Thursday, 13 September 2012

EDI 5010 Documentation 837 Professional - Loop 2000C Patient Hierarchical Level

LOOP 2000C Patient Hierarchical Level and  and LOOP 2010CA – Patient Name
 
        

Important Note:
This loop required only when the patient is a different person than the subscriber.
 
In this loop, all the information will be taken from Patient demographics.
Take a look of our sample screen here how Patient demographics information are stored in the system.
Now let’s start the detail implementation.

 
Loop Seg ID Segment Name Format Length Ref# Req Value
2000C HL Patient Hierarchical Level ID 2 R HL
Element Separator AN 1 *
HL01 Hierarchical ID Number AN 1/12 828 R Unique alphanumeric number for each occurrence of the HL segment in the transaction set.
HL01 could be used to
indicate the number of occurrences of the HL segment, in which case the value of
HL01 would be “1" for the initial HL segment and would be incremented by one in
each subsequent HL segment within the transaction

Element Separator AN 1 *
HL02 Hierarchical Parent ID Number AN 1/12 734 R HL02 identifies the hierarchical ID number of the HL segment to which
the current HL segment is subordinate
Element Separator AN 1 *
HL03 Hierarchical Level Code ID 1/2 735 R 23
Element Separator AN 1 *
HL04 Hierarchical Child Code ID 1/1 736 R 0
Segment Terminator ~
 
LOOP 2000C  Patient Information

 
Loop Seg ID Segment Name Format Length Ref# Req Value
2000C PAT Patient Information ID 3 R PAT
Element Separator AN 1 *
PAT01 Individual Relationship Code ID 2/2 1069 R See below for more information
Element Separator AN 1 *
PAT02 Patient Location Code ID 1/1 1384 Not Used
Element Separator AN 1 *
PAT03 Employment Status Code ID 2/2 584 Not used
Element Separator AN 1 *
PAT04 Student Status Code AN 1/1 1220 Not used
Element Separator AN 1 *
PAT05 Date Time Period Format Qualifier ID 2/3 1250 S D8 if patient is known to be deceased.
Element Separator AN 1 *
PAT06 Date time Period AN 1/35 1251 S Print patient death date if patient is known to be deceased. Format CCYYMMDD
Element Separator AN 1 *
PAT07 Unit or Basis for Measurement Code ID 2/2 355 S GR – Required when the patient’ age is less than 29 days old.
Element Separator AN 1 *
PAT08 Weight X 1/10 81 S Print patient weight. Required when the patient’s age is less than 29 days old.
Element Separator AN 1 *
PAT09 Yes/No Condition ID 1/1 1073 O Print “Y” if the patient is pregnant. Leave blank if the patient is not pregnant.
Segment Terminator ~

PAT01 – Individual Relationship Code
 
Code Definition
01 Spouse
19 Child
20 Employee
21 Unknown
39 Organ Donor
40 Cadaver Donor
53 Life Partner
G8 Other Relationship
 
LOOP 2010CA Patient Name
 

Loop
Seg ID Segment Name Format Length Ref# Req Value
2000CA NM1 Patient Name ID 3 R NM1
Element Separator AN 1 *
NM101 Entity Identifier Code ID 2/3 98 R QC
Element Separator AN 1 *
NM102 Entity Type qualifier ID 1/1 1065 R 1
Element Separator AN 1 *
NM103 Name Last or Organization Name AN 1/60 1035 R Patient Last Name
Element Separator AN 1 *
NM104 Name First AN 1/35 1036 S Patient First Name
Element Separator AN 1 *
NM105 Name Middle AN 1/25 1037 S Patient Middle Name
Element Separator AN 1 *
NM106 Name Prefix AN 1/10 1038 Not used
Element Separator AN 1 *
NM107 Name Suffix AN 1/10 1039 S Patient Suffix
Element Separator AN 1 *
NM108 Identification code Qualifier ID 1/2 66 R MI (Required if the patient identifier is different than the subscriber identifier.
Element Separator AN 1 *
NM109 Identification code AN 2/80 67 R Print Patient Primary Identification Number or Insured ID or Subscriber ID or Health Insurance claim Number
Segment Terminator ~
 
