Techno-functional 15 Years EMR/PMS experience.Love to work in EMR, e-Prescription, HL7, Medical Billing, EDI 4010, EDI 5010, CMS 1500 FORM, etc. Email : vbsenthilinnet@gmail.com
X12 EDI Examples
EDI 837 Professional. Version 005010X222A1
Example 1: Outpatient Visit
Example 2: Claim level Attachment (PWK) Example.
Example 3: Claim with Referring Provider example.
Example 4: Claim with Pay to Address example.
Example 5: Claim for Ambulance service.
Example 6: Claim with Prior Authorization Number.
Example 7: Claim with Payer Claim Number.
Example 8: Billing Provider Secondary identification.
Example 9: Facility with Secondary identification.
Example 10: Billing Laboratory Claims Electronically
Example 11: Payer with secondary identification
Example 12: Billing Provider Complete information
Example 13: Patient is a different person than the Subscriber
Example 14: K3 File Information
Example 15 : Claim Note NTE Segment
Example 16 : Billing for Physician Administered Drugs and NDC Reporting
EDI 837 Dental . Version 005010X224A2
Example 1: Orthodontic-treatment-plan
Example 2: One Claim with 12 Procedure Codes
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Difference between 277CA and 277
EDI 277 generated by the Payer whereas EDI 277CA generated by clearing house or payer or both. EDI 277CA will be generated as soon as EDI 837 File is passed whereas EDI 277 will be generated only upon request by EDI 276 transaction.
EDI 277CA will provide a claim level acknowledgement such as your claim is accepted or rejected. But it does not guarantee that payment will be made.If accepted, an payer claim number will be generated and the same claim will pass to next level of process in the payer system called adjudication system. EDI 277 will be generated only if the claim is accepted and having an payer claim number. If the claim is rejected at the 277CA level itself, then we cannot check the claim status because that claim is not in the payer adjudication system.
Today, many insurance companies respond to claims using their own report formats and/or electronic transaction formats. The ASC X12 277CA offers a common interface to the insurance company and the provider, thus standardizing the response. Because a claim may progress through several different statuses before reaching a final processing disposition, a provider may receive multiple ASC X12 277CA transactions for a single claim.
Sample EDI 277CA
ISA*00* *00* *ZZ*XXXXXXX *ZZ*9085 *210301*1322*%*00501*000000000*0*P*:
GS*HN*XXXXXXX*9085*20210301*132234*1*X*005010X214
ST*277*0001*005010X214
BHT*0085*08*0001*20210301*132234*TH
HL*1**20*1
NM1*AY*2*XXXXX.XXXXXX*****46*XXXXX
TRN*1*000000001
DTP*050*D8*20210301
DTP*009*D8*20210301
HL*2*1*21*1
NM1*41*2*XXXXXX XXXXX LLC-TEST ACCOUNT*****46*9085
TRN*2*0001
STC*A1:19*20210301*WQ*120
HL*3*2*19*1
NM1*85*2*DEMO CLINIC*****XX*1215099528
TRN*1*0
HL*4*3*PT
NM1*QC*1*XXXXX*XXXXX****MI*XYZ312322
TRN*2*124309
STC*A7:21*20210301*U*120********Rendering NPI Fails LUHN check.
DTP*472*D8*20190604
SE*20*0001
GE*1*1
IEA*1*000000000