Importing 835 Remittance in Alpha

[speech1121]

HI Everyone,

I am importing a 835 form of payments to a doctor. I want to be able to pull the data that I need from this form to put into the payment section of a table that I wrote.

I import the file from the clearinghouse. I have been able to identify the patient involved in each line by adding a field to the import and putting in the patient ID number, by having alpha copy the previous field.

Now I need to associate each line with a "line control number" which is a number that is assigned when the charge is sent out to the billing company. Unfortunately, this number is down about 6 lines in the file(and its position is not always the same number of lines down), as well as the billing date-so I cannot find a way to get this number into the previous lines. I have not found an operation that looks past the field it needs to fill in and then go back.

For example:
CLP*Patient ID #* Last Name*First Name*Ins ID#
SVC*HC:CODE*Charge*Paid
DTM*Date of Service
HL*Location
XX*Line Control Number
AMT*Amt Approved

I can assign the patient ID # to each line, but that does not help with linking this payment to a charge in the table-because there can be many open charges for the same patient. The line control number is unique to this charge, so that is the best way to link it.

Any suggestions are greatly appreciated

Debbie

[aschone]

Re: Importing 835 Remittance in Alpha

Do you have the 5010|835 Health Care Claim Payment/Advice guide? This guide will explain that file layout and how to determine what is occurring with the claim payment.

If you don't have the 835 format documentation I strongly suggest investing in it and reading it prior to tackling this task.

[Stan Mathews]

Re: Importing 835 Remittance in Alpha

I import the file from the clearinghouse.

What is the file type of the 835? Is it a plain text file?

[aschone]

Re: Importing 835 Remittance in Alpha

Yes; it is a plain text file.

[Stan Mathews]

Re: Importing 835 Remittance in Alpha

Andrew,

You have to know more than I do (absolutely nothing) about the file. I was just thinking of reading all the line control numbers into a list with Alpha's file methods. Then processing the file again and writing the line control number for each section at the end of each CLP line.

[aschone]

Re: Importing 835 Remittance in Alpha

I am very familiar with the file layout and data elements. Currently I have a database that will read the file and convert it to a report from which we manually post payments from.

The file is broken down into "Loops" each loop is a predefined group of segments. Each loop and segment can be required or situational. When a loop/segment is situational it may or may not appear in your initial test case and if that is all you program for you will be continuously editing your code whenever you come across a loop/segment that was unaccounted for.

Also each loop and segment has a predefined number of times it can repeat. Some of the possible repeat numbers are 1,4,5,10 99, 999, or >1. If a loop or segment has a repeat of >1 then it can reused until all of the required information for that loop/segment is conveyed. The format is extremely flexible and allows for a massive amount of data to be transmitted.

This style of file formatting is very complex and I spent numerous months programming for both the 835 and the 837 formats.

To quickly cut to the chase each segment is prefixed with a character code. The start of the Claim payment loop (Loop 2100) is the Claim Payment Information segment prefixed with CLP. This loop continues until first Service Payment Information segment (SVC). Loop 2100 can be repeated as many times as needed within one file. This loop represents the overall healthcare claim, it will identify the patient, provider, facility, insurance policies involved, and total charge amount.

The SVC segment starts loop 2110. Loop 2110 is entirely situational and can be repeated up to 999 times for each 2100 loop. Loop 2110 ends with the Health Care Remark codes (LQ segment) . Loop 2110 represents each individual charge appearing on the claim. It will indicate how much was paid, when the date of service was, how much was charged, how much was written off and the reasons for the write off.

You could start reading the file and write the value of CLP01 to the end of each line until you encounter the CLP prefix again. Then you would change what you write to what is in the CLP01 element of new CLP segment.

The line control # is in the Loop 2110 REF segment. The REF segment can be repeated numerous times for numerous reasons in the file. When the first element of the REG segment is equal to "6R" you have a Line Item control Number segment. 6R is the code for Provider Control Number.

[speech1121]

Re: Importing 835 Remittance in Alpha

I have the breakdown of the file--I just didn't have it with me when I wrote the post. I listed all the items with all the possibilities and found that for my requirements there are only about 6 items I need . I can download a "medicare eob" format for manual posting, but what I am trying to do is automate the process. I would like the approved amounts, paid amounts, insurer name, date of check (or EFT) and ckeck or EFT number for each line of service. Other programs out there allow the user to download the file, and click "auto post" and this info is filled in into the payment area. That's what I'm trying to do.

It comes through as a plain text file. The 837 file was much easier because everything was moving forward. Here the info I need is not at the beginning of the file--is there a way to bring it forward? Or have it looked at out of sequence? I could not find an answer for this?

Thanks
Debbie

[Stan Mathews]

Re: Importing 835 Remittance in Alpha

Read all the line control numbers into a list with Alpha's file methods. Then process the file again and write the line control number for each section at the end of each CLP line.

[aschone]

Re: Importing 835 Remittance in Alpha

Here is how I handled this.

1) I read the file into a variable using File.to_string().

vTextC = File.to_string(vFileC)

2) I then capture the delimitor values

Data = mid(vTextC,4,1)							
Repetition = mid(vTextC,83,1)
Component = mid(vTextC,105,1)
Terminator = mid(vTextC,106,1)

3) I replace the the Terminator delimitor with crlf()

strtran(vTextC,Terminator, crlf())

4) Then using a For Each ... Next loop I step through each line capturing the data that I need.

FOR EACH FOO in vTextC

5) As you read each line capture the Segment code using

word(foo.value,1,Data)

When you hit the CLP segment you know you are now reading data for a claim. The next claim will start when you hit the next CLP statement.

This should get you started. Reference your 835 manual to determine which segments and elements contain the data you are looking for. Inside of your For Each ... Next loop run a SELECT CASE statement where you test the Segment code and then perform the action you need based on the value.

SELECT
		CASE vSegmentC = "Amt"
                CASE vSegmentC = "Bpr"
                CASE vSegmentC = "Cas"
                 .
                 .
                 .
END SELECT

[martinwcole]

Re: Importing 835 Remittance in Alpha

I process 835's
there should be a SSN in the claim, as well as a name
then the cpt codes, and the amount paid

but you do have to learn how to break the text file down into the claims