Map claim information between EDI 837 and EDI 835

Every EDI Developer will have a question about how to map the claim information received in EDI 835 with my database claim record? That is very simple. All we need to pass our claim Number or ID and our Line-item Number or ID in 837 files. When the payer processes the claim and puts it back the same number(s) in the EDI 835 file.


1. Where to put claim number or ID in the EDI 837?
   In Loop 2300, put the claim number as the first element as shown in the  example
   CLM*124304*60.00***11:B:1*Y*A*Y*Y
   Here 124304 is the claim number in our database.


2. Where to put the line item number or ID in the EDI 837?
   In the Loop 2400 REF Segment. Here is an example
   REF*6R*75965
   Here 75965 is the line item number or ID in our database.

3. How to get those numbers back in the EDI 835?
   In Loop 2100, claim Payment Information. Example as follows     
   CLP*124304*1*477.5*0**MB*0914212571750*81*1
   As you can see, the same number is echo back in the first element of Loop  2100 and for  line item number or id, you can see the same 6R segment 
   after the line  item segment as follows
   
   SVC*HC:82646*477.5*0****2
   DTM*472*20140530
   CAS*CO*151*477.5
   REF*LU*81
   REF*6R*75965

4. What number will be returned in EDI 835 if I send the claim via Paper?
    Well, whatever the value you are putting in Box 26, that will be returned in the EDI 835.  But there is no option to put the line item number in
    CMS 1500 form.


5. How to map the claim if EDI 835 does not echo back the numbers?     
    Yes, there are some cases, where the payer does not echo back the numbers. In that case, we need to map using the visit date, Procedure code,  
    modifier, patient, or subscriber from the EDI 835 file.

   
  For Medical Billing software or Medical Billing software consultation,   please contact vbsenthilinnet@gmail.com    
 https://emrpms.blogspot.com/2013/09/about-me.html




Are you looking for a solution to generate 837P or 837I in your medical billing product? Then you are in the right place.

I am Senthil Muthiah, A technology-driven professional with over 20 years of experience including nearly 9 years in Software Development and Business Analysis.  Well versed with US Healthcare Domain – Electronic Medical Record (EMR) & Medical Billing. In particular, 15 years of experience in the Healthcare domain specifically in Claim processing, Claims adjudication, clearing house-related processes.

Consultation Option

1. if your product is in java, then we are very close. You can buy my java Spring Boot API Service source code which converts JSON to EDI and vice versa.

  1. JSON to EDI 270 Eligibility and Benefit Inquiry
  2. Create EDI 270 from JSON
  3. Parse EDI 271 Message to Human Readable Text
  4. JSON to EDI 837 Professional Claims
  5. Parse EDI 837p Message into JSON
  6. Parse EDI 835 Message into JSON   
  7. Parse EDI 835 Message to PDF
  8. JSON to cms 1500 Form
  9. Parse EDI 837p To HTML
  10. JSON To EDI 837 Institutional
  11. Parse EDI 837I to JSON
  12. Parse EDI 837 Institutional To HTML
  13. Create CMS 1500 Form using JSON
  14. Parse EDI 837p to CMS 1500 Form
Here is the demo link
https://demo.nagatabilling.com/NagataEDITool/login.zhtml 
User Name: demo, password: demo

2. if your product in different technology, then I will help your developer to create an EDI file using Pseudo.  Here is a sample Pseudocode 

 For more detailed resume and skills, please refer to the following link

·       Online Resume

·       Linked Profile

My Email ID :  vbsenthilinnet@gmail.com

Labels: ,