Fw: DRG and Deductible Info Not Showing up in CSV file

[Philip LaRochelle]

Request number 2:

Claim Supplement Information
Loop: 2100 - CLAIM PAYMENT INFORMATION

1. Use this segment to convey information only. It is not part of the financial balancing of the 835.
2. Use this segment only when the value of specific quantities identified in the QTY01 qualifier are Non-zero.

QTY Quantity
Level: Detail
Position: 064
Loop: 2100
Requirement: Optional
Max Use: 20
Purpose: To specify quantity information.

This appears to be reporting covered days.

I need the following qualifiers reported:

CA - Covered Actual
CD - Co-insured actual
OU - Outlier Days

Again here is an example.
All PII has been removed.

QTY*CA*6~



CLP*XXXXXXXXX*1*26589.87*8285.72**MA*XXXXXXXXXXXMIA*11*1**377*1.6149*1~
CAS*CO*45*17204.15~
CAS*PR*1*1100*0~
NM1*QC*1*LNAME*FNAME****HN*XXXXXXXXXA~
MIA*0***9385.72*MA01*609.91**665.26*665.26******6*8110.55~
REF*EA*663222~
DTM*050*20100617~
DTM*232*20100525~
DTM*233*20100531~
AMT*AU*26589.87~
QTY*CA*6~
SVC*NU>0200*8274*8274**6~
DTM*472*20100531~
AMT*B6*8274~
SVC*NU>0250*43.37*43.37**1~
DTM*472*20100531~
AMT*B6*43.37~
SVC*NU>0251*1027.47*1027.47**1~
DTM*472*20100531~
AMT*B6*1027.47~
SVC*NU>0252*2354.49*2354.49**1~
DTM*472*20100531~
AMT*B6*2354.49~
SVC*NU>0258*2635.34*2635.34**1~
DTM*472*20100531~
AMT*B6*2635.34~
SVC*NU>0271*429.2*429.2**1~
DTM*472*20100531~
AMT*B6*429.2~
SVC*NU>0272*281*281**1~
DTM*472*20100531~
AMT*B6*281~
SVC*NU>0300*1274*1274**1~
DTM*472*20100531~
AMT*B6*1274~
SVC*NU>0301*1262*1262**1~
DTM*472*20100531~
AMT*B6*1262~
SVC*NU>0305*497*497**1~
DTM*472*20100531~
AMT*B6*497~
SVC*NU>0307*29*29**1~
DTM*472*20100531~
AMT*B6*29~
SVC*NU>0320*234*234**1~
DTM*472*20100531~
AMT*B6*234~
SVC*NU>0324*240*240**1~
DTM*472*20100531~
AMT*B6*240~
SVC*NU>0360*1392*1392**1 ~
DTM*472*20100531~
AMT*B6*1392~
SVC*NU>0390*3012*3012**1~
DTM*472*20100531~
AMT*B6*3012~
SVC*NU>0450*1815*1815**3~
DTM*472*20100531~
AMT*B6*1815~
SVC*NU>0480*1432*1432**1~
DTM*472*20100531~
AMT*B6*1432~
SVC*NU>0710*200*200**1~
DTM*472*20100531~
AMT*B6*200~
SVC*NU>0730*158*158**1~
DTM*472*20100531~
AMT*B6*158~

----- Forwarded Message ----
From: Philip LaRochelle <plar...@yahoo.com>
To: x12-u...@googlegroups.com
Sent: Tue, March 8, 2011 1:18:26 PM
Subject: Re: DRG and Deductible Info Not Showing up in CSV file

OK Dave a new request, if possible

Claim Supplement Information
Loop: 2100 - CLAIM PAYMENT INFORMATION

1. Use this segment to convey information only. It is not part of the financial balancing of the 835.

2. Use this segment only when the value of specific amount identified in the AMT01 qualifier are Non-Zero.

Segment: AMT
Data Segment: 522
Level: detail
position: 062
loop: 2100
requirement: optional
max use: 20
purpose: to indicate the total monetary amount.

What I really need reported is the "AU" code," Coverage Amount" and monetary amount.. It is my understanding that Coverage Amount is different than ClaimTotalPaid.


Below is where the segment is located in the claim record. It appears to be in all records not just IP or OP. All PII data has been removed.

