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BA Healthcare Assignment

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Nikhil Satav
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44 views4 pages

BA Healthcare Assignment

Uploaded by

Nikhil Satav
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOC, PDF, TXT or read online on Scribd
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The goal of this Business Scenario is to gain understanding of the 837 Transaction structure and analyze the individual

claim data.

The Patient is the same person as the Subscriber. The Payer is Blue Cross and Blue Shield of North Carolina. The encounter has been transmitted
through a clearinghouse. The Submitter is the clearinghouse.

Data Element Value


Subscriber/Patient: Mary B Dough
Subscriber Address: PO Box 12312, Durham, NC 27701
Sex: F
DOB: August 7, 1967
Employer: Acme, Co.
Group #: ABC123101
Payer ID Number: 987654321
Member Identification Number 24670389600
Destination Payer: Blue Cross Blue Shield of North Carolina (BCBSNC)
Payer Address 5901 Chapel Hill Road, Durham, NC 27707
AHLIC #: 987654321
Submitter: ABC Clearinghouse
Billing Provider: Elizabeth Smith, MD
Address: 123 Mudd Lane, Durham, NC, 27715
TIN: 123456789
Billing Provider ID 0123456789
Contact Person & Phone Number Wilma Flintstone 919 555-1111
Patient Account Number: Ptacct2235057
DOS 8/1/2010
POS Office
Services Rendered Office visit
Charges 1st office visit - $100.50
Total charges $100.50
Exhibit-1
Assignment-1: Enter the above Professional Claim data (see Exhibit-1) in one of the EDI Claims Tool, and try to generate the 5010 EDI
837-Professional Transaction. You need to download the trial version of the one of EDI Tool where some inks have been provided.

Answer: The 5010 EDI 837 Transaction should be as shown below:

ISA*00* *00* *01*9012345720000 *01*9088877320000 *100822*1134*U*00200*000000007*0*T*:~


GS*HC*901234572000*908887732000*20100822*1615*7*X*005010X222~
ST*837*0007*005010X222~
BHT*0019*00*123BATCH*20100822*1615*CH~
NM1*41*2*ABC CLEARINGHOUSE*****46*123456789~
PER*IC*WILMA FLINTSTONE*TE*9195551111~
NM1*40*2*BCBSNC*****46*987654321~
HL*1**20*1~
NM1*85*1*SMITH*ELIZABETH*A**M.D.*XX*0123456789~
N3*123 MUDD LANE~
N4*DURHAM*NC*27701~
REF*EI*123456789~
HL*2*1*22*0~
SBR*P*18*ABC123101******BL~
NM1*IL*1*DOUGH*MARY*B***MI*24670389600~
N3*P O BOX 12312~
N4*DURHAM*NC*27715~
DMG*D8*19670807*F~
NM1*PR*2*BCBSNC*****PI*987654321~
CLM*PTACCT2235057*100.5***11::1*Y*A*Y*N~
REF*EA*MEDREC11111~
HI*BK:78901~
LX*1~
SV1*HC:99212*100.5*UN*1*12**1**N~
DTP*472*D8*20100801~
SE*24*0007~
GE*1*7~
IEA*1*000000007~

Exhibit - 2
Assignment-2: Fill the below table with segment data from the 837 transaction file generated or use the Exhibit-2. Last 3 rows have been pre-
filled. Print this table and pre-fill claim data in the appropriate cells. Refer the Companion Guide to understand individual elements in the
segments.

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