# Presentation: 619039

## Lesson 4
Reading 837 Error Reports and Making Corrections

**Reading 837 Error Reports and Making Corrections**

**Notes:**
Welcome to the fourth lesson in “Electronics Transactions . . . It’s Easier Than You Think”.  In the previous lessons you have learned how to prepare for the testing process and then how to complete testing and begin production. This lesson will cover reading the 837 error reports and making the necessary corrections.  
At any time, you can click on Next to move forward or Back to review a screen.  Click on Main Menu to choose other lessons or click on the Exit block to leave this program.
[Trainer’s Notes]
With a live group, be sure to welcome the participants.  If the size of the group is appropriate, give participants an opportunity to introduce themselves.  Convey the time expectations for the session.  Review housekeeping and safety information:  emergency exits, bathrooms, use of cell phones. Remind participants that these lessons follow the same sequence as the electronic newsletters and that supplemental resource information is in the Quick Reference Guide which is included on the interactive CD-ROM and accessible through links on the IHS Electronic Transactions website.  Suggest colleagues who could be helpful.

## Lesson 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**

**Notes:**
In order to read the 837 Error Reports, you will need to be familiar with the 837 data layout.  

Once the 837 data layout has been described, this lesson will cover the HIPAA Implementation Guides and other information you will need to read the 837 Error Reports and make the appropriate corrections.

[Trainer’s Notes]

## What Does It Mean For You?

- Application Coordinator:**“Once you understand the 837, it’s going to make your job more efficient.”**

**Notes:**
Well, I think from the beginning if you’re not familiar with the 837 it’s going to be a little complicated.  You basically have to learn how to read the 837 files and what’s required, but once you understand that, then it’s going to make your job more efficient.

## 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

**Notes:**
Data in the 837 format is transmitted in one uninterrupted stream.  This stream is called a Transaction Set.  

Transaction sets are made up of sections, and each section provides a specific kind of information.

As described in Lesson 2, a transaction set generally consists of a header control segment followed by data segments and concluded by a trailer control segment. 

The data segments are made up of four required sections
Billing provider detail
Subscriber detail
Patient detail, and
Claim detail

[Trainer’s Notes]
Review the definitions of data elements and delimiters.

## 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

**Notes:**
Every section of the Transaction Set contains data segments.

Each data segment is a separate line of detail and each segment begins with an identifier of 2 or 3 letters, for example “ISA” or “GS”.  The illustration on the screen shows the beginning of each segment by using bold type, but the actual 837 data stream would not use bold.  In the screen example, the first two lines make up one segment.

[Trainer’s Notes]
The illustration on this slide is only that, an illustration. The data stream has been parsed into segments to make it easier to decipher.  Instructions to parse the 837 data are in the Quick Reference Guide under “To convert an 837 file to line-by-line”.

## 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 segment 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

**Notes:**
Each segment in the transaction set contains data elements that are generally similar to the data provided by each individual Form Locator position on the UB-92 or HCFA-1500 form. 

The number of elements in a particular segment varies depending on the purpose of the segment.  Within the segment, asterisks are used as delimiters to separate the data elements.

In the 837 transaction sets, spaces are allowed as data within certain data elements, so don’t confuse spaces with delimiters.

In the screen example, segment ST has two elements; segment BHT has six elements.

[Trainer’s Notes]

## 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

**Notes:**
To find and correct the errors in an 837 transaction set, you need to know how to count elements.  The segment identifier (SH in the first example) is not a data element.  The first data element to the right of SH would be 837, and it would be identified as SH01 – the first data element in segment SH.

If you needed to correct element BHT03, you would count to the third data element to the right of BHT, in this case “101537”.

[Trainer’s Notes]
Think of the segment identifier as the street name and the element number as the house number.

Distinguishing between the number 0 and the letter O can be difficult.  The only solution is to be very careful.

## 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

**Notes:**
Reading the 837 Error Reports and making corrections is highly detailed work.  In the beginning, you will find it much easier if you take advantage of any available assistance.  The Quick Reference Guide provides detailed examples and useful tips.  One of the useful tips for reading the 837 Error Reports is how to break the data stream down into a collection of data segments that is much easier to decipher.

[Trainer’s Notes]
Be sure to remind learners that the Quick Reference Guide can be downloaded from the IHS Electronic Transactions website or copied from the “Electronic Transactions . . . It’s Easier Than You Think” CD-ROM.

## Lesson 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**

**Notes:**
The preceding information applied to 837 error reports in general, but there are three different versions of the 837.  This lesson will address some of the specifics of dealing with each.

