Requirement Constraints

  • Subscribe to our RSS feed.
  • Twitter
  • StumbleUpon
  • Reddit
  • Facebook
  • Digg

Monday, 2 July 2012

EDI 5010 Documentation 837 Professional - Loop 2300 Claim Information

Posted on 04:40 by Unknown

        

2300 Claim information

Loop Seg ID Segment Name Format Length Ref# Req Value
2300 CLM Claim information ID 3 R CLM
Element Separator AN 1 *
CLM01 Claim Submitter Identifier AN 1/38 1028 R Unique Claim Number
Element Separator AN 1 *
CLM02 Monetary Amount R 1/18 782 R Total Charges
Element Separator AN 1 *
CLM03 Claim Filling Indicator       Not Used  
Element Separator AN 1 *
CLM04 Non Institutional Claim Type       Not Used  
Element Separator AN 1 *
CLM05-1 Facility Code Value AN 1/2 1331 R Place of Service Code
Component Element Separator   :
CLM05-2 Facility Code Qualifier ID 1/2   R B
Component Element Separator   :
CLM05-3 Claim Frequency Type Code ID 1 1325 R 1 = Original
2 = Replacement
8 = Void
Element Separator AN 1 *
CLM06 Yes/No Provider Signature on File ID 1 1073 R Y
Element Separator AN 1 *
CLM07 Provider Accept Assignment Code ID 1 1359 R A = Assigned
B = Assignment Accepted on Clinical Lab Services Only
C = Not Assigned
Element Separator AN 1 *
CLM08 Yes/No Assignments of Benefit ID 1 1073 R Y
Element Separator AN 1 *
CLM09 Yes/No Release of Information ID 1 1363 R Y
Element Separator AN 1 *
CLM10 Patient signature source code ID 1 1351 S P
Element Separator AN 1 *
               
               
               
               

Examples:

CLM*249*60***11:B:1*Y*A*Y*Y

CLM*250*38***11:B:1*Y*A*Y*Y

********************************************************************************

Example : 2
Claim Setup

Field

Value

Claim No

252

Claim Location

NY Office

Place of Service

11 - Office

Rendering Provider

David Mark

ICD Code

410,415, 368.34, 522.3

Line items

Procedure Code

Mod1

Mod2

Mod3

Mod4

ICD

FromDOS

ToDOS

Units

Unit Charges

99214

1,2,3,4

01/09/2012

01/09/2012

1

40

92570

1

01/09/2012

01/09/2012

1

180.04

90371

3,4

01/09/2012

01/09/2012

1

83


CLM*252*303.04***11:B:1*Y*A*Y*Y~

By Loop
2300 - Claim Information CLM CLM*252*303.04***11:B:1*Y*A*Y*Y~
2300 - Claim Information - Clia Number REF REF*X4*CL324234~
2300 - Claim Information - ICDs HI HI*BK:410*BF:415*BF:36834*BF:5223~
2310B - Rendering Provider Name NM1 NM1*82*1*Mark*David****XX*1111111111~
2310D - Service Facility Location NM1 NM1*77*2*NY Office*****XX*1336177328~
2310D - Service Facility Location N3 N3*5081 Tellus. Avenue*668-2204 Non Rd.~
2310D - Service Facility Location N4 N4*White Plains*NY*809051232~
2310D - Service Facility Location REF REF*LU*484345~
2400 - Service Line LX LX*1~
2400 - Service Line SV1 SV1*HC:99214*40*UN*1*11**1:2:3:4~
2400 - Service Line DTP DTP*472*RD8*20120109-20120109~
2400 - Service Line REF REF*6R*1140~
2400 - Service Line LX LX*2~
2400 - Service Line SV1 SV1*HC:92570*180.04*UN*1*11**1~
2400 - Service Line DTP DTP*472*RD8*20120109-20120109~
2400 - Service Line REF REF*6R*1141~
2400 - Service Line LX LX*3~
2400 - Service Line SV1 SV1*HC:90371*83*UN*1*11**3:4~
2400 - Service Line DTP DTP*472*RD8*20120109-20120109~
2400 - Service Line REF REF*6R*1142~





        

Questions or feedback are always welcome. You can email me at vbsenthilinnet@gmail.com.
You can hire me as consultant for EMR/PMS Domain and Web development on EMR/PMS Product!
Email ThisBlogThis!Share to XShare to Facebook
Posted in | No comments
Newer Post Older Post Home

