MN
HIPAA
Collaborative
837 Institutional Claim MN HIPAA Companion
Guide 004010X096A1 Instruction
The Minnesota HIPAA Collaboration has developed an “implementation specification” spreadsheet to assist providers, payers, clearinghouses and other vendors in the implementation of the 837 Institutional Claim. This document includes the specific data edits and/or requirements for the participating entities. Some additional information concerning the use of this spreadsheet:
1.
This
was developed using Microsoft Excel 97.
2.
This
is based on the X12N May 2000
Implementation Guide (004010X096). This information has been updated to include
the proposed Addenda to the Implementation Guides (004010X096A1).
3.
Information
in this spreadsheet includes:
·
Specific
data conditions that must be met for each Payer
·
Specific
qualifier(s) that are recommended for adjudication or processing
·
Notes
regarding which segments and elements are not utilized by the Payers, and
therefore do not need to be sent by the Provider. Note: All of these segments and elements will be accepted by the
Payers, but the data will not be utilized.
4.
This
document does not include information concerning Required segments, elements and/or data conditions. It is the
expectation of all entities that required segments, elements and data
conditions will be included in every transaction. This spreadsheet must be
utilized with the official HIPAA Implementation Guide (004010X096) and Addenda (004010X096A1) published by Washington
Publishing Corporation.
5.
If
a submitter chooses to send segments or data elements where payers have
indicated “Not used”, the valid HIPAA code sets must be utilized to meet
compliance.
6.
Rules
applying to an entire segment are noted at the segment level and are in bold.
7.
Connectivity
information (ISA/IEA, GS/GE) is not included in this spreadsheet. Please refer
to the Connectivity Profiles for this information.
If you have any questions concerning a Payer’s information, please refer to the
Testing Profiles for contact information.