[Trainer’s Notes]

## 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

**Notes:**
There are three different versions of the 837:
Institutional
Professional, and
Dental

Each version of the 837 has an Implementation Guide and Addenda.  As shown on the screen, each guide is specified by an alphanumeric code in which the last two digits identify the guide: 96 for Institutional, 98 for Professional, and 97 for Dental.

The segments and elements may be different for each 837 and so the instructions would be different in each guide.  Be sure to use the Implementation Guide and Addendum that matches your batch type.

[Trainer’s Notes]

## 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

**Notes:**
To find the elements required in a specific segment, first find the segment in the appropriate Implementation Guide. The Table of Contents will help you find the page that contains the segment that interests you.

On that page, you will find
The loop name
Whether the segment is required or situational
Which data elements are required in that segment, and
How to enter the elements in the correct order.

[Trainer’s Notes]

## 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**

**Notes:**
The distinction between required and situational data is fundamental.  Required data, whether it be loops, segments, or elements, is mandatory: without it the claim will be rejected.  Situational data may or may not be needed depending on the criteria that apply to that claim.  The only way to know what is required and what is situational is to consult the relevant Implementation Guide and Addenda.

[Trainer’s Notes]
Point out that there are no “optional” data.  The Implementation Guides and Addenda determines whether the data is always required or required in certain situations, but the user has no option but to follow the Implementation Guide and Addenda for that claim.

## 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**

**Notes:**
The 837 data stream consists of sections called loops.  Each loop has a particular focus, for instance, submitter name or billing provider name.  The data stored in each loop is similar to the data stored in Patient Registration or Fileman files.  The only reliable way to identify a particular loop for a particular type of claim is to consult the Implementation Guide and Addenda for that type of claim.

Note that some data segments repeat in more than one loop, and they could have the same segment identifier.  For example, there could be several address lines: one for the billing provider, one for the subscriber, and so on.

[Trainer’s Notes]
Some people may be confused by the term “loop”, thinking that it means to repeat and repeat.  In this use, “loop” simply means a group or section of segments of data in the 837 data stream.

## 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

**Notes:**
Loops tell you where to find a specific data segment.  Some segments with the same segment identifier appear in different loops, so it is important to find and correct the segment in the correct loop.  For example, segment N3 of loop 2010AA includes the billing provider address, but segment N3 in loop 2010BA includes the Subscriber address.

[Trainer’s Notes]

## Loop Numbering

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

**Notes:**
Loops have identifying four digit numbers, often followed by one or two letters, for example 2400 or 2010BB.  Error Reports use the loop number to tell you which address caused the error.

Again, not all the loops will be the same for all Implementation Guides.  Be careful to use the appropriate Guide and Addenda.

[Trainer’s Notes]
Point out the distinction that segments begin with 2 or 3 letters and loops begin with 4-digit numbers.

## Lesson 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**

**Notes:**
Now that we have covered the 837 data layout and the Implementation Guides and Addenda, you are ready to learn about error reports.

[Trainer’s Notes]
Pause at this point to see if the group has any urgent questions. 

## 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

**Notes:**
The 997 Functional Acknowledgement is the generally recognized response to the 837 electronic transaction: you submit the 837 and the insurer replies with the 997. Its purpose is to indicate whether the 837 was accepted or rejected. 

The insurer may use a different error report format.  Arizona Medicaid uses a format called the 834, and clearinghouses and private insurers may use other forms.  

[Trainer’s Notes]

## How to Retrieve Error Report

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

**Notes:**
Instructions for retrieving the error report can be found in the insurer’s Companion Guide.  If you are working with a clearinghouse, it will provide instructions.  There will be an error report even if there are no errors in your transaction.

[Trainer’s Notes]
The process will vary from insurer to insurer.

## 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

**Notes:**
In the 997 Functional Acknowledgement, data elements are counted the same way as they are counted in an 837 file, but the 997 format is somewhat different from the 837 format. The most noticeable difference is that all segments between the header control segment and the trailer control segment begin with “AK”, followed by a numeral.

[Trainer’s Notes]
Suggest the mnemonic between AK and Acknowledgement.

## 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

**Notes:**
If an 837 file passes completely, the 997 will contain an “A” for “accepted” in the first element of the AK5 and AK9 segments, and no AK3 or AK4 segments will be listed.  This result indicates that no further attention is needed.

[Trainer’s Notes]

## 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

**Notes:**
If the 837 is rejected, the AK5 and AK9 segments will contain “R”, and the 997 will include AK3 and AK4 segments which identify the loop, segment, element, or line of the error on the matching 837 file.  

All rejected files and only rejected files will display AK3 and AK4 segments.  The AK3 and AK4 segments always occur in a pair for each error found.

