# Presentation: 619038

## Section 4
Reading 837 Error Reports and Making Corrections

**Reading 837 Error Reports and Making Corrections**

## Section 4 Topics

**837 Data Layout**
**Get to Know HIPAA Implementation Guides and Addenda**
**Error Report**
**Match 837 and 997 Files**
**Find Errors**
**Correct Errors and Resubmit Batch**

## Transaction Set Sections 

**Overall data stream of 837 is called a Transaction Set**
**Transaction Set contains sections; each section provides specific kind of information**

**Transaction Set sections:**
- Transaction Header
- Billing Provider Detail
- Subscriber Detail
- Patient Detail
- Claim Detail
- Transaction Trailer

## Data Segments

**Every section of Transaction Set contains data segments**
**Segments begin each line of detail**
**Segments are 2-3 alpha characters**
**Here segments are in bold**

-  **ISA***00*          *00*          *ZZ*000001063      *ZZ*NDDHSMED       *040812*1504*U*00401*000101537*1*P*:**GS***HC*000001063*NDDHSMED*20040812*1504*101537*X*004010X096A1**ST***837*0001**BHT***0019*00*101537*20040812*1504*CH**REF***87*004010X096A1

## Data Elements

**Each segment contains data elements**
- Similar to data provided by each individual Form Locator position on UB-92 or HCFA 1500
**Number of elements varies depending on segment’s purpose**
**Data elements separated by asterisks**
**In this example, ST segment has 2 elements; BHT segments has 6 elements**

-  ISA*00*          *00*          *ZZ*000001063      *ZZ*NDDHSMED       *040812*1504*U*00401*000101537*1*P*:GS*HC*000001063*NDDHSMED*20040812*1504*101537*X*004010X096A1ST***837*****0001**BHT***0019*****00*****101537*****20040812*****1504*****CH**REF*87*004010X096A1

## Counting Data Elements

**To correct errors in an 837, you need to know how to count data elements**
**Element counts begin to the right of the segment; elements separated by asterisk**
**In this example:**
- ST01 is “837” (first set of data between asterisks)
- BHT03 is “101537” (third set of data between asterisks)

-  ISA*00*          *00*          *ZZ*000001063      *ZZ*NDDHSMED       *040812*1504*U*00401*000101537*1*P*:GS*HC*000001063*NDDHSMED*20040812*1504*101537*X*004010X096A1ST***837*****0001**BHT***0019*****00*****101537*****20040812*****1504*****CH**REF*87*004010X096A1

## Quick Reference Guide

**Shows typical billing scenario and how it looks when presented in 837 format**
- 837 data string is broken out line-by-line so you can see the loops, segments, and data elements
**Explains how to convert 837 file into lined item that is easier to troubleshoot**
- When viewed on screen, 837 file is one long data stream
- Can be very difficult to read

## Section 4 Topics

**837 Data Layout**
**Get to Know HIPAA Implementation Guides and Addenda**
**Error Report**
**Match 837 and 997 Files**
**Find Errors**
**Correct Errors and Resubmit Batch**

## Three Different Guides/Addenda

**Three versions **
-  Institutional: 004010X0_96_
- Professional: 004010X0_98_
- Dental: 004010X0_97_
**Use correct Implementation Guide for batch type**
- Segments and data elements may be different in each

## What Elements Are Required in a Segment?

**Find segment listed in appropriate Implementation Guide’s Table of Contents**
**Go to given page**
**You will find:**
- Loop name
- Whether segment is required or situational
- Data elements required in segment
- How to enter data elements
- Correct order of elements

## Required or Situational?

**Loops, segments, and elements can be required or situational**
**“****Required” is mandatory **
- Claim will be rejected if this information is not included
**Situational information**
- Information may or may not be needed
- Depending on the claim’s criteria
**Each Implementation Guide explains what information is required and what is situational**

## Loops Are Important

**Loop is a section of data on 837**
**Examples**
- Submitter Name loop
- Billing Provider Name loop
- Claim Level Information loop
**Similar to data stored ****in Patient Registration or Fileman files**

## What Loops Tell You

**Where to find a data segment **
**Some data segments repeat**
- E.g., address line or N3
- Billing Provider address
- Subscriber address
- Patient address
**But ****each address line will be in a different loop**
- Segment N3 of loop 2010AA has Billing Provider address
- Segment N3 of loop 2010BA has Subscriber address