AMT*AU*248~


CLP*XXXXXXXXX*1*248*62.34**MA*XXXXXXXXXXXXMIA*13*1~
NM1*QC*1*LNAME*FNAME*MI***HN*XXXXXXXXXXXXA~
MOA*.35*62.34*MA01~
REF*EA*504312~
DTM*050*20100617~
DTM*232*20100519~
DTM*233*20100519~
AMT*DY*.35~
AMT*AU*248~
SVC*HC>36415*18*3*0300*1~
DTM*472*20100519~
CAS*CO*45*15~
AMT*B6*18~
SVC*HC>80048*72*9.63*0301*1~
DTM*472*20100519~
CAS*CO*45*62.37~
AMT*B6*72~
SVC*HC>80061*62*14.53*0301*1~
DTM*472*20100519~
CAS*CO*45*47.47~
AMT*B6*62~
SVC*HC>84443*60*24.06*0301*1~
DTM*472*20100519~
CAS*CO*45*35.94~
AMT*B6*60~
SVC*HC>85025*36*11.12*0305*1~
DTM*472*20100519~
CAS*CO*45*24.88~
AMT*B6*36~

Thanks,

Phil

---

From: "infor...@com1software.com" <infor...@com1software.com>
To: x12-u...@googlegroups.com
Sent: Mon, March 7, 2011 12:49:30 PM
Subject: Re: DRG and Deductible Info Not Showing up in CSV file

Yes it is,
If need be PAYERCLAIMCODE will give element 7 of the CLP and
CLAIMSTATUSCODE will give element 2 of the same with no
qulaifications to elemnt 2.

On 7 Mar 2011 at 9:41, Philip LaRochelle wrote:

