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
Passing Parameter between two files using MVVM
This examples shows how to pass parameter between two zul screens. In this example, we are passing some parameters from the parent vm to child VM and child VM returns back some information.
Practice Management software (Medical Billing system)
Practice Management software (Medical Billing system) As a developer, i have written PMS software on different computer Languages for more than 5 times. In the year 2003, started writing coding for Practice management System in Microsoft Visual Basic 6, and then Microsoft access for small providers, and then move to VB.Net and now in 2015, written a complete Practice Management system, purely using Java and other Open source technologies to achieve the same result in WEB. In 2012, again I was involved in developing an independent system for PMS using VB6 with SQL server 2005. I really enjoyed myself and love to work/complete that project. One of my best period in my life. But unfortunately, we could not able to market the product because of VB6 no longer used widely in the industry.
Video Demo
1. Master Screens
3. Charge Entry
4. Submit Electronic Claims
5. Reports
Screen shots
1. Practice Management System (PMS) Sample screens Part 1
2. Practice Management System(PMS) Sample Screens Part 2
3. Patient demographics and Patient case screens
4. Charge Entry screen design
Difference Between 837 Institutional and 837 Professional
837 Professional
Professional billing is responsible for the billing of claims generated for work performed by physicians, suppliers and other non-institutional providers for both outpatient and inpatient services. Professional charges are billed on a CMS-1500 form. The electronic version of the CMS-1500 is called the 837-P, the P standing for the professional format.
837 Institutional
Institutional billing is responsible for the billing of claims generated for work performed by hospitals and skilled nursing facilities. Institutional charges are billed on a UB-04.
And also Hospital Billing uses Revenue Codes.
Revenue Codes
Revenue codes are 3-digit numbers that are used on hospital bills to tell the insurance companies either where the patient was when they received treatment, or what type of item a patient might have received as a patient. A medical claim will not be paid if this is missing from a bill.
Revenue codes go along with procedure codes. When putting them in a charge master, you would add the correct revenue code to the CPT code you were going to use for a particular department. It's the use of revenue codes which allows hospitals to use the same CPT code in multiple departments because it will show which department the services were provided in.
An easy example to use here would be to match up CPT code 99282, which is for an emergency room visit of low to moderate severity, and revenue code 450, which stands for emergency room. In this case, revenue code 450 is the only code that could be used for this CPT code, thus making this one easy to code.
In short, Revenue Codes are descriptions and dollar amounts charged for hospital services provided to a patient. The revenue code tells an insurance company whether the procedure was performed in the emergency room, operating room or another department.For example, stitches may be given to a patient in the emergency room, or in a completely different area of the hospital like the maternity ward.
837 Specification
Both sets of 837 specifications are same. The only differences would be claim specific data that pertains to a single transaction. All three transactions contain ISA, GS and ST segments but some data and qualifying codes are specific to the type of 837. Another way to quickly identify which type of 837 is being encountered is by the codes sent in the GS-08 or in the ST-03. Professionals use a 005010X222, Institutional uses a 005010X223 and Dental uses a 005010X224.
837 Institutional Transaction Sample
| Data Element | Value |
| Subscriber: | Clark Kent |
| Subscriber Address: | 123 Fake St. Pittsburgh, PA 15123 |
| Sex: | M |
| DOB: | May 3, 2006 |
| Insurance ID#: | 000000001-03 |
| Payer ID #: | 987654321 |
| Patient: | Clark Kent |
| Primary Payer: | UPMC Health Plan |
| Submitter: | Line Medical Center |
| EDI #: | 111111111 |
| Receiver: | UPMC Health Plan |
| EDI #: | 222222222 |
| Billing Provider: | Line Medical Center |
| Provider # | 111111111 |
| Address: | 123 Line Blvd. Pittsburgh, PA 15123 |
| Contact Person and Number | Dr. J, 412-454-1000 |
| Attending Physician: | William J. Line, MD |
| Attending Physician NPI: | 2222222222 |
| UPIN # | P97777 |
| Patient Account Number: | 333333 |
| Date of Admission: | 04/17/2011 |
| Place of Service: | Hospital |
| Occurrence Codes and Dates: | 41 on 5/1/2010 27 on 7/15/2010 33 on 4/15/2010 C2 on 4/10/2010 |
| Value Code | 30 |
| Value Amount | $20. |
| Condition Codes: | 01 |
| ICD-9 Procedure Code and Date: | 449.1, 7/30/2010 |
| Principal Diagnosis Code: | 250.00 |
| Secondary Diagnosis Codes: | 789.01 |
| Revenue Codes | 0300 0320 0270 |
| Services: | HC |
| Institutional Services Rendered: | 81000 76092 J1120 |
| Line Item Charge Amounts | $120. $50. $30. |
| Total Charges: | $200. |
Example 837 Data String
The following transmission sample illustrates the file format used for an EDI transaction, which includes delimiters and data segment symbols. The sample includes the ISA (Interchange Control) and GS (Functional Group) portions of a transmission, and only one ST/SE segment. This sample contains a line break after each tilde to provide an easy illustration of where a new data segment begins.