## Loop Numbering

**Loop number is four digits**
**Number is often followed by one or two alphabetical characters**
- 2400
- 2010BB

## Section 4 Topics

**837 Data Layout**
**Get to Know HIPAA Implementation Guides and Addenda**
**Error Report**
**Match 837 and 997 Files**
**Find Errors**
**Correct Errors and Resubmit Batch**

## Types of Error Reports

**997 Functional Acknowledgement**
- Is the generally recognized response to 837 electronic transaction
- Indicates whether file was accepted or rejected
** ****Other error report formats**
- Arizona Medicaid uses format called 824
- Other formats used by clearinghouses and private insurers

## How to Retrieve Error Report

**Instructions for retrieving error report can be found in Companion Guide**
**If you are working with a clearinghouse, they will provide instructions**** **

## 997 Functional Acknowledgement

**Data elements are counted in same way they are for an 837 file**
**997 format somewhat different from 837 format**
- Segments after header all begin with AK_

## If File Is Accepted ...

**If 837 file passed, it contains an “A” for “accepted” in first element of AK5 and AK9 segments**
- Files that have only AK5 and AK9 segments are error free; no more attention is needed

- ISA*00*          *00*          *ZZ*NDDHSMED       *ZZ*000001063      *040812*1717*U*00401*000000011*0*P*>GS*FA*NDDHSMED*000001063*20040812*1717*9*X*004010X096A1ST*997*0001**AK1***HC*101537**AK2***837*0001**AK5*****A**   **(Accepted File)****AK9*****A***1*1*1 **(Accepted File)**SE*6*0001ST*997*0002

## If File Is Rejected ...

**If 837 file is rejected, it contains an “R” for “rejected” in AK5 and AK9 segments**
**Only rejected files display AK3 and AK4 segments**
**AK3 and AK4 segments occur for each error found**
- AK3 and AK4 segments on 997 report show  user the location (loop, segment, element, line) of the error on the matching 837 file

## 997 Showing Rejected File

** **ISA*00*          *00*          *ZZ*NDDHSMED       *ZZ*000001063      *040812*1717*U*00401*000000011*0*P*>GS*FA*NDDHSMED*000001063*20040812*1717*9*X*004010X096A1ST*997*0001AK1*HC*101542AK2*837*0001AK3*DTP*242*2300*8AK4*03*1251*8*20040419-AK3*DTP*253*2300*8AK4*3*1251*8*20040406-AK5***R*****5  (Rejected File)**AK9***R***1*1*0  **(Rejected File)**SE*10*0002ST*997*0003

## Section 4 Topics

**837 Data Layout**
**Get to Know HIPAA Implementation Guides and Addenda**
**Error Report**
**Match 837 and 997 Files**
**Find Errors**
**Correct Errors and Resubmit Batch**

## Match Rejecting 997 to 837 File 

**Some key things to learn to look for:**
- Batch number
- Type of file
- Dates and times

## Batch Number

**837 is assigned individual batch number when batch is created**
**Corresponding 997 file will contain  same batch number**
**Find batch number**
- On 837 file, BHT03 contains batch number
- On 997 file, AK102 contains batch number

## Type of File

**On both 837 and 997, ST01 identifies the type of file (837 or 997)**
**Files can also be identified by alphanumeric code that corresponds to Implementation Guides **
- Institutional (...096)
- Professional (...098)
- Dental (...097)

## Dates and Times

**Dates and time of file transmissions are stored in Header elements of each file**
**This information can be used to identify file batches **

## This 837 and This 997 Match

- ISA*00*          *00*          *ZZ*000001063      *ZZ*NDDHSMED       *040812*1504*U*00401*000101537*1*P*:GS*HC*000001063*NDDHSMED***20040812(Date)*****1504(Time)***101537*X***004010X096A1(Institutional)**ST***837***0001 (**Transaction Type)**	BHT*0019*00***101537(Batch Number)*****20040812(Date)*****1504(Time)***CHREF*87***004010X096A1(Institutional)**

