The X12 837 EDI file format allows for much more information than fits on a paper form. The creators of the 837 standard included many health care business scenarios besides only a professional or institutional environment. The 837 has segments for ambulance billing, Chiropractic care, home oxygen therapy, home health care, repricing information and a variety more. In addition the 837 has a much finer resolution to express complicated COB situations with several payers. The information in those segments is usually not displayed on the standard paper forms. For this reason the HIPAA Claim Master comes with additional pages that aim to display every possible piece of information that an 837 can contain.

 

The HIPAA Claim Master checks each claim for the existence of those special segments. You will see additional buttons in the claim view window to alert you of their existence. By clicking on "Addl" or "COB" the screens to display this information will show. Page through buttons will also show, if this information does not fit on one page.

The 837 P and 837 I can contain different pieces of additional information which is expressed through the following segments. The HIPAAsuite parsing engine catches and stores each bit of information.

837 P

The 837 P can contain...

On the claim level:

On the line level:

 

 

837 I

The 837 I can contain...

On the claim level:

On the line level:

 

837 D

The 837 D can contain...

On the claim level:

On the line level:

 

837 R

The 837 R can contain...

On the claim level:

On the line level:

To configure the additional information pages options, select Setup  Additional Info Pages in the main menu.

The "Configuring Additional Info Pages" menu

The following screen will appear.

The "Additional Information Page Configuration" window

 

You can configure the following options:

Once you have finished editing the options, click "Save."

 

Below you can see screen-shots of the tabs.

The "Institutional Claim" tab

 

The "Dental Claim" tab

 

The "Reporting Claim" tab

The HIPAA Claim Master checks for additional information every time a claim is displayed or printed. Should the claim contain one of the above mentioned segments, you will see the button "Addl Info" enabled.

 

The "Addl Info" button enabled

The arrow buttons indicate that several pages of claim information are available.

Click on the "Addl Info" button to show the additional information as shown on the following screen-shot.

Additional Claim information

The HIPAA Claim Master displays every element of a specific segment. Sometimes only the HIPAA codes are displayed, often they are translated into their descriptions. If you need to find out about these codes, please consult the 837 implementation guide.

COB information can be very complex within the 837:

...can be tracked in the nested structure of an 837. To display such a nested structure is a daunting task, as you can imagine. I still recommend that you fully understand the nesting of COB data.

On the Claim level, we find additional payers in the 2320 loops. Within the 837 EDI file, adjudication information is stored in either CAS segments or the Medicare, MIA (inpatient) and MOA (outpatient) segments. Specific amounts are similarly stored in the AMT segments. On the line level, each line can contain up to 25 different adjudication actions; SVD segments, which identify the payer and their amounts. Adjudication information is then written in multiple CAS segments and optionally, in the DTP segment, the adjudication date.

If the HIPAA Claim Master finds that a claim lists several payers, the claim preview screen will display the "COB" button.

The "COB Info" button

Click this button, and the following display appears:

Information about additional payers

Each payer is in one block. Any claim level adjudication will be displayed, listing adjustment group and adjustment reason.

Line level information is displayed on the following pages.

COB information on the line level

Notice the nested structure of the display. For each line, we see a recap of the line information, followed by payer information and possibly several lines of adjudication information.

The EDI envelope contains information about the transaction set, the sender, the receiver, dates and other pieces that are not printed on medical forms.

Follow the instructions below to print a blank form.

Select the "Forms" menu.

The "Form" menu and its sub-menus

Select one of the following claim forms that the HIPAA Claim Master can display:

Clicking on this menu displays a blank form depending on the choice of claim type. This form can be sent to the Printer by clicking on the "Print" button.

Display of a blank ADA 2000 form