NM102 - Entity Type Qualifier
Code qualifying the type of entity
 
Code Definition
1 Person
2 Non-Person Entity
 
2010CA Patient Address

Loop Seg ID Segment Name Format Length Ref# Req Value
2010CA N3 Patient Address AN 2 R N3
Element Separator AN 1 *
N301 Address Line 1 AN 1/55 166 R Patient Address Line 1
Element Separator AN 1 *
N302 Address Line 2 AN 1/55 1065 S Patient Address Line 2 if exists
Segment Terminator ~

2010CA  Patient City/State/Zip code

 
Loop Seg ID Segment Name Format Length Ref# Req Value
2010CA N4 Patient City / State / Zip Code AN 2 R N4
Element Separator AN 1 *
N401 City Name AN 2/30 19 R Patient City Name
Element Separator AN 1 *
N402 State or Province Code ID 2/2 156 R Patient State Code
Element Separator AN 1 *
N403 Postal Code ID 3/15 116 R Patient Zip Code
Segment Terminator ~


2010CA Patient Demographic Information.

 
Loop Seg ID Segment Name Format Length Ref# Req Value
2010CA DMG Patient Demographic information ID 3 R DMG
Element Separator AN 1 *
DMG01 Date time Period Format Qualifier ID 2/3 1250 R D8
Element Separator AN 1 *
DMG02 Date time Period AN 1/35 1251 R Patient Date of birth in the Format CCYYMMDD
Element Separator AN 1 *
DMG03 Gender Code ID 1 1068 R Print M for Male
Print F for Female
Print U for unknown
Segment Terminator ~


Loop 2000C and 2010CA  Sample

Patient Demographic Information
 
Field Value
Patient Last Name Marvin
Patient First Name White
Insured ID 86J353
Patient Address Line 1 2832 Linden Blvd
Patient Address Line 2 NA
Patient City Southern View
Patient State NY
Patient Zip Code 11234
Patient DOB (mm/dd/yyyy) 10/05/2002
Patient Gender Female
 
PAT*19~
NM1*QC*1*MARVIN*WHITE****MI*86J353~
N3*2832 LINDEN BLVD~
N4*Southern View*NY*11234~
DMG*D8*20021005*F



Complete Example :

The conditions are follows
  1. Bill with Group and Individual NPI
  2. Provider Bill with Tax ID
  3. Patient is NOT same as the Insurer (Self). Son is the patient and father is the insurer.
  4. Bill to Patient Primary Insurance
  5. ICD Version 9
  6. Number of Line Items 1
  7. No of Claims : 1


Clearing House Settings

image

Practice Setup

image


Patient Demographics Information

image

Patient Insurance Information


image

Claim Header Information

image


Claim Line items

image


EDI Content
Note : For Understanding, segments are shown as one line. In the actual file, there should not be any line separator.

ISA*00*          *00*          *ZZ*S32433         *01*Zirmed         *140423*1258*^*00501*999      *0*P*:
GS*HC*S32433*Zirmed*20140423*1258*999*X*005010X222A1
ST*837*0001*005010X222A1
BHT*0019*00*0001*20140423*1258*CH
NM1*41*2*Demo Practice*****46*S32433
PER*IC*STEVEN RONALD*TE*3523412412*FX*3453241234
NM1*40*2*Zirmed*****46*Zirmed
HL*1**20*1
NM1*85*2*Demo Practice*****XX*3232323232
N3*1186 East 58TH Street
N4*Richmond Hill*NJ*114191232
REF*EI*432323232
HL*2*1*22*1
SBR*P********CI
NM1*IL*1*CAROL*AUGUSTIN****MI*YU13224
N3*5411 FILMORE AVENUE
N4*Fort Leavenwort*FL*323231212
DMG*D8*19560101*M
NM1*PR*2*WESTFIELD INSURANCE*****PI*10874
N3*7221 Engle Road*Suite 220
N4*Fort Wayne*IN*468042233
HL*3*2*23*0
PAT*19
NM1*QC*1*ADAMS*JACKIE
N3*18 HUBERT PLACE
N4*South Dayton*NY*11238
DMG*D8*19921111*M
CLM*100071*15712.25***11:B:1*Y*A*Y*Y
HI*BK:49
NM1*82*1*MOON*BRIAN****XX*1003018342
NM1*77*2*Pepin Office*****XX*3423423535
N3*668-2204 Non Rd.
N4*White Plains*NY*809051232
REF*LU*484345
LX*1
SV1*HC:99213*120.00*UN*1.00*11**1
DTP*472*RD8*20142304-20142304
REF*6R*186
SE*37*0001
GE*1*999
IEA*1*999     