ISA*00* *00* *ZZ*111111111 *33*7306849549*110418*1336*^*00501*000000312*1*P*:~
GS*HC*111111111*7306849549*20110418*1336*312005010X223~
ST*837*0034*005010X223A1~
BHT*0019*00*3920394930203*20100816*1615*CH~
NM1*41*2* LINE MEDICAL CENTER*****46*111111111~
PER*IC*DR. J*TE*4124541000~
NM1*40*2*UPMCHP*****46*222222222~
HL*1**20*1~
NM1*85*2* LINE MEDICAL CENTER*****XX*1111111111~
N3*123 LINE BLVD~
N4*PITTSBURGH*PA*15123~
REF*EI*111111111~
PER*IC*CLARK KENT*TE*00000000101*FX*6145551212~
HL*2*1*22*0~
SBR*P*18*XYZ1234567******BL~
NM1*IL*1*KENT*CLARK*S**MI*00000000101~
N3*123 FAKE ST~
N4*PITTSBURGH*PA*15123~
DMG*D8*19820503*M~
NM1*PR*2*UPMCHP*****PI*222222222~
CLM*333333 *200***13:A:1***A**Y*Y~
DTP*434*RD8*20110417-20110417~
CL1*1*9*01~
REF*F8*ASD0000123~
HI*BK:25000~
HI*BF:78901~
HI*BR:4491:D8:20100730~
HI*BH:41:D8:20100501*BH:27:D8:20100715*BH:33:D8:20100415*BH:C2:D8:20100410~
HI*BE:30:::20~
HI*BG:01~
NM1*71*1*LINE*WILLIAM*AL***34*2222222222~
REF*1G*P97777~
LX*1~
SV2*0300*HC:81000*120*UN*1~
DTP*472*D8*20100730~
LX*2~
SV2*0320*HC:76092*50*UN*1~
DTP*472*D8*20100730~
LX*3~
SV2*0270*HC:J1120*30*UN*1~
DTP*472*D8*20100730~
SE*41*0001~
GE*1*312~
IEA*1*000000312~
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.
- JSON to EDI 270 Eligibility and Benefit Inquiry
- Create EDI 270 from JSON
- Parse EDI 271 Message to Human Readable Text
- JSON to EDI 837 Professional Claims
- Parse EDI 837p Message into JSON
- Parse EDI 835 Message into JSON
- Parse EDI 835 Message to PDF
- JSON to cms 1500 Form
- Parse EDI 837p To HTML
- JSON To EDI 837 Institutional
- Parse EDI 837I to JSON
- Parse EDI 837 Institutional To HTML
- Create CMS 1500 Form using JSON
- Parse EDI 837p to CMS 1500 Form
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
My Email ID : vbsenthilinnet@gmail.com
Understanding EDI 835 Electronic Remittance Advice
First Let us understand the Workflow
- Patient Calls / Walks to the Physician(or Doctor or Provider) office to fix an Appointment.
- On the Appointment day, patient checked In to the office and give all the demographics information(last name, first name, DOB, address,etc.) and insurance information;
- Doctor check the Patient Previous medical record and does the treatment to the patient for the current problem(or Disease);
-
Each Disease represents by a Code. That code is called ICD. It is also called Dx Codes or Problems or ICD Codes or Diagnosis Codes; So for each patient visit, doctor choose the correct ICD Code;
-
Each treatment represent a code and that code is called CPT. It is also called Procedure Codes; So for each patient visit, doctor choose the correct CPT Code;
-
Once all the process are over, now patient leaves the doctor room. Now the doctor office to get paid for the service provided to the the patient;
- Since the patient has health insurance, so patient leaves(checked out) the clinic and ask the clinic to get money from the insurance company;
- Now the Billing department of the Clinic prepare the Bill(Claim) by entering all the necessary information. This process is called Charge entry or Charge Posting;
- Once the Claim is prepared and send to the Insurance company for payment;
- Billing Department using the Practice Management System (PMS), send the claim via EDI File. The EDI Transaction used to create the claim in the Electronic format is EDI 837
Refer the Following Link to understand more on EDI 837
What is an EDI ?
EDI 837 Health Care Claim
- Once the 837 EDI File is created, then it will be send to the Clearing House.
- Clearing House will validate the EDI File and send to the particular insurance company.
- Insurance Company Process the Claim and prepare the Check (Cheque) and Statement(This statement is called Explanation of Benefits OR Remittance Advisory (EOB)
Refer the following Link for EOB
EOB - An explanation of benefits
- Insurance company also generates the EDI 835 File using their System. EDI 835 is electronic version of EOB.
The Electronic Remittance Advice (ERA), or 835, is the electronic transaction which provides claim payment information in the HIPAA mandated ACSX12 005010X221A1 Format. These files are used by practices, facilities, and billing companies to Auto Posting payments into their systems.
Refer the following link for Sample
EDI 835 Health Care Claim Payment/Advice:
- Once the Check, Statement (EOB) and ERA File are ready, then insurance company first send the ERA File and EOB to the clearing house.Second , insurance company will send the Check and copy of the EOB to the billing provider address . Third for each patient in the statement, the copy of the EOB will be emailed.
- Now the Billing Team download the EOB and ERA from the clearing house. If the PMS system has Auto Posting Using ERA File, then they will download the EDI File and do auto posting. If there is no auto posting Module, then they will download the EOB PDF and apply posting manually.Remember, some time, ERA/EOB file will be reach the clearing house, even before the insurance company send the payment check to the doctor.
Are you looking for EDI Integration with the clearing house for EDI 835, then please contact me for more information.
And also, you can check our Tool which converts EDI 835 to PDF or Push EDI 835 information into database via JSON.
Parse EDI 835 into PDF
Schedule Payment ERA File (EDI 835) Parsing Job
Here is the demo link
https://demo.nagatabilling.com/NagataEDITool/login.zhtml
User Name: demo, password: demo
For more detailed resume and skills, please refer to the following link
My Email ID : vbsenthilinnet@gmail.com