[Trainer’s Notes]
The combination of AK segments and the designation of “A” or “R” make identifying accepted or rejected 837s easy.

## 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

**Notes:**
The Implementation Guide and the 837 will be essential to identify the error and the reason for the error.

The screen shows an example of a 997 Functional Acknowledgement for a rejected file.  The important indicators are the letter “R” in both the AK5 and AK9 segments and the presence of AK3 and AK4 pairs.  In a real 997, the “Rejected File” label would not appear.

[Trainer’s Notes]
In the on-screen example, learners should be able to 
Identify that the 837 was rejected (R at AK5 and AK9).
Note there are two DTP03 errors.
The DTP03 errors occur on lines 242 and 253 of the 837
Both DTP03 errors occur in the 2300 loop.
Identify the incorrect data.

## Lesson 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**

**Notes:**
In order to confirm whether batches were accepted or rejected by an insurer, you must be able to identify which batches passed. Most importantly, you need to be able to match the rejecting 997 to the right 837 file.

[Trainer’s Notes]
Each 997 is an acknowledgement of a particular 837, and they must be matched exactly.

## Match Rejecting 997 to 837 File 

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

**Notes:**
When matching a rejecting 997 to an 837 file, look for these key features
The batch number
The type of file, and
The date and time of the file

[Trainer’s Notes]

## 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

**Notes:**
When an 837 batch is created, it is assigned a individual batch number which will appear in element BHT03.  The corresponding 997 will contain the same batch number in element AK102. 

[Trainer’s Notes]
BHT03 would be the third data element in segment BHT.

## 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)

**Notes:**
On both the 837 batch and the 997 Functional Acknowledgement, the ST01 element identifies the type of file, either 837 or 997 respectively.

Files can also be identified by an alphanumeric code within the GS08 element in which a two digit code corresponds to the appropriate Implementation Guide.  For example, the numerals “96” in 004010X096A1 would indicate the Institutional Implementation Guide.

[Trainer’s Notes]
GS08 would be the 8th element to the right of the beginning of the GS segment.

## Dates and Times

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

**Notes:**
The date and time of file transmission are stored in the header segments of each file, and this information can be used to identify file batches.  

The date element is always expressed as an eight digit number showing the century, the year, the month, and the day.  The time element is expressed as a four digit number showing hours and minutes on a 24 hour clock.  Time and date can identify batches, but the times and dates will not be the same. The combined date and time for a 997 must always be later than the submission time for the corresponding 837. 

[Trainer’s Notes]
RPMS and other software programs often incorporate a routine that accepts dates entered in a variety of ways and converts them into the CCYYMMDD format.

## 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

**Notes:**
The example on the screen shows an 837 and its matching 997.

When the 837 and 997 match, all of these four features would be true:
The batch numbers, shown in red, are the same.
The ST01 element, shown in blue, shows the correct transaction type.
GS08, shown in green, specifies the same Implementation Guide, and
The 997 was originated after the 837, as shown in purple.

[Trainer’s Notes]
Batch numbers are preceded by BHT.
The dates are in element GS04 and the time is in GS05.

## Lesson 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**

**Notes:**
The 997 Functional Acknowledgement tells you where to look for errors on the matching 837.  Now that you know how to match the two files, you can begin to find the errors.

[Trainer’s Notes]

## 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**

**Notes:**
An 837 can be rejected due to error caused by
Incorrect formats
Missing information, or
Incomplete information

The Quick Reference Guide includes a helpful list of common data errors that will cause an 837 to be rejected.

[Trainer’s Notes]
Emphasize that errors can result from more than one cause.  Completing information in the wrong format will not solve the problem.

## 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 **

**Notes:**
In the 997, the AK3 segment identifies the error segment, the line number, and the loop indicator.  The AK4 segment identifies the data element error in that location. You need to use the combination of AK3 and AK4 to find the exact segment and element that contains the error.

[Trainer’s Notes]
AK3 is a segment identifier.  It is not referring to the third element in segment AK.  AK301 refers to the first element in segment AK3.

## 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

**Notes:**
The screen example shows two errors that need to be corrected.  Each error is located by a pair of AK3 and AK4 segments.  For example, the first AK3 segment identifies the segment (DTP), the line number (242) and the loop (2300).  The first AK4 segment specifies the number of the erroneous data element on that segment, line, and loop.  The AK4 segment also displays the erroneous data.

In the screen example, note that the second AK3/AK4 pair refers to the same error, but on a different line within the 2300 loop.