0 comments:

Post a Comment

Subscribe to: Post Comments (Atom)

Popular Posts

  • ZK Example for inline Editing with Add New and Delete
    I am quite impressed on this demo from ZK . But adding new record and delete existing record is missing as part of typical CRUD. So i thoug...
  • ZK Passing Parameter between two files using MVVM–Part 1
    Overview This is the first series of articles about Passing parameter between two zul files using MVVM Design pattern .This article will fo...
  • Hibernate Validator Example 2
    In this example, we will see some more validation constraints such as @email, @past, @length, etc. And also we will also define custom error...
  • ViewModel Class Java Annotation @Init, @NotifyChange, @Command
    In following sections we'll list all syntaxes that can be used in implementing a ViewModel and applying ZK bind annotation. The ZK binde...
  • History of Present Illness
    HPI - One of the main component of Clinical History. What is an HPI ? The history of present illness (HPI) is a chronological description...
  • ZK Border Layout–Another example
    This examples show how you can use ZK Border Layout to show the product information on clicking image. ZK Version 6 Project Name : BorderL...
  • Good Website Design Links
    Form Design Label Placement in Forms International Address Fields in Web Forms 40 Eye-Catching Registration Pages blog-comment-form-...
  • How to refer CSS File in ZK Style tag
    In this example, we will see how to create CSS file as separate file and include in zul file to change the look and feel Project structure a...
  • ZK MVVM Form Binding CRUD with Spring and Hibernate - Part 4
    Presentation Layer using ZK Framework          In part 3 , We have completed Spring integration with hibernate. In this post, we will des...
  • Load Tab box Content on Demand Using MVVM
    ZK Version : 6.5.0 CE In this post, let us see how we can load individual ZUL File on each tab box content Step : 1 First let us create indi...

Categories

  • Billing Process
  • C Workbook
  • C++ Workbook
  • Eclipse Tips
  • EDI 5010
  • EMR Appointment Features
  • EMR Labs Stuff
  • EMR PMS Links
  • EMR Use cases
  • EMR Vital Sign
  • Good Website Design
  • Hibernate Criteria Queries
  • Hibernate Introduction
  • Hibernate Introduction Setup
  • Hibernate Mapping
  • Hibernate POC
  • Hibernate Validator
  • Hibernate–Java Environment setup
  • HPI
  • Java
  • Maven
  • MU Certification
  • NPI
  • PQRS
  • Practice Management System
  • Spring Security
  • Tech Links
  • Today Tech Stuff
  • zk
  • ZK Hibernate
  • ZK 5 Databinding
  • ZK Application
  • ZK Calling Another ZUL
  • ZK CheckBox
  • ZK CreateComponents
  • ZK CSS
  • ZK extended Components
  • ZK Foreach
  • ZK Forum Posts
  • ZK Framework
  • ZK Hibernate Setup
  • ZK ID Space
  • ZK Include
  • ZK Installation
  • ZK iReport
  • ZK Layout
  • ZK Listitem Pagination
  • ZK Message Box
  • ZK MVC
  • ZK MVC Combox Box
  • ZK MVC CRUD Examples
  • ZK MVC Listbox
  • ZK MVVM
  • ZK MVVM Combo
  • ZK MVVM CRUD
  • ZK MVVM ListBox
  • ZK Spring
  • ZK TextBox

Blog Archive

  • ►  2013 (105)
    • ►  December (3)
    • ►  September (7)
    • ►  August (13)
    • ►  July (1)
    • ►  June (11)
    • ►  May (3)
    • ►  April (14)
    • ►  March (19)
    • ►  February (21)
    • ►  January (13)
  • ▼  2012 (177)
    • ►  December (1)
    • ►  November (13)
    • ►  October (19)
    • ►  September (24)
    • ►  August (26)
    • ▼  July (6)
      • My date box Component
      • Tech Links
      • ZK Hibernate one to one annotation mapping bidirec...
      • ZK Component extend
      • ZK Messagebox Styling
      • EDI 5010 Documentation 837 Professional - Loop 230...
    • ►  June (37)
    • ►  May (30)
    • ►  April (16)
    • ►  March (1)
    • ►  January (4)
  • ►  2011 (5)
    • ►  December (1)
    • ►  November (1)
    • ►  July (1)
    • ►  June (1)
    • ►  April (1)
  • ►  2010 (1)
    • ►  September (1)
Powered by Blogger.

About Me

Unknown
View my complete profile