HIPAA 5010 837P Professional Claim

Follow

Comments

5 comments

  • Avatar
    Stephen Sweeney

    Is the ordering here intentional/correct with respect to Loop_2000C and Loop_2300?

     

    On this transaction example it's the other way round with 2000C preceding 2300, and we've an actual issue where the EDI is failing to validate at a major healthcare clearinghouse for the same reason.

    Is there a way to override the order in which the generated EDI appears? i.e. deviate from the explicit positions above?

  • Avatar
    Admin

    Absolutely, the reason we provide all EDI templates as C# files is exactly that - they can be amended to comply with any format and requirement. 

    In this particular issue you can do:

    1. Swap 2300 and 2000C in the template (this will require that you maintain two copies of the template - the original and the swapped). I assume other partners would require the loops to be in their original order.

    This is fine and when reading you can add this logic into the LoadFactory, to load the swapped template when the trading partner is that particular clearing house.

    To swap them simply change the Pos attribute, e.g from:

     [Pos(5)]
    public List<Loop_2300> Loop_2300 { get; set; }
    [Pos(6)]
    public List<Loop_2000C> Loop_2000C { get; set; }

    to:

     [Pos(6)]
    public List<Loop_2300> Loop_2300 { get; set; }
    [Pos(5)]
    public List<Loop_2000C> Loop_2000C { get; set; }

    2. Create an ALL group, which works just like all in XSD - does not account for order, so from this (it's only pseudo code):

     public class Loop_2000B
    {
    [Required]
    [Pos(1)]
    public HL_SubscriberHierarchicalLevel HL_SubscriberHierarchicalLevel { get; set; }
    [Required]
    [Pos(2)]
    public SBR_SubscriberInformation SBR_SubscriberInformation { get; set; }
    [Pos(3)]
    public PAT_PatientInformation PAT_PatientInformation { get; set; }
    [Required]
    [Pos(4)]
    public All_NM1_3 All_NM1_3 { get; set; }
    [ListCount(100)]
    [Pos(5)]
    public List<Loop_2300> Loop_2300 { get; set; }
    [Pos(6)]
    public List<Loop_2000C> Loop_2000C { get; set; }
    }

    you'll change it to this:

     public class Loop_2000B
    {
    [Required]
    [Pos(1)]
    public HL_SubscriberHierarchicalLevel HL_SubscriberHierarchicalLevel { get; set; }
    [Required]
    [Pos(2)]
    public SBR_SubscriberInformation SBR_SubscriberInformation { get; set; }
    [Pos(3)]
    public PAT_PatientInformation PAT_PatientInformation { get; set; }
    [Required]
    [Pos(4)]
    public All_NM1_3 All_NM1_3 { get; set; }
    [ListCount(100)]
    [Pos(5)]
    public All_MyNewGroup Loop_2300_Or_2000C { get; set; }
    }

    [Serializable()]
    [All()]
    public class All_MyNewGroup
    {
    [Pos(1)]
    public List<Loop_2300> Loop_2300 { get; set; }
    [Pos(2)]
    public List<Loop_2000C> Loop_2000C { get; set; }
    }
  • Avatar
    Stephen Sweeney

    Thanks for the quick response. 

    We've went with (1) and it's working, so the immediate need is met.

    Question - how do you decide the default behavior/ordering? I've not seen a 2000C follow a 2300 anywhere on the web, but perhaps that case is buried in the TS spec itself?

    Or is the reason to leave it as-is down to it being a potentially breaking change to existing implementations depending on EDIFabric? More curiousity/for future reference, as our issue is effectively resolved.

    Thanks again,

    Stephen

     

  • Avatar
    Admin

    It's both really, we've seen sample files that have it in the original order as well as flipped, as in your case which also seems to be state bound, e.g. Texas. There is no other reason rather than whichever is the prevalent case and also for backward compatibility. 

    As I said, the templates are just templates. They give you the starting point and are supposed to be living templates and change over time.

    BTW, we are reworking the templates in the moment, as they are really cumbersome to work with and will release a much improved and lightweight version by the end of next month.

    Admin

  • Avatar
    Stephen Sweeney

    Understood. And new templates are definitely of interest. Will stay tuned...

    Thanks!

     

Please sign in to leave a comment.