Sample 837 file layout

This is displayed next to the ClaimItem element via a green xpath with a Foreach modifier prefix. So, the Foreach relationship means this:. Foreach loop relationships are established by dragging a parent node in the source onto a parent node in the destination. Parent nodes are nodes with children, but no value. Once the Foreach relationship has been established to generate a new CSV row for each claim line item, the fields of each row need to be filled in with data from the source EDI document.

These value-to-value mappings are displayed via the green xpaths in square brackets without a Foreach modifier prefix. The green xpath shows the path in the source document where the value should come from.

Note : The green xpaths for value mappings are relative to the Foreach xpath that they are inside of; in this mapping example, there is only one Foreach xpath, so all value xpaths are relative to the LXLoop1 element in the source. This syntax can be chained together to move outward i. Value-to-value mappings are established by dragging a leaf node in the source onto a leaf node in the destination. Leaf nodes are nodes with values but no children they cannot be expanded or contracted, but they contain the actual data.

During a full custom mapping, the process of dragging a source leaf node onto the destination would be repeated many times to map each of the values from the source to the destination. Naturally, this requires an understanding of which values in the source correspond to the desired fields in the destination. Some value mappings require additional syntax to ensure that the correct value is mapped from the source.

Each of the lookahead examples for this mapping involve a value coming from an NM1Loop in the source. Each NM1Loop represents a party in the exchange, e.

Since each NM1Loop contains the data for a different party, it is important to differentiate between the NM1Loop segments when mapping data. For clarity, the xpath to both of these NM1Loop2 nodes is provided below:. One of these NM1Loop2 segments contains data for the payer, and one contains data for the subscriber.

Only once we have determined this value do we know if this NM1Loop2 contains the data we want to map to a particular destination node. This way, we are confident that the Subscriber last name will be mapped, rather than the Payer last name. Lookaheads are specified in the Expression Editor , which can be opened by clicking the Tablet and Pencil icon next to a destination node.

You can open up the expression editor for the SubscriberLastName node to see that the lookahead condition is added in the middle of the usual xpath notation, using escaped square brackets. When adding your own lookahead conditions, use the following two steps:. The sample mapping includes two nodes, IsReissue and IsChargeable , that are mapped to custom scripting logic.

This section will briefly explain the script in the IsChargeable node, to help demonstrate how custom logic can be implemented during a mapping. The first thing to note is that this mapping script is written in ArcScript, a dedicated scripting language included with the application. A primer for getting comfortable with ArcScript is provided in our Knowledge Base here. For example, Loop A includes information about the billing provider, Loop B relates to the subscriber, Loop contains claim information, and Loop includes service line information.

This resource by Availity provides a full list of how each loop and segment of the EDI correlates with information on the CMS Understanding how the file works will allow you to more effectively respond to rejections and denials and increases your chance of getting resubmitted claims accepted.

A practice management solution like KASA can make billing much easier. You can file claims electronically with information stored digitally. The software saves time otherwise spent finding information stored in various locations and manually filling the CMS Check out our resource center to find other tips and tools you can use to streamline your practice management. See how KASA can help make billing simpler so you can focus on helping your clients.

Billing Services. Phone Answering Services. Loops, Segments, and Elements, Oh My! We will only process one iteration of HI Labels: Basic billing concept , EDI. No comments:.

Newer Post Older Post Home. Subscribe to: Post Comments Atom. The other ID number of the referring provider, ordering provider, or other source should be reported in 17a in the shaded area. The qualifie Corrected Claims A corrected claim is a claim that has already been processed, whether paid or denied, and is resubmitted with additional Completed CMS form.