>
> Dave,
>
> When reviewing thecomplete file I also see a Claim Satus Code of 4
> (Denied) as another
> instance of records not being populated with a
> PRIMARYPAYERCLAIMCODE. Is this the same
> issue withthe 22 Claim Satus Code explained below?
>
>
> From: Com1 Software <infor...@com1software.com>
> To: X12 Utility <x12-u...@googlegroups.com>
> Sent: Mon, March 7, 2011 12:28:53 PM
> Subject: Re: DRG and Deductible Info Not Showing up in CSV file
>
> Phil,
>
> The reason the PRIMARYPAYERCLAIMCODE is not populated is due to
> the
> Claim Status Code is a 22 and not a 19.
>
> In looking at our documentation:
> http://com1software.com/c1d0f431.htm#0612
>
> I need to make some improvements to better reflect the qualifiers
> involved in the field operation.
> We may also need to add some additional fields to our export
> capability.
>
> Below is the list of applicable status codes:
>
> Thanks
> Dave
>
>
> 1 Processed as Primary
>
> 2 Processed as Secondary
>
> 3 Processed as Tertiary
>
> 4 Denied
>
> 5 Pended
> NOT ADVISED
> 1266 Claims with this status should be reported in the
> Claim Status (277) transaction when the payer
> implements it.
>
> 10 Received, but not in process
> NOT ADVISED
> 1266 Claims with this status should be reported in the
> Claim Status (277) transaction when the payer
> implements it.
>
> 13 Suspended
> NOT ADVISED
> 1266 Claims with this status should be reported in the
> Claim Status (277) transaction when the payer
> implements it.
>
> 15 Suspended - investigation with field
> NOT ADVISED
> 1266 Claims with this status should be reported in the
> Claim Status (277) transaction when the payer
> implements it.
>
> 16 Suspended - return with material
> NOT ADVISED
> 1266 Claims with this status should be reported in the
> Claim Status (277) transaction when the payer
> implements it.
>
> 17 Suspended - review pending
> NOT ADVISED
> 1266 Claims with this status should be reported in the
> Claim Status (277) transaction when the payer
> implements it.
>
> 19 Processed as Primary, Forwarded to Additional
> Payer(s)
>
> 20 Processed as Secondary, Forwarded to Additional
> Payer(s)
>
> 21 Processed as Tertiary, Forwarded to Additional
> Payer(s)
>
> 22 Reversal of Previous Payment
>
> 23 Not Our Claim, Forwarded to Additional Payer(s)
>
> 25 Predetermination Pricing Only - No Payment
>
> 27 Reviewed
> NOT ADVISED
> 1389 Claims with this status should be reported in the
> Claim Status (277) transaction when the payer
> implements it.
>
> On Mar 3, 11:11am, Philip LaRochelle <plaroc...@yahoo.com> wrote:
> > Dave,
> >
> > The update did the trick. I am now able to tie out and or balance:
> Claim Total
> > minus Adjustments = Claim Total Paid.
> >
> > Moving on I have something else that I need you to look at. It
> appears that
> > when a claim is not paid Zero dollars or a claim is a "take back"
> a negative
> > number in the CLAIMTOTALPAID column the PRIMARYPAYERCLAIMCODE does
> not
> populate:
> >
> > The attached excel file shows the X-12 utility output, again I
> have provided
> > just numbers with no identifying information. The highlighted rows
> show that the
> > PRIMARYPAYERCLAIMCODE column is empty when the CLAIMTOTALPAID cell
> within a
> > record is either zero or a negative number.
> >
> > The 835 file data is that of record 1 without any identifying
> information.
> >
> > The CLP segment shows that there is a PRIMARYPAYERCLAIMCODE which
> ends in MIA.
> > As you can see the totals here reflect what is in the output
> file.
> >
> >CLP*15*22*-9736.7*-4039.85**MA*XXXXXXXXXXXXXXMIA*11*8**293*-.694*-1
> ~
> > CAS*CO*45*-5696.85~
> > NM1*QC*1*FNAME*LNAME****HN*XXXXXXXXX1A~
> >MIA*0***-4039.85*MA02*-262.57**-285.69*-285.69******-4*-3491.59~
> > REF*EA*548744~
> > DTM*050*20100329~
> > DTM*232*20100202~
> > DTM*233*20100206~
> > AMT*AU*-9736.7~
> > QTY*CA*-4~
> > SVC*NU>0110*-2676*-2676**-4**4~
> > DTM*472*20100206~
> > AMT*B6*-2676~
> > SVC*NU>0250*-8*-8**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-8~
> > SVC*NU>0251*-880.99*-880.99**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-880.99~
> > SVC*NU>0252*-65.71*-65.71**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-65.71~
> > SVC*NU>0300*-1004*-1004**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-1004~
> > SVC*NU>0301*-611*-611**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-611~
> > SVC*NU>0305*-219*-219**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-219~
> > SVC*NU>0306*-260*-260**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-260~
> > SVC*NU>0307*-29*-29**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-29~
> > SVC*NU>0324*-240*-240**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-240~
> > SVC*NU>0351*-850*-850**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-850~
> > SVC*NU>0421*-164*-164**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-164~
> > SVC*NU>0424*-135*-135**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-135~
> > SVC*NU>0434*-135*-135**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-135~
> > SVC*NU>0450*-632*-632**-2**2~
> > DTM*472*20100206~
> > AMT*B6*-632~
> > SVC*NU>0480*-1432*-1432**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-1432~
> > SVC*NU>0730*-395*-395**-1**1~
> > DTM*472*20100206~
> > AMT*B6*-395~
> >
> > Thanks,
> >
> > Phil
> >
> > Also is the X-12 Utility, X-12 Version 5010 compliant?
> >
> > ________________________________
> > From: "informat...@com1software.com"
> <informat...@com1software.com>
> > To: x12-u...@googlegroups.com
> > Sent: Wed, March 2, 2011 2:28:58 PM
> > Subject: DRG and Deductible Info Not Showing up in CSV file
> >
> > Phil,
> >
> > We we able to find a problem with some claim level fields were
> picking up
> > service level
> > information. It should be fixed in version Version 1.17B-18.
> >
> > I appreciate your help and patience in finding this problem.
> >
> > Thanks
> > Dave
> >
> > Let my try to explain this again using one outpatient record from
> the 835 file
> > and then
> >
> > compare it to what the x-12 utility is generating. Ultimately, I
> need to
> > balance, Claim Total
> >
> > minus Adjustments = Claim Total Paid.
> >
> > Record 10 in the 835 file is below. ( I am using this record
> because it only has
> > two
> >
> > adjustments )
> >
> > I only see two CAS segments:the first has an amount of 161.39 and
> the second at
> > 36.2. The
> >
> > total billed amount is 255.00the total paid amount is 57.41.
> >
> > total billed amount 255.00 minus CAS 161.39 minus CAS 36.2 =total
> paid amount
> > 57.41.
> >
> > Which I see below.
> >
> > CLP*XXXXXXX*19*255*57.41**MA*MIA*13*1~
> > NM1*QC*1*LNAME*FNAME****HN*XXXXXXXXXA~
> > NM1*TT*2*BCBS*****PI*XXXXXXX7~
> > MOA*.35**MA01~
> > REF*EA*700234~
> > DTM*050*20100617~
> > DTM*232*20100518~
> > DTM*233*20100518~
> > AMT*DY*.35~
> > AMT*AU*255~
> > SVC*HC>76536*255*57.41*0402*1~
> > DTM*472*20100518~
> > CAS*CO*45*161.39~
> > CAS*PR*2*36.2~
> > REF*1S*00266~
> > AMT*B6*255~
> >
> > Now if you open up the excel file that has just numbers and no
> identifying
> > information. I have
> >
> > highlighted record 10. Now when I do the calculation from the
> numbers I see in
> > the X-12
> >
> > utility output:
> >
> > CLAIMTOTALCHARGE (255) MINUS CLMADJAMT1 (161.39) MINUS CLMADJAMT2
> (
> > 36.2) MINUS PROCADJAMT1.1 ( 161.39 ) MINUS PROCADJAMT1.2 ( 36.2 )
> = total paid
> > amount-140.18 This is incorrect. It should total CLAIMTOTALPAID
> (57.41)
> >
> > I only see two CAS statements in the above claim record. The
> output file states
> > there are
> >
> > four.
> >
> > You can also look at claim record #11 and do the balancing calc.
> The total
> > billed minus all
> >
> > the adjustments does not equal the total paid.
> >
> > What do I need to do to get the output file to tie to: Total
> Billed minus
> > Adjustments = Total
> >
> > Paid Or Total Billed = Total Paid plus all the Adjustments ?
> >
> > This needs to be clean in the output file with no manipulation
> after the file is
> > created by the X-
> > 12 Utility.
> >
> > Phil
> >
> > --
> > You received this message because you are subscribed to the Google
> Groups "X12
> > Utility" group.
> > To post to this group, send email to
> x12-u...@googlegroups.com.
> > To unsubscribe from this group, send email to
> > x12-utility+unsub...@googlegroups.com.
> > For more options, visit this group
> athttp://groups.google.com/group/x12-utility?hl=en.
> >
> > export12.xls
> > 34KViewDownload
>
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[Com1 Software]