- ISA*00*          *00*          *ZZ*NDDHSMED       *ZZ*000001063      *040812*1717*U*00401*000000011*0*P*>GS*FA*NDDHSMED*000001063***20040812(Date)*****1717(Time)***9*X***004010X096A1 (Institutional)**
- ST***997***0001 **(Transaction Type)**AK1*HC***101537(Batch Number)**AK2*837*0001

## Section 4 Topics

**837 Data Layout**
**Get to Know HIPAA Implementation Guides and Addenda**
**Error Report**
**Match 837 and 997 Files**
**Find Errors**
**Correct Errors and Resubmit Batch**

## Reasons for Errors

**Errors can result from one or more of following: **
- Incorrect formats
- Missing information
- Incomplete information
**See Quick Reference Guide for list of common data errors that cause an 837 claim to be rejected**

## AK3 and AK4 Segments on 997

**AK3 and AK4 segments show user location of error on matching 837 file**
- Loop
- Segment
- Data element
- Line
**Combination of AK301 and AK401 show segment and element where error is found on 837 file **

## 997 Rejected File

**Example shows loop number, error segment, error element, line number, and data that needs to be corrected**** **

-  ISA*00*          *00*          *ZZ*NDDHSMED       *ZZ*000001063      *040812*1717*U*00401*000000011*0*P*>GS*FA*NDDHSMED*000001063*20040812*1717*9*X*004010X096A1ST*997*0001AK1*HC*101542AK2*837*0001AK3***DTP(Error Segment)*****242(Line Number)*****2300(Loop Indicator)***8  AK4***03(Error Element)***1251*8***20040419-(copy of data in error)**AK3*DTP(Error Segment)*253(Line Number)*2300(Loop Indicator)*8  AK4*03(Error Element)*1251*8*20040406-AK5***R*****5  (Rejected File)**AK9***R***1*1*0  **(Rejected File)**SE*10*0002ST*997*0003

## To Identify Error and Error Reason

**You must use HIPAA Implementation Guide and 837 to identify error and reason for error**
**For process to follow, see steps and example in Quick Reference Guide**

## Section 4 Topics

**837 Data Layout**
**Get to Know HIPAA Implementation Guides and Addenda**
**Error Report**
**Match 837 and 997 Files**
**Find Errors**
**Correct Errors and Resubmit Batch**

## Correct Error in RPMS

**837 file contains multiple claims run together**
**You must locate claim number for problem claim on order to make correction**
**For process to follow, see steps in Quick Reference Guide**

## Recreate and Resubmit Batch

**Once all errors identified and corrected:**
- Recreate batch(es)
- Resubmit files to insurer in next submission
**Process for recreating batches remains unchanged**
**Remember that changes made to claims will not reflect on new 837 transmission unless batch was recreated prior to transmitting new file**

## Tips

**Process will speed up as you become more acquainted with 837 and 997 files and with HIPAA Implementation Guides**
**Error correction process is not simple but it can be mastered**
- Some sites have found it expedient to designate one person to correct all errors

## Tips (cont’d)

**Filename for batch cannot be more than 16 characters**
- Your trading partner’s Companion Guide may have naming conventions that  partner wants to use
**Each recreated batch gets new RPMS number**
**Make sure to only include corrected claims in recreated batch**

## Tips (cont’d)

**Monitor error reports carefully**
- Check every batch in a report
- Resubmit all errors
- Until claim is submitted correctly, insurer has no record of the claim
**If 20 claims are rejected for one patient, it could be as simple as a name entered wrong in one place**
- Error must be corrected at source as well as on claim so that it doesn’t repeat

## Tips (cont’d)

**Know**** differences between insurers when resubmitting previously rejected claims**
- _Medicare:_ Only rejected claims do not pass.  Only resubmit rejected claims, not  entire batch.
- _Medicaid_: Any rejected claim causes entire batch to fail. Correct rejected claim(s); recreate and resubmit entire batch.
- _Private Insurance:_  Insurer specific.  Ask each insurer how they will process files with rejects (e.g.,will entire batch fail or only rejected claims?)

## Lessons Learned

**Learn 837 data layout**
**Get to know Implementation Guides and Addenda**
**Learn how to read error report**
**Match 837 and 997 files**
**Find errors**
**Correct errors and resubmit batch**