a small file and sent it to the provider we’re expecting this data from for them to verify.

The claims will adjudicate either way because we’re also getting the claims encounter data from them in the 2400 loop. We have a weird partnership where their actually paying the claims and we’re administrating their something or other, and just need this data for accounting purposes.

 

[berkshire_rider]

I can't believe this thread has over 200 views. People are probably reading the title and saying wtf is 4010x098? Is that a Specialized FSR patent?

 

[The Toninator]

bumpers. i had one field incorrect becuase i was using an older draft. But fyi you put ALL of your CAS segs (upto 99) under a single SVD under that lx.

LX*1~
SV1*HC:99213*125*UN*1***1~
DTP*472*RD8*20041229-20041229~
SVD*(nm109)*0*HC:99213**1~
CAS*CO*24*110~
CAS*PR*3*15~
DTP*573*D8*20041230~
LX*2~
SV1*HC:99000*8*UN*1***1~
DTP*472*RD8*20041229-20041229~
SVD*(nm109)*0*HC:99000*1~
CAS*CO**8~
DTP*573*D8*20041230~

 

[berkshire_rider]

bumpers. i had one field incorrect becuase i was using an older draft. But fyi you put ALL of your CAS segs (upto 99) under a single SVD under that lx.

Makes sense. Thanks for following up.