EDI Content by Loop

LOOP Segment EDI
ISA Header ISA*00*          *00*          *ZZ*S32433         *01*Zirmed         *140423*1245*^*00501*999      *0*P*:~
GS Header GS*HC*S32433*Zirmed*20140423*1245*999*X*005010X222A1~
ST Header ST*837*0001*005010X222A1~
BHT Header BHT*0019*00*0001*20140423*1245*CH~
1000A - Submitter Name NM1 NM1*41*2*Demo Practice*****46*S32433~
1000A - Submitter Name EDI Contact PER PER*IC*STEVEN RONALD*TE*3523412412*FX*3453241234~
1000B - Receiver Name NM1 NM1*40*2*Zirmed*****46*Zirmed~
2000A - BILLING/PAY-TO PROVIDER HIERARCHICAL HL HL*1**20*1~
2010AA - Billing Provider Name NM1 NM1*85*2*Demo Practice*****XX*3232323232~
2010AA - Billing Provider Address N3 N3*1186 East 58TH Street~
2010AA - Billing Provider City/State/ZipCode N4 N4*Richmond Hill*NJ*114191232~
Billing Provider Secondary Identification 1 Ref REF*EI*432323232~
2000B - Subscriber Hierarchical Level HL HL*2*1*22*1~
2000B - Subscriber Hierarchical Level SBR SBR*P********CI~
2010BA - Subscriber Name NM1 NM1*IL*1*CAROL*AUGUSTIN****MI*YU13224~
2010BA - Subscriber Address N3 N3*5411 FILMORE AVENUE~
2010BA - Subscriber City/State/Zipcode N4 N4*Fort Leavenwort*FL*323231212~
2010BA - Subscriber DOB and Gender DMG DMG*D8*19560101*M~
2010BB - Payer Name NM1 NM1*PR*2*WESTFIELD INSURANCE*****PI*10874~
2010BB - Payer Name Address N3 N3*7221 Engle Road*Suite 220~
2010BB - Payer City/State/ZipCode N4 N4*Fort Wayne*IN*468042233~
Loop 2000C Patient Hierarchical Level HL HL*3*2*23*0~
Loop 2000C Patient Hierarchical Level PAT PAT*19~
Loop 2000C Patient Hierarchical Level NM1 NM1*QC*1*ADAMS*JACKIE~
Loop 2000C Patient Hierarchical Level N3 N3*18 HUBERT PLACE~
Loop 2000C Patient Hierarchical Level N4 N4*South Dayton*NY*11238~
Loop 2000C Patient Hierarchical Level DMG DMG*D8*19921111*M~
2300 - Claim Information CLM CLM*100071*15712.25***11:B:1*Y*A*Y*Y~
2300 - Claim Information - ICDs HI HI*BK:49~
Loop 2310B Rendering Provider NM1 NM1*82*1*MOON*BRIAN****XX*1003018342~
2310D - Service Facility Location NM1 NM1*77*2*Pepin Office*****XX*3423423535~
2310D - Service Facility Location N3 N3*668-2204 Non Rd.~
2310D - Service Facility Location N4 N4*White Plains*NY*809051232~
2310D - Service Facility Location REF REF*LU*484345~
2400 - Service Line LX LX*1~
2400 - SERVICE LINE SV1 SV1*HC:99213*120.00*UN*1.00*11**1~
2400 - SERVICE LINE DTP DTP*472*RD8*20142304-20142304~
2400 - SERVICE LINE REF REF*6R*186~
SE Trailer SE*37*0001~
GE Trailer GE*1*999~
IEA Trailer IEA*1*999      ~


That's all.

 

        
Questions or feedback are always welcome. You can email me at vbsenthilinnet@gmail.com.

2 comments:

  1. Michael J. Cassidy25 February 2015 at 11:54

    It is a shame that many implementation of 837 choose to not use Patient demographics. Patient demographics are useful in fighting fraud, avoiding inappropriate treatments and creating statistics for medical research and cost control. Having work on 7 or 8 Health Care assignments from UB-92 up to NCPDP D.0, I find people choosing to supply the minimum amount of information to get paid, viewing 837 as only a financial transaction, when the possibilities are much more.

    ReplyDelete
  2. I agree with michael

    ReplyDelete