[Trainer’s Notes]
Two errors need to be corrected, but only one of them is indicated with bold type.  In a real 997, there would be no explanations or bold type.

## 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**

**Notes:**
You must use the corresponding HIPAA Implementation Guide, and the 837 to identify the location of and reason for the error.

The Quick Reference Guide will help you step through the process of finding errors.

[Trainer’s Notes]
See the section “Reading 837 Error Reports and Making Corrections” in the Quick Reference Guide.

## Lesson 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**

**Notes:**
Now that you know how to use the 997, the Implementation Guide and the 837 to find the errors, you are ready to learn how to correct them and resubmit the batch.

[Trainer’s Notes]
Pause at this point to see if the group has any urgent questions. 

## Correct Error in RPMS

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

**Notes:**
Errors must be corrected in RPMS.  The 837 contains multiple claims strung together.  To fix the error, you must locate the claim number for the problem claim.  The correction process to follow is described in the Quick Reference Guide.

[Trainer’s Notes]
See “Reading the 837 Error Reports and Making Corrections” in the 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**

**Notes:**
Correcting the record in RPMS will not solve the problem. In order for the corrections you have made to take effect, you must recreate the batch, using the same process you used originally. 

Once the batch has been recreated, you can resubmit it.  If you corrected all the errors successfully, you receive a 997 with an “A” at AK5 and AK9 and no AK3 or AK4 segments.

[Trainer’s Notes]
If appropriate, you might equate the “A” for Accepted with getting an “A” on a report card.  Would you say the course was accounting, computer programming, or a foreign language?

## What Does It Mean For You?

- Assistant Site Manager:** ****“You get familiar with what the errors are when you see them.”**

**Notes:**
Initially the process of correcting errors was fairly difficult. You had to have the Companion Guide for the payer that you were dealing with, you had to  find the error in the claim, and then go back to the companion guide to find out what that error really meant in order to correct it within your system in order to retry the claim.  The process has gotten much easier. You get much more familiar with what the errors are when you see them.  Also the software is getting better so that in many cases now the vendor will have the software available that will automatically tell you what the error is and where it’s at, within the 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

**Notes:**
The process of finding and correcting errors will speed up as you become more familiar with 837 and 997 files and with the HIPAA Implementation Guides.

The error correction process is not simple, but it can be mastered.

[Trainer’s Notes]
One of the reasons the process accelerates is that users learn they must refer to and rely on the Implementation Guides and other resource documents.  It quickly becomes clear that it is much faster to do it right the first time.

## 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**

**Notes:**
The following tips should help you master the process:
Batch filenames cannot be more than 16 characters.  Consult the appropriate Companion Guide.
Each recreated batch gets a new RPMS number.
Only include corrected claims in a recreated batch.

[Trainer’s Notes]

## 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

**Notes:**
Monitor your error reports carefully, and check every batch in a report.  
Resubmit all errors.  Remember, until the claim is submitted correctly, the insurer has no record of that claim.
One error can result in multiple rejections.  If a name were entered wrong in one place, all claims for that patient would be rejected.  
You must correct errors at their sources as well as on the claim, or the errors will continue to repeat.

[Trainer’s Notes]

## 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?)

**Notes:**
Insurers handle rejections and resubmissions differently.  

Medicare only rejects the claims that do not pass, so only resubmit rejected claims, not the entire batch.
Medicaid rejects the entire batch if one claim fails.  After making corrections, recreate and resubmit the entire batch.
Private Insurance companies vary, so you will need to ask your contact how they process files with rejects.

[Trainer’s Notes]

## What Does It Mean For You?

- Applications Coordinator:**“What I like about the 837 is the turnaround.”**

**Notes:**
What I like about the 837 is the turnaround. You don’t have to print  your claims, you don’t have to pull your claims apart, you don’t have to fold it, you don’t have to stuff it, you don’t have to mail it, and you don’t have to do any of that and then wait 14 days for Access to go ahead and key enter that, and there could be human errors on their end, and then and get a denial and then rework those claims. If you submit an 837 file you get payment within the next week from Arizona Medicaid and then 14 days for Medicare.

## 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**

**Notes:**
This lesson has covered six major points:
Learn the 837 data layout
Use the Implementation Guides and Addenda
Learn how to read the error reports
Match the right 837 and 997 files
Find all the errors. and
Correct the errors and resubmit the batch.

This concludes Lesson 4:  “Reading the 837 Error Reports and Making Corrections”. 

At this point, you may return to the Main Menu.  You can click on Back to review, Next to begin the next lesson or click on the Exit symbol to end this session.

[Trainer’s Notes]
Ask for and address any questions members of the group might have.  Thank the group for their participation.