837 differences that can cause headache's

If your working in HealthCare with BizTalk odds are you have a solution for the 837. The 837 is the standard for a HealthCare Claim. There are three different flavors of the 837, Dental, Professional and Institutional. There are many differences between these formats, impeticular, the beginning name of each node, TS837Q3 for Institutional, TS837Q1 for professional and TS837Q2 for Dental. The differences I speak of are very subtle. The one I want to share is the a node in the 2300 segment that we currently use to store a unique ID which we call the BizTalkID; it is how we track claims as we send it to different vendors for repricing. I am not saying that is a best practice but its what we have to deal with in the current BizTalk solution we have adopted.

Listed below is the node and its attributes on an Institutional claim:

<TS837Q3_2300_REF_ClaimIdentificationNumberForClearinghousesAndOtherTransmissionIntermediaries TS837Q3_2300_REF01__ReferenceIdentificationQualifier="D9" TS837Q3_2300_REF02__ValueAddedNetworkTraceNumber="02397SC05232604" />

Listed below is the node and its attributes on an Professional Claim:

<TS837Q1_2300_REF_ClaimIdentificationNumberForClearingHousesAndOtherTransmissionIntermediaries TS837Q1_2300_REF01__ReferenceIdentificationQualifier="D9" TS837Q1_2300_REF02__ClearinghouseTraceNumber="03497SC05318645" />

Can you spot the difference's.... besides the Q1 and Q3? That's right they are subtle.

The first and most oblivious is REF02 segment. One is ValueAddedNetworkTraceNumber and the other is ClearinghouseTraceNumber. The difference that has bitten us time and time again in XSL Transforms and XPaths is the node name. One has a capital H and the other has a lower case h.



Why is this? Their both are based off the 837 spec.......The answer is, who knows. Maybe different people were in charge of each sub type of the 837 and did not communicate. Just be careful and don't assume that they are the same.


Ed K.

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