Phil,

In Version 1.17C-09 we should have all the CLAIMSUPPLEMENTALAMT
and CLAIMSUPPLEMENTALQTY fields your looking for.

http://groups.google.com/group/com1software/t/688fbaaddcfc1de4


Let me know if you have any problems or questions.

Thanks
Dave

> From: "informat...@com1software.com" <informat...@com1software.com>
> To: x12-u...@googlegroups.com

> Sent: Mon, March 7, 2011 12:49:30 PM
> Subject: Re: DRG and Deductible Info Not Showing up in CSV file
>
> Yes it is,
> If need be PAYERCLAIMCODE will give element 7 of the CLP and
> CLAIMSTATUSCODE will give element 2 of the same with no
> qulaifications to elemnt 2.
>
> On 7 Mar 2011 at 9:41, Philip LaRochelle wrote:
>
> > Dave,
>
> > When reviewing thecomplete file I also see a Claim Satus Code of 4
> > (Denied) as another
> > instance of records not being populated with a
> > PRIMARYPAYERCLAIMCODE. Is this the same
> > issue withthe 22 Claim Satus Code  explained below?
>

> > > x12-utility...@googlegroups.com.
> > > For more options, visit this group

> > athttp://groups.google.com/group/x12-utility?hl=en.
>
> > > export12.xls
> > > 34KViewDownload
>
> > --
> > You  received this message because you are subscribed to the Google
> > Groups "X12 Utility" group.
> > To post to this group, send email to x12-u...@googlegroups.com.
> > To unsubscribe from this group, send email to

> > x12-utility...@googlegroups.com.
> > For more options, visit this group at
> >http://groups.google.com/group/x12-utility?hl=en.
>
> > --
> > You received this message because you are subscribed to the Google
> > Groups "X12 Utility" group.
> > To post to this group, send email to x12-u...@googlegroups.com.
> > To unsubscribe from this group, send email to
> > x12-utility...@googlegroups.com.
> > For more options, visit this group at
> >http://groups.google.com/group/x12-utility?hl=en.
>
> --
> You received this message because you are subscribed to the Google Groups "X12
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[infor...@com1software.com]

Phil,

The X12 Utility is a great tool to view and export X12 837 and 835 files to CSV or XML, it
hopefully should fit all your clients needs. The only thing I would make people more aware of
is that if they need to automate a process, or do things like convert a whole folder of X12 files
into CSV or XML, our X12 Parser allows you to do that. The same mapping and technology
as the X12 Utility, but with just a few extra bells and whistles.

Thanks
Dave

On 10 Mar 2011 at 9:47, Philip LaRochelle wrote:

>
> Dave,
>
> I am visiting a client on March 29th to discuss the X-12 Utility
> application. Is there anything you
> would like me to include in my spiel?
>
> Phil

>
>
> From: Com1 Software <infor...@com1software.com>
> To: X12 Utility <x12-u...@googlegroups.com>
> Sent: Wed, March 9, 2011 4:28:28 PM
> Subject: Re: Fw: DRG and Deductible Info Not Showing up in CSV
> file
>
> Phil,
>